Objective To investigate the clinical efficacy and safety of high intensity focused ultrasound ( HIFU) combined with intensity modulated radiation therapy in the treatment of advanced primary liver cancer .Methods From 2011 May to 2013 December , 60 patients with primary liver cancer were randomly divided into study group and control group , 30 cases in each group .The study group was treated with HIFU combined with intensity modulated radiotherapy .The short-term efficacy, pain score were compared, and detected the liver function, tumor markers (AFP, CEA), T cell subsets and NK cell level, and observed the adverse reactions of the 2 groups.Results The total effective rate of the study group was 80.0%, sig-nificantly higher than the 53.3%of control group ( P <0.05);along with increasing of the radiation dose , 2 groups’ pain scores were reduced than before treatment gradually ( P <0.05) and the degree of pain relief of the study group were more significantly than the control group , the difference was statistically significant ( P <0.05); compared the before and after treatment, total bilirubin, alanine aminotransferase , aspartate aminotransferase in the study group and the control group did not show significant differences , CEA, AFP were improved in both the two groups ( P <0.05), and the AFP in study group improved more significantly than the control group ( P <0.05 ); 4 weeks after therapy , the study group ’ s CD3+, CD4+, CD4+/CD8+,NK cells significantly improved than before the treatment and control groups ’ after 4 weeks of treatment ( P <0.05);2 group after treatment, adverse reactions mainly were leukopenia , hemoglobin, thrombocytopenia, kidney gut reac-tion, renal dysfunction,but the two groups showed no significant difference of these adverse reactions ( P >0.05).Conclusion HIFU combined with intensity modulated radiation therapy can improve the treatment effect of primary liver cancer , relieve pain,improve the quality of life ,improve the patient's immunity,and do not increase the incidence of radiation-induced liver disease.The HIFU combined with intensity modulated radiation therapy is a safe and effective method for treatment of patients with advanced liver cancer .%目的：探讨高强度聚焦超声（ HIFU ）联合调强适形放射治疗中晚期原发性肝癌的临床疗效及安全性。方法2011年5月—2013年12月收治原发性肝癌患者60例，按照患者入院时间的先后顺序随机分为研究组和对照组各30例，研究组采用HIFU联合调强适形放疗，对照组单纯行调强适形放疗。比较2组近期疗效、疼痛评分并检测肝功能、肿瘤标记物（ CEA、AFP）、T细胞亚群及NK细胞水平，观察2组不良反应。结果研究组的总有效率为80．0％，明显高于对照组的53．3％（ P ＜0．05）；随着放疗剂量的增加，2组疼痛评分均较治疗前逐渐减轻（ P ＜0．05），且研究组疼痛减轻程度较对照组明显，差异有统计学意义（ P ＜0．05）；治疗前后研究组、对照组的总胆红素、丙氨酸氨基转移酶、天冬氨酸氨基转移酶均无明显差异，2组治疗后CEA、AFP均改善（ P ＜0．05），且研究组AFP改善较对照组更明显（ P ＜0．05）；研究组治疗后4周CD3＋、CD4＋、CD4＋／CD8＋、NK细胞较其治疗前及对照组治疗后4周明显改善（ P ＜0．05）；2组治疗后不良反应主要是白细胞减少、血红蛋白减少、血小板减少、肾肠道反应、肾功能损害，但2组比较差异无统计学意义（ P ＞0．05）。结论采用HIFU联合调强适形放疗可以提高原发性肝癌的治疗效果，缓解患者疼痛，改善生存质量，提高患者免疫力，并不增加放射性肝病的发生，未加重不良反应，HIFU联合调强适形放疗是治疗晚期肝癌患者安全有效的方法。
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