微球TACE对小肝癌治疗的影响及相关因素分析  

Effects of Microsphere TACE on the Treatment of Small Hepatocellular Carcinoma and Analysis of Relevant Factors

作　　者：王秀香 李海霞 郭琳 许淑君 刘冠龙 杨元磊 高爱华 WANG Xiu-xiang;LI Hai-xia;GUO Lin;XU Shu-jun;LIU Guan-long;YANG Yuan-lei;GAO Ai-hua(CT Room,Cangzhou Third Hospital,Cangzhou 061001,China;Radiology Department,Cangzhou Third Hospital,Cangzhou 061001,China;Medical Security Department,Cangzhou Third Hospital,Cangzhou 061001,China;Nursing Department,Cangzhou Third Hospital,Cangzhou 061001,China;Department of Ultrasound,Cangzhou Third Hospital,Cangzhou 061001,China;Medical Department,Cangzhou Third Hospital,Cangzhou 061001,China)

机构地区：[1]沧州市第三医院CT室,河北沧州061001 [2]沧州市第三医院放射科,河北沧州061001 [3]沧州市第三医院医保科,河北沧州061001 [4]沧州市第三医院护理部,河北沧州061001 [5]沧州市第三医院超声科,河北沧州061001 [6]沧州市第三医院医务科,河北沧州061001

出　　处：《药物生物技术》2024年第1期45-52,共8页Pharmaceutical Biotechnology

基　　金：2022年沧州市科技计划自筹项目(No.222106022)。

摘　　要：探讨载药微球肝动脉化疗栓塞(Transcatheter arterial chemoembolization,TACE)对原发性小肝癌血清趋化因子CXC配体9(Chemokine CXC Motif ligand 9,CXCL9)水平及近期疗效的影响及预后因素的分析。选择2016年6月至2020年6月本院收治的110例原发性小肝癌患者,根据随机数表法将患者分成观察组和对照组,各55例。所有患者均行续贯微波消融术,观察组患者行载药微球TACE,对照组患者行常规碘化油TACE。比较两组患者生活质量、血清CXCL9、血管内皮生长因子(Vascular endothelial growth factor,VEGF)和甲胎蛋白(Alpha fetoprotein,AFP)、术后并发症、生存期等指标。随访至2021年9月,单因素和多因素分析小肝癌患者术后生存情况,确定影响患者预后的独立影响因素。治疗后,观察组患者生活质量评分显著低于对照组。观察组患者血清CXCL9、VEGF和AFP浓度明显低于对照组。治疗期间,两组患者均出现恶心呕吐、白细胞减少、血小板减少、贫血、肾毒性、发热、脏器损伤和膈肌损伤等并发症,但差异未见显著性。观察组患者中位无瘤生存期为25.9月,明显高于对照组的21.9月,差异有统计学意义(χ^(2)=0.431,P=0.019)。单因素分析结果显示,小肝癌中位无瘤生存期与年龄、冠心病、高血压、肝硬化、腹水、吸烟史、术中输血量、肿瘤数目、包膜是否完整、门脉癌栓、治疗方式、CXCL9、VEGF和AFP等指标相关(P<0.05)。Cox回归分析,结果显示,术中出血量、肿瘤数目、门脉癌栓、包膜不完整、治疗方式和CXCL9是影响患者预后的独立影响因素(P<0.05)。载药微球TACE联合续贯微波消融术可有效提高患者生活质量,降低血清CXCL9、VEGF和AFP水平,安全有效,且术中出血量、肿瘤数目、门脉癌栓、包膜不完整、治疗方式及血清CXCL9是原发性小肝癌癌症复发的独立影响因素,值得临床进一步研究。To study the effects of drug-loaded microspheres TACE on serum CXCL9 levels and short-term efficacy of primary small hepatocellular carcinoma and analysis of prognostic factors,a total of 110 patients with primary small liver cancer admitted to Cangzhou third hospital from June 2016 to June 2020 were selected and divided into observation group and control group according to random number table method,with 55 cases in each group.All patients underwent radiofrequency ablation.Patients in the observation group received drug-loaded microsphere TACE,and patients in the control group received conventional iodized oil TACE.Quality of life,serum CXCL9,vascular endothelial growth factor and alpha fetoprotein,postoperative complications,long-term clinical efficacy were compared between the two groups.They were followed up to September 2021,univariate and multivariate analysis of postoperative survival of patients with small liver cancer,to determine the independent factors affecting the prognosis of patients.After treatment,the observed group exhibited significantly lower scores in quality of life compared to the control group.Serum concentrations of CXCL9,VEGF,and AFP in the observed group were markedly lower than those in the control group.During the treatment period,both groups experienced complications such as nausea,vomiting,leukopenia,thrombocytopenia,anemia,renal toxicity,fever,organ damage,and diaphragmatic injury,but no significant differences were observed.The median disease-free survival time of patients in the observation group was 25.9 months,which was significantly higher than the 21.9 months in the control group,and the difference was statistically significant(χ~2=0.431,P=0.019).Univariate analysis results indicated that the median disease-free survival in small hepatocellular carcinoma was correlated with age,coronary heart disease,hypertension,cirrhosis,ascites,smoking history,intraoperative blood transfusion volume,tumor number,encapsulation integrity,portal vein tumor thrombus,treatment modality,and ind

关 键 词：载药微球 肝动脉化疗栓塞术 原发性小肝癌 趋化因子CXC配体9 近期疗效 影响因素 

分 类 号：R735.7[医药卫生—肿瘤]