奥氮平联合醋酸甲地孕酮治疗晚期癌症性厌食症的疗效观察

目的:观察奥氮平联合醋酸甲地孕酮治疗晚期癌症性厌食症的疗效。方法:将85例癌性厌食患者随机分至治疗组（奥氮平联合醋酸甲地孕酮组+营养支持）和对照组（醋酸甲地孕酮组+营养支持）及单纯营养支持组,观察各组治疗前后食欲、体重、卡氏评分和免疫功能的变化并评价不良反应。结果:治疗结束后,治疗组食欲、卡氏评分改善率分别为82.8%、69.0%,对照组分别为65.5%、34.4%,空白组分别为40.7%、33.3%,治疗组改善率明显高于对照组和空白组（P＜0.05）;治疗组在体重、血清白蛋白、免疫功能改善程度方面均优于对照组和空白组（P＜0.05）。未见明显不良反应。结论:奥氮平联合醋酸甲地孕酮能有效改善晚期恶性肿瘤患者厌食症状,是治疗晚期恶性肿瘤患者有效辅助药物,药物不良反应小。     

康莱特注射液配合胃肠外营养治疗癌症恶液质

[目的]探讨康莱特注射液配合胃肠外营养治疗癌症晚期恶液质的疗效及毒副作用。[方法]晚期癌症恶液质患者61例，分对照组30例单用胃肠外营养，治疗组31例用康莱特注射液配合胃肠外营养。[结果]治疗组卡氏评分提高大于10分的占74．2％，对照组提高10分的占30％，两组比较差异有显著性，P〈0．05；治疗组体重增加的占54．8％，对照组占40％，两组比较，P〉0．05：治疗组癌症疼痛缓解率为74．2％，对照组为23.3％，两组比较，P〈0．05。[结论]康莱特注射液能够改善癌症晚期患者恶液质的精神状况，增加食欲及体重，缓解癌痛，提高抗体的免疫功能．     

甲羟孕酮对改善晚期乳腺癌患者化疗期间生活质量的研究

目的探讨甲羟孕酮对改善晚期乳腺癌患者化疗期间生活质量的影响。方法将116例晚期乳腺癌患者随机分为对照组（56例）和观察组（60例）,对照组患者接受紫杉醇联合表柔比星化疗方案,21d为1个周期,2个周期后评估疗效。观察组患者同时接受口服甲羟孕酮。比较两组患者近期疗效、化疗期间饮食、体重、KPS评分及药物不良反应。结果观察组患者治疗有效率与对照组比较,差异无统计学意义（73．3％和69．6％,P〉0．05）。化疗期间观察组进食量、体重及KPS评分增加患者的比例显著多于对照组（P〈0．05）;观察组患者Ⅲ～Ⅳ级白细胞减少、脱发及恶心呕吐发生率显著少于对照组（P〈0．05）。结论甲羟孕酮可显著减少晚期乳腺癌患者化疗期间的不良反应、改善饮食情况及生活质量。     

醋酸甲羟孕酮在口腔恶性肿瘤放疗中的作用

我院应用倍恩胶囊 (国产醋酸甲羟孕酮 )配合放射治疗对5 0例中晚期口腔恶性肿瘤患者进行临床观察 ,结果证实醋酸甲羟孕酮对口腔肿瘤放疗患者具有促进食欲 ,改善放疗中的厌食和骨髓抑制作用。1　临床资料1.1　一般资料选择 2 0 0 1年 2月 -2 0 0 2年 10月在我科接受治疗的 5 0例口腔恶性肿瘤患者 ,均诊断明确 ,且经病理证实 ,以鳞癌为主 ,占 82 % (4 1例 ) ,其他为腺样囊性癌和未分化癌 (9例 ) ,包括术后放疗 3 8例、单纯放疗 7例和姑息放疗 5例。全部患者中男2 0例 ,女 3 0例 ;年龄 48～ 82岁 ,中位年龄 61 5岁 ;分为用药组2 5例 ,男性 10例…     

醋酸甲羟孕酮在口腔恶性肿瘤放疗中的作用

我院应用倍恩胶囊(国产醋酸甲羟孕酮)配合放射治疗对50例中晚期口腔恶性肿瘤患者进行临床观察，结果证实醋酸甲羟孕酮对口腔肿瘤放疗患者具有促进食欲，改善放疗中的厌食和骨髓抑制作用。     

