超声引导下瘤体内注射重组人p53腺病毒治疗晚期肝癌  

Treatment of Advanced Hepatocellular Carcinoma with Ultrasound-Guided Intratumoral Injection of Recombinant Adenovirus p53 Agent

作　　者：贡雪灏[1] 朱志兵[2] 张家庭[1] 李泉水[1] 张琪[1] 

机构地区：[1]深圳市第二人民医院超声科,深圳518035 [2]深圳市第二人民医院肿瘤科,深圳518035

出　　处：《华中科技大学学报（医学版）》2008年第4期499-501,505,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：深圳市科技计划资助项目(No200404068)

摘　　要：目的评价超声引导下瘤体内注射重组人p53腺病毒治疗晚期难治性肝癌的临床疗效及超声导入基因治疗的临床应用价值。方法对57例晚期肝癌患者行超声引导下瘤体内注射重组人p53腺病毒(rAd-p53),每次剂量1×1012VP或2×1012VP,每周1次,4次1疗程,治疗后选择完成1个疗程及以上,并符合基因治疗入选标准者38例,采用彩色多普勒超声(彩超)及病理学检查评估其临床疗效。结果彩超结果示:肝脏肿块均有不同程度缩小,其中4例患者肿块缩小明显(>50%);16例患者肿块周边和内部彩色血流信号减少或消失。大部分患者病情稳定,症状好转,一般状况改善,Karuafsky评分明显提高[术前(55.79±11.30)vs术后(61.05±21.64),P<0.05]。11例患者行肝穿刺活检组织病理学检查,7例可见肿瘤组织纤维化伴淋巴细胞浸润及肿瘤组织明显变性坏死。治疗的不良反应主要为一过性自限性发热。结论超声引导瘤内注射既能控制肝癌基因治疗的靶向性,又能对基因药物疗效进行影像学评估,具有较高的临床应用价值。Objective To evaluate the efficacy of treatment of advanced hepatocellular carcinoma （HCC） with recombinant adenovirus-p53 （rAd-p53） and the clinical value of ultrasound-guided method for gene therapy. Methods Fifty-seven patients with HCC were subjected to ultrasound-guided intratumoral injection of rAd-p53 at 1×10^12 VP or 2×10^12 VP once a week, 4 times each course of treatment. Of the 57 patients, 38 who met the inclusion criteria for gene therapy and received one or two course（s） of treatment were enrolled. Color Doppler ultrasonography and pathologic examination were used for the assessment of the clinical efficacy. Results Color Doppler flowing imaging （CDFI） showed the tumor size in all the 38 cases was decreased to varying degrees and especially in 4 patients, the tumors shrank by more than 50%. The color Doppler flow signal in or around the lesions was reduced or even disappeared. Symptoms in most of the patients were alleviated and Karuafsky score was obviously increased after treatment （55.79±11.30 vs 61.05±21.64, P〈0.05）. In 11 patients subject to liver biopsy, tumor tissue fibrosis, accompanied by robust lymphocytic aggregation and remarkable necrosis, was observed in 7 patients. The main side-effect was a fleeting fever. Conclusion Ultrasound-guided intratumoral injection of rAd-p53 could not only help target the gene therapy for HCC, but also facilitate evaluating the clinical efficacy.

关 键 词：肝癌 基因治疗 超声引导 重组人P53腺病毒 

分 类 号：R445.1[医药卫生—影像医学与核医学]