目的 观察明胶海绵微粒(gelatin sponge particles,GSPs)联合重组人p53腺病毒注射液治疗肝癌的疗效及外周血突变型p53蛋白的变化.方法 从2013年1月至2013年12月间入我院行介入治疗的经病理确诊的肝癌患者中选择病例60例,随机分为GSPs+重组人p53腺病毒注射液混合栓塞组、单纯GSPs栓塞组、单纯重组人p53腺病毒注射液灌注组,每组20例.GSPs+重组人p53腺病毒注射液混合栓塞组选用直径350~560μm的GSPs联合重组人p53腺病毒注射液(根据肿瘤大小选取1~4支)混合行肝动脉栓塞术;单纯GSPs栓塞组选用直径350~560μm的GSPs混合行肝动脉栓塞术;将肿瘤供血血管及肿瘤一次性阻断,灌注组应用导管选择进入肿瘤供血责任动脉进行重组人p53腺病毒注射液灌注.观察肿瘤坏死缩小程度及治疗前后外周血突变型p53蛋白的动态变化.结果 GSPs+重组人p53腺病毒注射液混合栓塞组术后1、6、12个月完全缓解率分别为10%、15%、5%,有效率分别为85%、75%、70%,高于单纯GSPs栓塞组(P=0.03)和重组人p53腺病毒注射液单纯灌注组(P=0.01).GSPs+重组人p53腺病毒注射液混合栓塞组治疗后外周血突变型p53蛋白表达率(治疗前平均23.73%,治疗后平均12.01%)显著下降,差异有统计学意义(P<0.01);单纯GSPs栓塞组和重组人p53腺病毒注射液单纯灌注组治疗前后外周血突变型p53蛋白表达率比较差异无统计学意义(P>0.05).结论 应用GSPs联合重组人p53腺病毒注射液治疗肝癌肿瘤坏死效果明显,外周血突变型p53蛋白表达率显著下降,为肝癌患者提供了一种较好的治疗方案.%Objective To study the curative effect of gelatin sponge particles (GSPs) combined with recom-binant human p53 adenovirus injection on hepatocellular carcinoma and the changes of p53 protein in peripheral blood. Methods A total of 60 hepatocellular carcinoma patients admitted in Affiliated Zhongshan Hospital of Dalian University between Jan. 2013 and Dec. 2013 were collected inthis study. Patients were randomly divided into 3 groups: GSPs+recombinant human adenovirus injection group, simple GSPs embolization group, and simple recombinant human p53 adenovirus injection group, 20 patients in each group. GSPs+recombinant human p53 adenovirus injection mixed embolization group with diameter of 350~560 μm GSPs combined with recom-binant human p53 adenovirus injection, and then underwent mixed hepatic artery embolization; simple GSPs em-bolization group with diameter of 350~560 μm GSPs, and then mixed for with hepatic arterial embolization; tu-mor blood vessels and tumor were blocked once, and perfusion group was treated with catheter to enter the tumor blood supply responsibility artery for recombinant human adenovirus injection. The dynamic changes of tumor necrosis and shrinkage and the changes of p53 protein in peripheral blood were observed. Results The complete remission rate of GSPs+recombinant human p53 adenovirus injection embolization group was 10%, 15% and 5% after 1, 6 and 12 months respectively, and the effective rates were 85%, 75% and 70%, which were signifi-cantly higher than those in simple GSPs embolization group (P=0.03) and simple recombinant human adenovirus injection group (P=0.01); but the expression rate of p53 protein was significantly decreased (23.73% for before treatment, 12.01% for after treatment, P<0.01). There was no significant difference in the expression rate of p53 protein between the simple GSPs embolization group and the simple recombinant human adenovirus injection group before and after treatment. Conclusion GSPs combined with recombinant human p53 adenovirus injection for the treatment of hepatocellular carcinoma, achieves obvious effect on tumor necrosis, and obvious decrease of peripheral blood mutant p53 protein expression, which provides a better treatment choice for hepatocellular car-cinoma.
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