重组人血管内皮抑制素联合顺铂、IL-2胸腔内注入治疗癌性胸水的临床观察  

Clinical study on the treatment of cancerous pleural effusion by itrapleural injection with recombinant human endostatin and isplatin,interleukin-2

作　　者：龚素萍[1] 李延霞[1] 杜海莲[1] 张海津[1] 牛义凯[1] 

机构地区：[1]山东潍坊益都中心医院呼吸内科,山东潍坊262500

出　　处：《中华肺部疾病杂志（电子版）》2012年第3期43-47,共5页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的探讨胸腔内注入抗肿瘤新药重组人血管内皮抑制素(恩度)联合顺铂、IL-2治疗癌性胸水的有效性和安全性。方法经病理学和细胞学检查确诊癌性胸水患者73例,随机分成治疗组(40例)和对照组(33例)。其中肺腺癌25例,肺鳞癌18例,肺小细胞癌13例,乳腺癌10例,食道癌7例。两组间各项基线指标无显著差异。治疗组给予重组人血管内皮抑制素60mg(4支),顺铂40mg,IL-2100万U胸腔内注入。对照组给予顺铂40mg,IL-2100万U胸腔内注入。两组胸腔治疗均每周2次,治疗组注药次数最多4次,最少2次。对照组注药次数最多8次,最少6次。按照WHO胸水评价标准评价近期疗效,参照Karnofsky评分(KPS)变化评价生活质量(QOL)。按照NCICTC3.0版标准评价毒性反应。治疗前后检测胸水VEGF的水平。结果治疗组40例患者,接受恩度治疗的周期数2～4,中位周期数为3,共完成的周期数103。获得CR15例,PR13例,SD5例,客观有效率70%,QOL改善率85%(33/40),对照组33例患者,接受治疗的周期数6～8,中位周期数7,共完成的周期数208。获得CR例5例,PR13例,SD4例,客观有效率54.5%,QOL改善率66.7%,均较治疗组低。治疗组患者胸水VEGF基线水平40例患者有4例正常(10%),36例(90%)患者胸水VEGF水平在治疗前有不同程度的升高,治疗后均有下降。而对照组33例胸水VEGF水平升高患者无明显下降。3～4级药物不良反应主要伴随化疗药物,包括白细胞减少、恶心、呕吐、皮疹、腹泻、没有心血管的反应。结论胸腔内注入重组人血管内皮抑制素、顺铂、IL-2治疗癌性胸水有一定的疗效,且毒副作用少,对恶性肿瘤晚期患者是一种较好的治疗选择,可以改善生存质量,延长生存期。值得临床进一步推广应用。Objective To observe the efficacy and safety of the therapy for cancerous pleural effusion by intrapleural injection using anticancer drugs recombinant human endostatin （Entostar） combining with isplatin, intedeukin-2 （ IL-2 ）. Methods 73 patients were diagnosed malignant tumor through pathology and cytology with pleural effusion, in which 25 cases of adenoeareinoma, squamous cell carcinoma in 18 cases, small cell lung carcinoma in 13 cases, 10 cases of breast cancer, and esophagus cancer in 7 cases. Between the two groups each baseline index no significant difference. The patients of treatment group were intrapleural injected with recombinant human endostatin 60 mg （4）, cisplatin 40 rag, IL-21 million units, while the patients of the control group were intrapleural injected with cisplatin 40 mg, IL-21 million units. Two groups of chest treatment are 2 times per week, the treatment group note medicine most times four times, at least two times. The control group note medicine most times 8 times, at least six times. To evaluate the short-term curative effect according to the WHO evaluation of pleural effusion standard, and the quality of life （QOL） reference to the Karnofsky score （KPS）, and the toxic effects in accordance with the standard of NCI CTC3.0 version. Results Cycles of 40 patients of treatment group with the therapy of entostar was 2-4, with a median of 3 cycles, a total of 103 completed cycles, in which CR15 cases, PR13 cases, SD 5cases, objective efficiency 70% , QOL rate 85% （33/40）. Cycles of 33 patients of control group was 6-8, with a median of 7 cycles, a total of 208 completed cycles, in which CR 5 cases, PR 13 cases, SD 4cases, objective efficiency 54.5% , QOL rate 66.7%, which is lower than the treatment group. There are 4 patients （ 10% ） of the treatment group 40 patients whose chest water VEGF baseline are normal, while the other 36 patients （90%）, whose chest water vascular endothelial growth factor（VEGF） baseline increase in different rate, had a decrea

关 键 词：血管内皮抑制素 人 重组 顺铂 IL-2 癌性胸水 

分 类 号：R561[医药卫生—呼吸系统]