非肌层浸润性膀胱癌术后吉西他滨联合卡介苗膀胱灌注化疗的疗效及对免疫功能的影响  

Effect of gemcitabine combined with BCG bladder perfusion chemotherapy and its effect on immune function

作　　者：郭亮[1] 马曜辉 管庆军[1] 马杰锋[1] GUO Liang;MA Yao-hui;GUAN Qing-jun;MA Jie-feng(Department of Urinary Surgery,People’s Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州人民医院泌尿外科,郑州450000

出　　处：《医药论坛杂志》2020年第7期89-93,共5页Journal of Medical Forum

基　　金：通信作者:马杰锋,E-mail:[e-mail]。

摘　　要：目的探讨吉西他滨(GEM)联合卡介苗(BCG)膀胱灌注预防中高危非肌层浸润性膀胱癌(NMIBC)术后复发的疗效、不良反应及其对免疫功能的影响。方法选取经病理确诊并经尿道膀胱肿瘤切除术(TURBT)治疗的中高危NMIBC患者108例,随机平均分为GEM组(单纯灌注GEM),BCG组(单纯灌注BCG)和GEM+BCG组(联合灌注BCG和GEM)。随访并记录患者的复发及生存情况,收集患者的不良反应发生情况,并在灌注前后检测患者的免疫功能指标。结果GEM组,BCG组和GEM+BCG组的复发率分别为33.3%(12/36),19.4%(7/36)和8.3%(3/36),差异具有统计学意义(P<0.05);GEM组无复发生存时间为(34.07±1.90)个月,BCG组无复发生存时间为(37.81±1.50)个月,均显著低于GEM+BCG组的无复发生存[(40.77±0.96)个月]。GEM组的不良反应发生率为为16.7%(5/36)明显低于BCG组41.7%(15/36)和GEM+BCG组30.5%(11/36),但GEM+BCG组不良反应发生率与BCG组无统计学差异。膀胱灌注6个月后,GEM+BCG组患者免疫球蛋白IgM,IgG,IgA水平及T淋巴细胞亚群中CD4+比例和CD4+/CD8+比值比明显高于GEM组和BCG组,而CD8+明显低于GEM组和BCG组,差异具有统计学意义(P<0.05)。结论BCG联合GEM膀胱灌注化疗能够显著降低NMIBC患者术后复发率,延长患者的无复发生存时间,提高患者的免疫功能,且不良反应发生率与单用BCG无显著差异。Objective To investigate the efficacy,side effects and immune function of gemcitabine(GEM)combined with BCG intravesical infusion in the prevention of recurrence of middle and high risk non-myenteric invasive bladder cancer after(NMIBC).Methods Totally 108 patients with middle and high risk nmibc diagnosed pathologically and treated with(TURBT)for bladder tumor resection were randomly divided into GEM group(GEM alone),BCG group(BCG alone)and GEM+BCG group(BCG and GEM).The recurrence and survival of the patients were followed up and recorded,the adverse reactions were collected,and the immune function indexes were measured before and after perfusion.Results The recurrence rates of GEM group,BCG group and GEM+BCG group were 33.3%(12/36),19.4%(7/36)and 8.3%(3/36),respectively and the difference was statistically significant(P<0.05).The non-recurrence survival time of GEM group was(34.07±1.90)months,and that of BCG group was(37.81±1.50)months,which was significantly lower than that of GEM+BCG group[(40.77±0.96)months].The incidence of adverse reactions in gem group was 16.7%(5/36),which was significantly lower than that in BCG group 41.7%(15/36)and GEM+BCG group 30.5%(11/36),but there was no significant difference in the incidence of adverse reactions between GEM+BCG group and BCG group.After 6 months of intravesical perfusion,the level of immunoglobulin IgM,IgG,IgA and the ratio of CD4+and CD4+/CD8+in tlymphocytes subsets in,GEM+BCG group were significantly higher than those in GEM group and BCG group,while CD8+was significantly lower than that in GEM group and BCG group(P<0.05).Conclusion BCG combined with GEM intravesical infusion chemotherapy could significantly reduce the recurrence rate,prolong the non-recurrence survival time and improve the immune function of NMIBC patients,and the incidence of adverse reactions was not significantly different from that of BCG alone.

关 键 词：吉西他滨 卡介苗 膀胱灌注 复发 免疫功能 

分 类 号：R737.14[医药卫生—肿瘤]