恩度联合顺铂局部治疗非小细胞肺癌合并恶性胸腔积液的疗效及对 VEGF、HIF-1α的影响

摘要

目的：观察恩度联合顺铂局部治疗非小细胞肺癌（ NSCLC）合并胸腔积液的疗效及对积液中VEGF、HIF-1的影响。方法选取30例NSCLC合并恶性胸腔积液患者为研究对象，均采用顺铂联合恩度胸腔局部注入治疗，并在治疗前、后抽取患者3 ml胸腔积液，酶联免疫吸附法测定血清VEGF、HIF-1α水平。观察局部化疗的临床效果，分析不同疗效患者VEGF、HIF-1α水平的变化。结果所有患者均完成2周化疗，其中CR 1例，PR 9例，SD 12例，PD 8例，总有效率为33．3％，疾病控制率为73．3％，随访至今，中位缓解时间为65 d （7～354 d）。所有患者对局部灌注化疗耐受性较好，未出现严重不良反应，10例患者生存质量改善。按照临床疗效将30例患者分为有效组（ CR＋PR，10例）和无效组（SD＋PD，20例），化疗后CR＋PR患者胸腔积液中VEGF、HIF-1α水平较化疗前显著降低（P＜0．05），而SD＋PD患者VEGF、HIF-1α水平稍有上升，但差异不明显（ P＞0．05）。结论恩度联合顺铂局部灌注治疗晚期NSCLC合并胸腔积液具有一定的临床效果，不良反应较少，能提高部分患者的生活质量，其作用机制与抑制VEGF、HIF-1α表达水平有关。%Objective To observe the clinical effect of local injection in non-small cell lung cancer ( NSCLC) with ma-lignant pleural effusion and its influence on VEGF and HIG-1α.Methods 30 cases of NSCLC with malignant pleural effusion were selected in our study .All cases were treated with intrapleural injection of endostar combined with DDP ,and extracted 3 ml of pleural effusion pre-treatment and post-treatment.Enzyme linked immunosorbent assay were used to detect the level of serum VEGF and HIG-1α.The clinical effect were recorded ,and the level of serum VEGF and HIG-1αin different clinical effect were observed.Results All patients endured the course of chemotherapy .1 case had CR,9 cases had PR,12 cases had SD and 8 ca-ses had PD.The total effective rate was 33.3%,and the disease control rate was 73.3%.The median remission time were 65 d(7~354 d) .There were no severe side effects ,and all patients had high tolerance to local injection chemotherapy ,10 cases had life quality improved.Based on the clinical effect ,30 cases were divided into effective group ( CR+PR,10 cases) and non-effective group(SD+PD,20 cases).The level of serum VEGF and HIG-1αin effective group were decreased after treatment compared to pre-treatment(P<0.05),the difference had statistical significance .And the level of serum VEGF and HIG-1αhad increased slightly in effective group compared to pre-treatment(P>0.05).Conclusion Intrapleural injection of endostar with DDP in treatment of non-small cell lung cancer with malignant pleural effusion is safe and practicable ,and could enhance the life quality . Its effective mechanism is inhibiting the expression of VEGF and HIG-1α.