培美曲塞联合顺铂治疗恶性胸腔积液的近期疗效及对血清糖类抗原199、循环肿瘤细胞水平的影响  

Short-term efficacy of pemetrexed combined with cisplatin in the treatment of malignant pleural effusion and its effect on serum carbohydrate antigen 199 level and circulating tumor cells

作　　者：王坚迪 陈杰 胡明杰 Wang Jiandi;Chen Jie;Hu Mingjie(Department of Respiratory Critical Care,Healthcare Group,Cixi Third People's Hospital,Cixi 315324,Zhejiang Province,China)

机构地区：[1]慈溪市第三人民医院医疗健康集团呼吸危重症科,浙江省315324

出　　处：《中国基层医药》2021年第6期849-854,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:分析培美曲塞联合顺铂治疗恶性胸腔积液的近期疗效及对血清糖类抗原199(CA199)、循环肿瘤细胞(CTC)水平的影响。方法:选择慈溪市第三人民医院医疗健康集团2017年1月至2020年1月收治的肺癌晚期合并恶性胸腔积液(MPE)患者60例为观察对象,采用随机数字表法分为顺铂组和联合组,每组30例。两组均行胸腔引流术,顺铂组胸内注射顺铂,联合组在此基础上加予培美曲塞静脉滴注。于治疗前、治疗结束后1个月采用B超检测患者胸腔积液情况,评估两组临床疗效及生活质量改善情况,检测血清癌胚抗原(CEA)、CA199、CTC水平,记录治疗期间不良反应发生情况。结果:联合组的有效率[66.67%(20/30)]、生活质量改善率[70.00%(21/30)]均明显高于顺铂组[40.00%(12/30)、43.33%(13/30)],差异均有统计学意义(χ^(2)=4.286、4.344,均P<0.05)。两组治疗后患者的血清CEA、CA199水平均明显下降(均P<0.05);且联合组血清CEA[(22.26±5.13)ng/mL]、血清CA199[(20.12±4.35)U/mL]下降程度大于顺铂组[(31.64±6.46)ng/mL、(28.07±5.61)U/mL],差异均有统计学意义(t=6.228、3.134,均P<0.05)。与同组治疗前比较,顺铂组治疗后的血清CTC阳性率差异无统计学意义(P>0.05),联合组明显下降,差异有统计学意义(χ^(2)=4.286,P<0.05),但组间差异无统计学意义(P>0.05)。治疗期间,两组皮疹、恶心呕吐、白细胞减少、贫血不良反应发生率差异均无统计学意义(均P>0.05)。结论:培美曲塞联合顺铂治疗MPE的近期疗效较优,有利于缓解临床症状,提升患者生活质量,且安全性较优。Objective To investigate the short-term efficacy of pemetrexed combined with cisplatin in the treatment of malignant pleural effusion and its effect on serum carbohydrate antigen 199 level and circulating tumor cells.Methods Sixty patients with advanced lung cancer complicated by malignant pleural effusion who received treatment in Healthcare Group of Cixi Third People's Hospital,China from January 2017 to January 2020 were included in this study.They were randomly assigned to receive intrapleural injection of cisplatin(cisplatin alone group,n=30)or intrapleural injection of cisplatin combined with intravenous injection of pemetrexed(cisplatin+pemetrexed group,n=30)after thoracic drainage.Before and 1 month after treatment,pleural effusion was measured to evaluate clinical efficacy and improvement in quality of life.Serum carcinoembryonic antigen level,serum carbohydrate antigen 199 level and circulating tumor cells were determined.Adverse reactions during the treatment were recorded.Results Total effective rate and the rate of improvement in quality of life in the cisplatin+pemetrexed group were 66.67%(20/30)and 70.00%(21/30),respectively,which were significantly higher than those in the cisplatin alone group[40.00%(12/30)and 43.33%(13/30),χ^(2)=4.286,4.344,both P<0.05].After treatment,serum carcinoembryonic antigen and serum carbohydrate antigen 199 levels in each group were significantly decreased compared with before treatment(both P<0.05).Serum carcinoembryonic antigen and serum carbohydrate antigen 199 level in the cisplatin+pemetrexed group were(22.26±5.13)ng/mL and(20.12±4.35)U/mL,respectively,which were significantly lower than those in the cisplatin alone group[(31.64±6.46)ng/mL,(28.07±5.61)U/mL,t=6.228,3.134,both P<0.05).In the cisplatin alone group,there was no significant difference in the proportion of circulating tumor cells before and after treatment(P>0.05).In the cisplatin+pemetrexed group,the proportion of circulating tumor cells after treatment was significantly lower than that before tre

关 键 词：胸腔积液 恶性 叶酸拮抗剂 抗肿瘤联合化疗方案 肿瘤细胞 循环 抗原 肿瘤相关 碳水化合物 癌胚抗原 治疗效果 安全 生活质量 

分 类 号：R734.2[医药卫生—肿瘤]