博莱霉素胸腔内注射治疗恶性胸腔积液疗效观察及机制探讨

摘要

Objective To observe the treatment efficacy and to investigate the mechanism of bleomycin on patients with malignant pleural effusions treated by intrapleural injection.Methods A total of 35 patients with pathological confirmed malignant pleural effusions were recruited in this study.Bleomycin(BLM) 60mg was administrated intrapleurally after the pleural effusion drainage was controlled.Then intravenous chemotherapy was performed 3 days later.Samples from the pleural effusions were collected before and after the treatment.Concentrations of IL-8 and PAI-1 were detected by ELISA; and CEA,Cyfra21-1,NSE and SCC-Ag were detected by microparticle luminescence enzyme immunoassay.Treatment effect was analyzed 1 month later.Results One month after BLM injection,11 patients got CR and 14 got PR.The overall control rate was 71.43％.The major short-term adverse reactions were mild,including fever,gastrointestinal reactions and chest pain.The levels of IL-8 and PAI-1 were increased after the administration of BLM (all P ＜ 0.05).The concentrations of CEA and Cyfra21-1 dropped after the BLM treatment in this series of patients (all P ＜ 0.05).Conclusions Intrapleural injection of BLM is an effective and safe treatment option for malignant pleural effusions,with mild adverse reactions and high control rate.The induction of pleural inflammation and anti-tumor effect might be involved in the mechanism of BLM.%目的 观察博莱霉素胸腔内注射治疗恶性胸腔积液的效果,并对其治疗机制进行探讨.方法 经病理检查证实的恶性胸腔积液患者35例,先行胸腔内置管引流,待胸腔积液减少后,予博莱霉素60 mg胸腔内注入,并于胸腔注射博莱霉素3d后行全身化疗.收集胸腔注药前后的胸腔积液,双抗体夹心ELISA法测定其白细胞介素-8(IL-8)、纤溶酶原激活剂抑制剂-1(PAI-1)水平,采用免疫微粒电发光法测定癌胚抗原(CEA)、细胞角质蛋白19片段(Cyfra21-1)、神经特异性烯醇化酶(NSE)、糖类抗原50 (SCC-Ag)水平.治疗1个月后评价疗效.结果 博莱霉素注射后1个月,CR 11例,PR 14例,总有效率为71.43％.不良反应比较轻微,主要为发热20例,胸痛6例,胃肠道反应4例,经对症处理后均好转.胸腔内注药后,胸腔积液中IL-8、PAI-1水平高于治疗前(P均＜0.05);CEA、Cyfra21-1水平低于治疗前(P均＜0.05).结论 博莱霉素胸腔内注射治疗恶性胸腔积液疗效确切,胸腔积液控制率高,不良反应轻微,其机制可能与博来霉素诱发胸腔内炎症反应、杀伤肿瘤细胞等有关.