索拉非尼联合肝动脉化疗栓塞治疗肝癌并肝动-静脉分流的安全性及疗效评价

摘要

目的 评价索拉非尼联合肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗肝癌并肝动-静脉分流的安全性及疗效.方法 选取本院2013年1月至2015年1月收治的96例肝癌并肝动-静脉分流患者为研究对象,按照随机数表法将其分为观察组和对照组,每组各48例.所有患者均行TACE治疗,观察组患者口服索拉非尼,坚持使用至无法耐受.比较两组患者治疗前和治疗8周后肝功能、血清甲胎蛋白(alpha-fetal protein,AFP)和血管内皮生长因子(vascular endothelial growth factor,VEGF)水平变化、临床疗效、不良反应发生情况及生存时间.结果 治疗8周后,两组患者谷丙转氨酶和总胆红素水平较治疗前均显著升高(P<0.05),血清白蛋白、AFP及VEGF水平较治疗前均显著降低(P<0.05);观察组患者AFP和VEGF水平均显著低于对照组(P<0.05).两组患者治疗总有效率、临床获益率及治疗期间不良反应发生率比较均无显著差异(P>0.05).观察组患者总生存期和无进展生存期均显著长于对照组(P<0.05).结论 单用TACE与索拉非尼联合TACE治疗肝癌并肝动-静脉分流的短期疗效相似,联合用药方案可显著延长患者生存期,且安全性较好.%Objective To evaluate the safety and efficacy of Sorafenib combined with hepatic artery chemoembolization (TACE) in the treatment of hepatocellular carcinoma with hepatic arteriovenous shunt. Method 96 cases of hepatocellular carcinoma with hepatic arteriovenous shunt patients treated in our hospital from January 2013 to January 2015 were selected as the research objects. They were randomly divided into observation group and control group, 48 cases in each group, all patients were treated with TACE. Patients in observation group were treated with Sorafenib orally, and persisted until they could not be tolerated. The liver function, serum alpha fetoprotein (AFP) and vascular endothelial growth factor (VEGF) levels changes, clinical efficacy, adverse reactions and survival time were compared between the two groups before and 8 weeks after treatment.Result 8 weeks after treatment, alanine aminotransferase and total bilirubin in the two groups were significantly higher than before treatment (P<0.05), albumin, AFP and VEGF levels were lower than before treatment (P<0.05), AFP and VEGF levels of observation group were significantly lower than control group (P<0.05). There were no significant differences of clinical total effective rates, clinical benefit rates and incidence of adverse reactions during treatment between the two groups (P>0.05). The overall survival and progression free survival time of observation group were longer than that of control group (P<0.05). Conclusion Single TACE and Sorafenib combined with TACE in the treatment of hepatocellular carcinoma with hepatic arteriovenous shunt have similar short-term efficacy, combination therapy has a more positive effect on prolonging survival time of the patients, and the security is good.