益气养阴清热化痰中药复方调节肺癌恶病质细胞因子的研究

目的研究益气养阴清热化痰中药对晚期肺癌恶病质小鼠治疗反应状况。方法建立晚期Lewis肺癌动物模型,随机分为非荷瘤对照组、荷瘤对照组、中药组和甲羟孕酮组。浓缩中药溶液和甲羟孕酮（16mg／kg·d）于造模5天后出现恶病质后每日灌服0．2ml,对照组0．2ml生理盐水灌胃,连续8天。观察小鼠体重、饲料消耗量;免疫组织化学法检测肿瘤组织TNF-α、IL-6的表达。结果（1）小鼠生存状态：体重和饲料消耗量,中药组和甲羟孕酮组与荷瘤对照组比较差异有统计学意义（P〈0．05）;中药组和甲羟孕酮组之间差异无统计学意义（P〉0．05）。（2）免疫组化检测肺癌组织：中药组和甲羟孕酮组TNF-α和IL-6表达较荷瘤对照组有不同程度减少（表现为灰度值增加）,差异有统计学意义（P〈0．05）。结论益气养阴清热化痰中药对TNF-α、IL-6表达有不同程度的抑制作用,在改善Lewis肺癌恶病质小鼠的生活质量上与甲羟孕酮的作用相似。     

盐酸羟考酮控释片联合加巴喷丁治疗晚期癌症神经病理懒疗效分析

目的：探讨盐酸羟考酮控释片联合加巴喷丁治疗晚期癌症神经病理性疼痛的疗效。方法：晚期癌症的神经病理性疼痛患者,通过视觉模拟划线法（VAS）和口头叙述法（VRs）分级进行疼痛强度评估,分为A组盐酸羟考酮控释片20例,B组盐酸羟考酮控释片＋加巴喷丁20例,通过个体化用药,研究其洛疗疼痛缓解度,有效率。结果：A组轻度疼痛9例,无痛6例,有效率为75．0％,B组轻度疼痛5例,无痛13例,有效率为90．0％。结论：盐酸羟考酮控释片＋加巴喷丁治疗晚期癌症神经病理性疼痛疗效显著。     

甲羟孕酮治疗去势抵抗型前列腺癌的疗效观察

目的：观察甲羟孕酮对于去势抵抗型前列腺癌（CRPC）的疗效及毒副反应。方法：观察62例 CRPC患者口服甲羟孕酮后,对比口服药物前后 PSA、生活质量 KPS 评分、血红蛋白、营养状况的变化,评价药物毒副反应。结果：62例患者经过口服甲羟孕酮后,PSA 下降的有效率为11．3％、稳定率达24．2％。KPS 评分、血红蛋白较前明显改善（P 值均＜0．05）。营养状况的改善率为64．5％、稳定率达30．6％。未发现 III －IV 级毒副反应,6例出现轻度低钠血症,5例出现轻度低钾血症,Ⅰ度下肢水肿较治疗前增加4例。结论：甲羟孕酮可延缓部分 CRPC 患者的 PSA 进展,改善晚期肿瘤患者的生活质量,毒副反应小。     

NP方案联合醋酸甲羟孕酮治疗中晚期肺癌

[目的]比较醋酸甲羟孕酮联合NP方案与单用NP方案治疗中晚期非小细胞肺癌的近期疗效、毒副反应及生活质量。[方法]71例中晚期非小细胞肺痛患者随机分为醋酸甲羟孕酮＋NP方案治疗组（32例）与NP方案组（39例）。两组均以21天为1个周期，治疗2个周期。[结果]两组近期疗效无显著性差异。NP方案加醋酸甲羟孕酮组生存质量明最改善、进食量和体重显著增加及恶心呕吐毒副反应明显低于单纯NP方案组。[结论]醋酸甲羟孕酬联合NP方案治疗中晚期肺癌患者有效率无明显提高，但毒副反应低、耐受性好。     

