醋酸甲羟孕酮抑制卵巢癌患者术后盆腔病理血管生成的临床研究  

A Study of Inhibitory Effects of Medroxyprogesteron Acetate Combined with Chemotherapy on Pathologic Angiogenesis of Pelvic Cavity in Post-operation Patients with Ovarian Epithelial Cancer

作　　者：谢守珍[1] 宋成文[1] 陈枝岚[1] 王晶[1] 闫小纺[2] 蒋红卫[3] 

机构地区：[1]广州军区武汉总医院妇产科,430070 [2]广州军区武汉总医院放射科导管室,430070 [3]广州军区武汉总医院统计室,430070

出　　处：《医药导报》2008年第6期643-646,共4页Herald of Medicine

基　　金：湖北省自然科学基金资助项目(基金编号:2004ABA210)

摘　　要：目的探讨卵巢癌手术后化疗联合醋酸甲羟孕酮(MPA)抑制盆腔病理血管生成作用及其对预后的评价。方法治疗组53例,Ⅰ/Ⅱ期30例(56.6%),Ⅲ/Ⅳ期23例(43.4%)。化疗方案:1998年以后采用PAC(顺铂+多柔比星+环磷酰胺)或PC(顺铂+环磷酰胺)方案;2001年以后为PT方案(紫杉醇+卡铂)静脉化疗6个疗程;第7个疗程行髂内动脉化疗栓塞,同时数字减影观察盆腔病理血管。术后1a时,再增加一次髂内动脉化疗栓塞造影。术后进食开始服用MPA250mg.d-1,6～30个月。每次化疗前测定CA125。对照组37例,Ⅰ/Ⅱ期20例(54.1%),Ⅲ/Ⅳ期17例(45.9%),除不用MPA外,卵巢癌手术后化疗方案及检查方法与治疗组均相同。随访两组3,5a生存率。结果①CA125水平治疗组在第7疗程结束后和术后1a时,Ⅰ/Ⅱ期和Ⅲ/Ⅳ期与对照组比较下降明显(均P<0.05或P<0.01)。②治疗组髂内动脉分支血管走形迂曲、紊乱及火焰状病理血管者明显少于对照组(P<0.05);第7个疗程后盆腔病理血管改变与血CA125水平呈明显正相关(r=0.95,P<0.01),即盆腔造影有病理血管者,血CA125升高。③Ⅰ/Ⅱ期3和5a生存率治疗组分别为88.33%,41.23%;对照组分别为79.59%,34.31%,两组比较治疗组高于对照组(P<0.01或P<0.05);Ⅲ/Ⅳ期3和5a生存率治疗组分别为17.52%,1.34%;对照组分别为12.49%,0.00%,治疗组高于对照组(P<0.05,P<0.01)。结论MPA对卵巢癌盆腔病理血管生成有明显抑制作用。MPA联合化疗可延长卵巢癌患者的生存时间。髂内动脉造影显示盆腔病理血管,可作为评价治疗效果及预后的指标。连续服用MPA是安全的。Objective To investigate the inhibitory effects of medroxyprogesteron acetate （MPA） combined with chemotherapy on pathologic angiogenesis in post-operation patients with ovarian epithelial cancer , and evaluate the prognosis of patients . Methods 53 patients including phase Ⅰ/Ⅱ 30 cases （56.6%） and Ⅲ/Ⅳ 23 eases（43.4% ） were admitted to the experimental group. PAC or PC chemotherapy regime was taken from 1998, and PT chemotherapy regime was taken from 2001. Six cycles were conducted. The internal iliac artery chemoembolization was performed and then pelvic angiography was scanned by DSA durring the seventh chemotherapy. One year after embolization, the internal iliac artery chemoembolization and DSA were conducted once more. The MAP 250 mg · d^-1 was orally administered 6 -30 months. CA125 was monitored before each cycle of chemotherapy.②37 patients including phase Ⅰ/Ⅱ 20 cases （54. 1% ） and Ⅲ/Ⅳ 17 cases（45.9% ） were admitted to the control group. The patients received the same treatment as the experimental group except MPA. The three and five years survival rate was followed-up, Results ①One year later after chemotherapy and chemoembolization, the decline of CA125 in the experimental group of phase Ⅰ/Ⅱ and Ⅲ/Ⅳ were more significant than those in the control group, respectively （ P 〈 0.05, P 〈 0,05 ; P 〈 0. 05, P 〈0. 01 ） . ②The tortuous branches of internal iliac arterial and flaming pathlogical vessels in the experimental group were obviously mild than those in the control group （ P 〈 0.05 ）. The change of pelvic pathlogical vessels was positively relevant to the value of CA125 （r = 0.95, P 〈 0. 001 ）. ③ The three and five years survival rates of Ⅰ/Ⅱ in experimental group were higher than those in control group ,88.33% , 41.23% , vs 79.59% , 34.31% respectively （P 〈 0.05） , The same results was observed in Ⅲ/Ⅳ patients （ 17.52% , 1.34% in experimental group vs 12.49% ,0.00% in control group, P 〈 0.05 ） , Conclusion T

关 键 词：甲羟孕酮 醋酸 卵巢癌 血管生成 

分 类 号：R979.1[医药卫生—药品] R737.31[医药卫生—药学]