大剂量甲氨蝶呤联合顺铂治疗骨肉瘤的效果分析

摘要

Objective To investigate the clinical effects of high dose Methotrexate ( HD-MTX) combined with Cisplatin ( PPD) in the treatment of osteosarcoma .Methods 60 patients with osteosarcoma were chosen as the research objects .According to hospitalization time sequence ,they were divided into the control group and the observation group .All patients were treated with PPD 80 mg/m2 ,1/d.The observation group was added with HD-MTX,6.0~8.0 g/m2 ,intravenous drip 6 hours,4 hours later with leucovorin calcium to free ,15 mg intravenous injection ,q3h ×9times;intramuscular 15 mg,q6h ×6~8times.The recent effi-cacy,long-term efficacy,adverse reactions and the influence to cytokines of the 2 groups were observed .Results After treatment, 1-,2-,3-year survival rates of the observation group and the control group were 76.67%(23/30),53.33%(16/30),36.67%(11/30),and 73.33%(22/30),36.67%(11/30),20.00%(6/30).There was no significant difference between the 2 groups in 1-year survival rate (P<0.05),but 2-and 3-year survival rates was significantly different (P<0.05).In addition,the difference of the recent clinical curative effects and adverse reactions in both groups were also statistically significant (P<0.05).After treat-ment ,serum IL-2 and TNF alpha and IFN-gamma levels of all patients increased significantly ,but the observation group was high-er(P<0.05).Conclusion HD-MTX combined with PPD therapy can improve the patients ’recent and long -term efficacy,re-duce adverse reactions ,and improve immune function .%目的：探讨大剂量甲氨蝶呤联合顺铂治疗骨肉瘤患者的临床疗效。方法选择60例骨肉瘤患者作为研究对象。按照患者住院时间先后顺序分组为对照组和观察组。对照组：采用顺铂治疗，80 mg/m2，静脉滴入，1次/天；观察组：采用大剂量甲氨蝶呤联合顺铂治疗，其中采用顺铂80 mg/m2，静脉滴入，1次/天；甲氨蝶呤，6．0～8．0 g/m2，静脉滴注6 h，之后第4 h采用甲酰四氢叶酸钙解救，15 mg静脉注射，q3 h ×9次，肌肉注射15 mg，q6h ×（6～8）次。观察2组患者的近、远期疗效和不良反应及对细胞因子的影响。结果治疗后，观察组1、2、3年生存率分别为76．67％（23/30）、53．33％（16/30）、36．67％（11/30），对照组分别为73．33％（22/30）、36．67％（11/30）、20．00％（6/30），2组1年生存率比较，P＞0．05；而2组2、3年生存率比较，P＜0．05。此外，2组患者近期临床疗效和不良反应比较，P＜0．05。2组患者治疗后血清IL-2和TNF-α及IFN-γ水平与治疗前比较，均出现明显上升，但观察组升高较为显著（P＜0．05）。结论相比顺铂来说，大剂量甲氨蝶呤联合顺铂治疗骨肉瘤患者，能提高近远期疗效，且不良反应少，同时还能有效改善患者免疫功能，提高患者抵抗力。