明胶海绵微粒经导管动脉化疗栓塞治疗肝细胞癌的疗效及免疫调节作用的研究
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摘要
目的:探讨明胶海绵微粒经导管动脉化疗栓塞(GSMs-TACE)治疗肝细胞癌(HCC)的效果及对患者的免疫调节作用。方法:选取我院收集的HCC患者97例,根据TACE方法分为研究组49例(采用GSMs-TACE方法治疗)和对照组48例(采用碘化油TACE方法治疗),对比两种方法的治疗效果及对患者免疫功能的影响。结果:研究组的缓解率89.80%、总有效率97.96%,对照组缓解率81.25%、总有效率95.83%,两组患者比较,差异不具有统计学意义(P>0.05);治疗后,两组患者的血清AFP水平较本组治疗前均显著的降低(P<0.05),研究组的KPS评分高于对照组(P<0.05);治疗后,研究组的IL-1、IL-6水平低于对照组(P<0.05),研究组的CD3~+、CD4~+、NK水平显著的高于对照组(P<0.05);两组患者治疗后的IL-1、IL-6、TNF-α、CD8~+水平较治疗前显著的降低(P<0.05),CD3~+、CD4~+、NK水平较治疗前显著的升高(P<0.05);研究组的肝区疼痛、消化道不良反应发生率显著的低于对照组(P<0.05)。结论:GSMs-TACE与碘化油TACE治疗HCC患者的效果均肯定,但免疫调节GSMs-TACE具有优势。
Objective:To explore the effect of GSMs-TACE in the treatment of HCC and its immunomodulatory effects on patients.Methods:97 cases of HCC patients collected by our hospital were selected,according to the TACE method,including 49 cases of study group(using GSMs-TACE treatment) and 48 cases of control group(treated with iodized oil TACE),and the effects of the two methods were compared and the immune function of the patients was compared.Results:The remission rate of the study group was 89.80%,the total effective rate was 97.96%,the remission rate of the control group was 81.25% and the total effective rate was 95.83%.The difference between the two groups was not statistically significant(P>0.05).After treatment,the serum AFP levels of the two groups were significantly lower than those before treatment(P<0.05),the KPS score of the study group was higher than that of the control group(P<0.05).After treatment,the levels of IL-1 and IL-6 in the study group were lower than those in the control group(P<0.05),the levels of CD3~+,CD4~+ and NK in the study group were significantly higher than those in the control group(P<0.05).The levels of IL-1,IL-6,TNF-α and CD8~+ in the two groups were significantly lower than those before treatment(P<0.05).The levels of CD3~+,CD4~+ and NK were significantly higher than those before treatment(P<0.05).The incidence of liver pain and gastrointestinal adverse reactions in the study group was significantly lower than that in the control group(P<0.05).Conclusion:GSMs-TACE and lipiodol TACE are effective in the treatment of HCC patients,but immunomodulatory GSMs-TACE has advantages.
Objective:To explore the effect of GSMs-TACE in the treatment of HCC and its immunomodulatory effects on patients.Methods:97 cases of HCC patients collected by our hospital were selected,according to the TACE method,including 49 cases of study group(using GSMs-TACE treatment) and 48 cases of control group(treated with iodized oil TACE),and the effects of the two methods were compared and the immune function of the patients was compared.Results:The remission rate of the study group was 89.80%,the total effective rate was 97.96%,the remission rate of the control group was 81.25% and the total effective rate was 95.83%.The difference between the two groups was not statistically significant(P>0.05).After treatment,the serum AFP levels of the two groups were significantly lower than those before treatment(P<0.05),the KPS score of the study group was higher than that of the control group(P<0.05).After treatment,the levels of IL-1 and IL-6 in the study group were lower than those in the control group(P<0.05),the levels of CD3~+,CD4~+ and NK in the study group were significantly higher than those in the control group(P<0.05).The levels of IL-1,IL-6,TNF-α and CD8~+ in the two groups were significantly lower than those before treatment(P<0.05).The levels of CD3~+,CD4~+ and NK were significantly higher than those before treatment(P<0.05).The incidence of liver pain and gastrointestinal adverse reactions in the study group was significantly lower than that in the control group(P<0.05).Conclusion:GSMs-TACE and lipiodol TACE are effective in the treatment of HCC patients,but immunomodulatory GSMs-TACE has advantages.
