内生场热疗联合腔内化疗治疗恶性胸腹腔积液的临床研究  

Clinical research of malignant hydrothorax or hydroperitoneum treated with intracavitary chemotherapy and local endogenetic thermotherapy

作　　者：宋海珠[1] 祁建胜[1] 王靖华[1] 张群[1] 褚晓源[1] 耿怀成[1] 管晓翔[1] 金洁[2] 陈龙邦[1] 

机构地区：[1]南京军区南京总医院肿瘤内科,江苏南京210002 [2]南京军区南京总医院博士后科研工作站,江苏南京210002

出　　处：《医学研究生学报》2007年第4期398-401,共4页Journal of Medical Postgraduates

基　　金：江苏省六大人才高峰重点课题基金资助项目(批准号:2005A3)

摘　　要：目的:观察腔内化疗联合内生场热疗治疗恶性胸腹腔积液的近期疗效和不良反应,评价热化疗前后机体免疫功能的变化,初步探讨热化疗的作用机制。方法:治疗组52例,腔内化疗每周1次,联合局部内生场热疗,每周2次;对照组50例,单纯腔内化疗,每周1次。连续治疗2周后休息1周,观察近期疗效和不良反应。检测治疗组患者治疗前后外周血和胸腹腔积液中T细胞亚群、自然杀伤(NK)细胞和血管内皮生长因子(VEGF)的含量。结果:治疗组中胸腔积液患者有效率为86.9%,对照组为60.0%,两组间差异有极显著性意义(P<0.05);治疗组腹腔积液患者有效率为79.3%,对照组为46.7%,两组间差异有显著性意义(P<0.01)。治疗组骨髓抑制发生率明显少于对照组(P<0.05)。治疗组患者治疗后胸腹腔积液中CD4/CD8值较治疗前明显升高(P<0.01),NK细胞明显下降(P<0.05);外周血中CD3、CD4、CD8、CD4/CD8值及NK细胞均较治疗前显著升高(P<0.05);胸腹腔积液和外周血中的VEGF较治疗前均显著下降(P<0.05)。结论:内生场热疗联合腔内化疗能有效地控制恶性胸腹腔积液,减轻不良反应。热化疗能提高局部及全身的细胞免疫功能,并可能具有抑制肿瘤新生血管形成的作用。Objective ：To observe the recent effects and toxicity of thermochemotherapy on malignant hydrothorax or hydroperitoneum, to evaluate the changes of the immunological functions, and to investigate the mechanism of thermochemotherapy. Methods ： Fifty-two patients were treated with weekly intracavitary chemotherapy, and then combined with local endogenetic thermotherapy twice a week. As the control,another 50 patients received weekly intracavitary chemotherapy. The treatment lasted for two weeks and was followed by one- week rest, and then the recent effects and toxicity were observed . The T cell subset, NK cells and VEGF levels in serum, hydrothorax or hydroperitoneum were tested. Results：Overall response rates of the malignant hydrothorax were 86.9% vs 60.0% （ P 〈 0.05 ）. Overall response rates of the malignant hydroperitoneum were 79.3% vs 46.7% （P 〈 0.01 ）. The incidence ratesof myelosuppression were 7.7% vs 24% （P 〈 0.05 ）. After thermochemotherapy, the ratio of CD4/CD8 was increased sig- nificanfly（P 〈0.01 ）,but the ratio of NK cells was decreased significantly （P 〈 0.05 ）in malignant hydrothorax or hydroperitoneum. While in peripheral blood, all the ratio of CD3 ,CD4,CD8,CD4/CD8 and NK cells were increased significantly（ P 〈 0.05 ）. Meanwhile the level of VEGF was decreased significantly （P 〈 0.05） whether in effusion or blood. Conclusion ： Combined intracavitary chemotherapy with local endogenetic thermotherapy could control the malignant hydrothorax and hydroperitoneum effectively with less-toxicity. The cellular immune functions could be elevated and the neovascularization was probablely inhibited.

关 键 词：恶性胸腹腔积液 热化疗 T细胞亚群 血管内皮生长因子 

分 类 号：R730.5[医药卫生—肿瘤]