伊立替康联合西妥昔单抗对晚期结直肠癌肝转移患者肝功能和组织学的影响  

Effect of irinotecan combined with cetuximab on liver function and histology in patients with advanced colorectal cancer and liver metastasis

作　　者：王芳[1] 陈随才[1] 曹娜娅[1] 张来启[1] 陆文慧[2] 

机构地区：[1]陕西省榆林市第二医院消化内科,榆林719000 [2]西安交通大学第一附属医院神经内科,西安710061

出　　处：《中国肿瘤临床与康复》2016年第9期1047-1050,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨伊立替康联合西妥昔单抗对晚期结直肠癌(colorectal cancer,CC)肝转移患者肝功能和组织学的影响。方法选取2010年5月至2014年5月陕西省榆林市第二医院收治的110例晚期CC肝转移患者,按照随机数字表法随机分为观察组和对照组,每组55例。对照组患者给予晚期CC常规治疗联合伊立替康治疗,观察组患者在对照组的基础上加用西妥昔单抗。观察两组患者治疗前后肿瘤标记物、肝转移灶直径、肝功能变化和非肿瘤肝组织病理表现,分析伊立替康联合西妥昔单抗的治疗效果和安全性。结果两组患者治疗后癌胚抗原(CEA)、CA19-9水平和转移灶直径均显著降低,观察组降低更为明显,差异有统计学意义(P<0.05)。两组患者疗程结束后凝血酶原时间(PT)、白蛋白(ALB)均显著降低,谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)均显著升高,观察组变化更为明显,差异有统计学意义(P<0.05)。对照组用药时间显著高于观察组,差异有统计学意义(P<0.05)。疗程结束后,观察组有效率为29.1%,疾病控制率为76.4%;对照组疾病控制率为58.2%,观察组有效率、疾病控制率均显著高于对照组,差异有统计学意义(P<0.05)。观察组非肿瘤肝组织外观淤血、水肿和窦状隙扩张伴肝萎缩、坏死发生率显著高于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。观察组患者2年生存率为58.2%(32/55),显著高于对照组的43.6%(24/55),差异有统计学意义(P<0.05)。结论伊立替康联合西妥昔单抗对患者肝功能可造成一定影响,随着患者肝脏细胞损伤的修复,该影响可逐渐降低。该方案在晚期CC肝转移的治疗中安全、有效,对改善患者预后、提高生活质量均有良好的效果,值得临床推广应用。Objective To investigate effect of irinotecan combined with cetuximab on liver function and histology in patients with advanced colorectal cancer（ CC） and liver metastasis. Methods A total of 110 advanced CC patients with liver metastasis treated in Yulin Second Hospital from May 2010 to May 2014 were divided into observation group and control group using random number tables,with55 patients in each group. Both groups were given conventional treatment combined with irinotecan.Based on this,cetuximab was added to the observation group. Changes of tumor markers,liver metastasis diameter,liver function and non-tumor pathological and histologic manifestations of liver were observed in two groups before and after treatment. Efficacy and safety of irinotecan combined with cetuximab were analyzed. Results After treatment,the level of CA19-9 and CEA and the diameter of the metastatic lesions significantly reduced in both groups,and observation group decreased much more obviously（ P〈0. 05）. After the end of treatment,ALB and PT significantly reduced,and AST,ALT and TBIL significantly increased in both groups and changes in observation group was much more obvious（ P〈0. 05）. Medication time in the observation group was significantly longer than the control group（ P〈0. 05）; after the end of treatment,efficiency ratio was 29. 1 % and disease control rate was76. 4 % in observation group,which was higher than those in the control group. For control group,the disease control rate was 58. 2 %. The difference was statistically significant（ P〈0. 05）. Non-tumor congestion of liver tissues,edema and antral gap expansion with liver atrophy and incidence of necrosis were significantly higher in observation group than those of the control group（ P〈0. 05）. There was no significant difference in the incidence of adverse reactions between the two groups（ P〉0. 05）. The 2-year survival rate for the observation group was 58. 2%（ 32 /55）,which was significantly higher than that of the control group w

关 键 词：伊立替康 西妥昔单抗 结直肠肿瘤 肝转移 肝功能 组织学 

分 类 号：R735.34[医药卫生—肿瘤]