引文
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[12] Zhou J,Liu Y,Ren Z,et al.Transarterial chemoembolization with gelatin sponge microparticles for barcelona clinic liver cancer Stage C and large hepatocellular carcinoma:Initial clinical experience[J].Journal of Cancer Research & Therapeutics,2017,13(5):767-772.
[13] Komada T,Suzuki K,Mizuno T,et al.Efficacy of percutaneous transhepatic portal vein embolization using gelatin sponge particles and metal coils[J].Acta Radiologica Open,2018,7(4):205846011876968.
[14] Ji WB,Wang WZ,Chen J,et al.Efficacy of Pingyangmycin iodized oil emulsion plus gelatin sponge granule embolization in interventional therapy of hepatic hemangioma[J].Chinese Journal of Medical Officer,2015,40(6):513- 514.
[15] Yuan XX,Jiang FF,Jia YM,et al.Clinical application value of serum ferritin and alpha-fetoprotein and alpha-fetoprotein heterogene-L3 single and combined detection in the diagnosis of primary liver cancer[J].Chinese Journal of Laboratory Medicine,2016,39(8):604-608.[袁星星,姜菲菲,贾泳梅,等.血清铁蛋白和甲胎蛋白及甲胎蛋白异质体-L3单项与联合检测对原发性肝癌辅助诊断的临床应用价值[J].中华检验医学杂志,2016,39(8):604-608.]
[16] Lungren MP,Lindquester WS,Seidel FG,et al.Ultrasound guided liver biopsy with gelatin sponge pledget tract embolization in infants weighing less than 10 kg[J].Journal of Pediatric Gastroenterology & Nutrition,2016,63(6):1-9.
[2] Huang QF,Li CR,Xu Fei,et al.Comparative study of gelatin sponge particles and sodium alginate microspheres in the treatment of primary liver cancer by arterial chemoembolization[J].Chinese Journal of Interventional Imaging and Therapy,2016,13(4):195-199.[黄秋峰,李忱瑞,许飞,等.明胶海绵颗粒与海藻酸钠微球经动脉化疗栓塞治疗原发性肝癌对比研究[J].中国介入影像与治疗学,2016,13(4):195-199.]
[3] Wang RT,Li JB,Zhang LQ,et al.Relationship between clinicopathological features and prognosis of lymph node metastasis in primary liver cancer[J].Chinese Journal of Digestive Surgery,2015,14(2):127-132.[王瑞涛,李建波,张灵强,等.原发性肝癌淋巴结转移临床病理特点与预后的关系[J].中华消化外科杂志,2015,14(2):127-132.]
[4] Zhang JK,Wang YY.Research progress in the mechanism and treatment of primary liver cancer[J].Chinese Pharmacy,2015,31(29):4171-4173.[张金坤,王燕燕.原发性肝癌发生机制及其治疗的研究进展[J].中国药房,2015,31(29):4171-4173.]
[5] Yao JX,Wang JB,Ai ST,et al.Short-term efficacy of microsphere combined with lipiodol embolization for liver cancer[J].Journal of Interventional Radiology,2017,26(6):531-534.[游建雄,王精兵,艾松涛,等.微球联合碘油栓塞治疗肝癌的近期疗效分析[J].介入放射学杂志,2017,26(6):531-534.]
[6] Yang Shuo.Expression and significance of PD-1 and PD-L1 in hepatocellular carcinoma[J].Academy of Military Medical Sciences,2016,11(3):136-142.[杨硕.PD-1、PD-L1在肝癌组织中表达及意义研究[J].中国人民解放军军事医学科学院,2016,11(3):136-142.]
[7] Wang XL,Su WY,Hu Q.Clinical value of preoperative peripheral blood neutrophil to lymphocyte ratio in evaluating the prognosis of hepatocellular carcinoma after radical resection[J].Cancer Progress,2017,15(5):592- 595.[王小兰,苏乌云,呼群.术前外周血中性粒细胞与淋巴细胞比值评估肝细胞癌根治性切除术后预后的临床价值[J].癌症进展,2017,15(5):592-595.]
[8] Yu ZN,Li JP,Lu MJ,et al.Short-term efficacy and safety of transcatheter hepatic artery perfusion with TACE in the treatment of unresectable hepatocellular carcinoma[J].Journal of Clinical Radiology,2016,35(6):929-933.[余子牛,李家平,卢鸣剑,等.经肝动脉灌注利卡汀序贯联合TACE治疗不可切除肝细胞癌的近期疗效与安全性分析[J].临床放射学杂志,2016,35(6):929-933.]
[9] Yu Liang,Pan Fei,Zhang Tao,et al.Meta-analysis of partial splenic embolization with gelatin sponge and polyvinyl alcohol granules in the treatment of cirrhosis and splenomegaly[J].Chinese Journal of Hepatobiliary Surgery,2016,22(12):827-831.[俞亮,潘飞,张涛,等.应用明胶海绵与聚乙烯醇颗粒行部分脾栓塞治疗肝硬化脾亢的Meta分析[J].中华肝胆外科杂志,2016,22(12):827-831.]
[10] Yu Qiang,Peng XM,Yang Bin,et al.Comparison of the efficacy and safety of gelatin sponge particles and Embosphere microspheres in the treatment of hepatocellular carcinoma rupture [J].Chinese Journal of Interventional Imaging and Therapy,2015,12(12):723-727.[余强,彭晓明,杨斌,等.明胶海绵颗粒与Embosphere微球治疗肝癌破裂出血有效性和安全性的对比分析[J].中国介入影像与治疗学,2015,12(12):723-727.]
[11] Li SL,Wan PQ,Peng T,et al.Cost-effectiveness analysis of arterial chemoembolization for prevention of tumor recurrence after radical resection of hepatocellular carcinoma[J].Cancer Research and Prevention,2015,42(4):350-355.[李仕来,万裴琦,彭涛,等.动脉化疗栓塞术预防肝癌根治性切除术后肿瘤复发的成本效果分析[J].肿瘤防治研究,2015,42(4):350-355.]
[12] Zhou J,Liu Y,Ren Z,et al.Transarterial chemoembolization with gelatin sponge microparticles for barcelona clinic liver cancer Stage C and large hepatocellular carcinoma:Initial clinical experience[J].Journal of Cancer Research & Therapeutics,2017,13(5):767-772.
[13] Komada T,Suzuki K,Mizuno T,et al.Efficacy of percutaneous transhepatic portal vein embolization using gelatin sponge particles and metal coils[J].Acta Radiologica Open,2018,7(4):205846011876968.
[14] Ji WB,Wang WZ,Chen J,et al.Efficacy of Pingyangmycin iodized oil emulsion plus gelatin sponge granule embolization in interventional therapy of hepatic hemangioma[J].Chinese Journal of Medical Officer,2015,40(6):513- 514.
[15] Yuan XX,Jiang FF,Jia YM,et al.Clinical application value of serum ferritin and alpha-fetoprotein and alpha-fetoprotein heterogene-L3 single and combined detection in the diagnosis of primary liver cancer[J].Chinese Journal of Laboratory Medicine,2016,39(8):604-608.[袁星星,姜菲菲,贾泳梅,等.血清铁蛋白和甲胎蛋白及甲胎蛋白异质体-L3单项与联合检测对原发性肝癌辅助诊断的临床应用价值[J].中华检验医学杂志,2016,39(8):604-608.]
[16] Lungren MP,Lindquester WS,Seidel FG,et al.Ultrasound guided liver biopsy with gelatin sponge pledget tract embolization in infants weighing less than 10 kg[J].Journal of Pediatric Gastroenterology & Nutrition,2016,63(6):1-9.
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