奥施康定联合罗通定治疗老年晚期癌痛患者中重度疼痛的临床研究

目的：观察奥施康定（盐酸羟考酮缓释片）联合罗通定用于治疗老年晚期癌痛患者中重度疼痛的治疗效果、疼痛自我效能感、不良反应及生活质量改善情况。方法：将160例老年晚期中重度癌痛患者随机分为A、B、C三组,A组53例采用硫酸吗啡缓释片治疗,B组53例采用盐酸羟考酮缓释片治疗,C组54例采用盐酸羟考酮缓释片联用罗通定治疗,根据患者疼痛控制情况调整患者用药剂量,从而达到有效的镇痛效果,并观察患者生活质量改善情况、不良反应及评定患者的疼痛自我效能感。结果：A组（硫酸吗啡缓释片组）总有效率为92．5％,B组（盐酸羟考酮缓释片组）总有效率为88．7％,C组（盐酸羟考酮缓释片＋罗通定组）总有效率为94．4％,三组总有效率差异无统计学意义（P＞0．05）,B组盐酸羟考酮缓释片的最终滴定剂量为（204．03±30．45）mg/天,C组盐酸羟考酮缓释片的最终滴定剂量为（163．67±25．49）mg/天,C组与B组相比差异有统计学意义（P＜0．05）;三组患者治疗后生活质量均较治疗前明显改善（P＜0．05）,与B组相比,C组的生活质量改善显著（P＜0．05）,但B组和A组相比,差异无统计学意义（P＞0．05）;疼痛自我效能感较治疗前明显提高（P＜0．05）,与B组相比,C组的疼痛自我效能感更高（P＜0．05）;三组患者治疗过程中的不良反应以嗜睡和便秘常见,其次是恶心、呕吐,无呼吸抑制及成瘾性的发生。结论：罗通定可增强盐酸羟考酮的镇痛、镇静作用,降低其抑制癌痛的用药剂量,两者联用在治疗老年晚期癌痛患者中重度疼痛方面安全有效性高,不良反应小,生活质量明显提高,管理疼痛及疼痛相关症状的能力增强,具有重要的临床推荐价值。     

醋酸甲地孕酮改善子宫内膜癌患者食欲和体重的临床研究

目的:探讨醋酸甲地孕酮在子宫内膜癌治疗中改善患者食欲和体重的临床疗效。方法:对38例ER、PR阳性的子宫内膜癌患者术后给予口服醋酸甲地孕酮,160mg/天,连续6~12个月;44例ER、PR阴性者术后不服用醋酸甲地孕酮作对照。结果:醋酸甲地孕酮可显著改善子宫内膜癌患者术后、放化疗后的食欲,明显增加体重,减轻化疗的毒副作用,提高Karnofsky评分,对子宫内膜癌患者的生存率无明显改善。结论:醋酸甲地孕酮可显著改善子宫内膜癌患者的食欲和体重,提高生活质量,但对部分患者可能会过分增加体重,未明显改善子宫内膜癌患者的生存率。     

A double blind placebo controlled trial of medroxyprogesterone acetate (MPA) in cancer cachexia.

Patients with breast cancer treated with MPA often report an improvement in appetite. Similar appetite stimulation is seen in patients treated with some corticosteroids, but MPA has a potential advantage over these drugs in that it does not exert a catabolic effect. MPA (100 mg tds orally) has therefore been compared with placebo in 60 patients with advanced malignant disease. Twenty-one patients in the MPA group and 20 in the placebo group were receiving chemotherapy. Patients were treated for 6 weeks and were assessed at weeks 0, 3 and 6 for appetite, energy, mood and pain using visual analogue scales. Nutritional status was assessed by the measurement of serum proteins and anthropometrics. Karnofsky score was recorded as a measure of performance status. There was a significant improvement in appetite in the MPA group between weeks 0 (pre-study) and 3 (P = 0.0002) and 0 and 6 (P = 0.015). There was no significant improvement in appetite in the placebo group. Supporting this finding was the significant increase in serum thyroid binding pre-albumin and retinol binding protein in the MPA group between weeks 0 and 3 and 0 and 6 (P = 0.023 and P = 0.039 respectively). These two parameters showed no significant change in the placebo group. There was no change in anthropometric measurements, weight, performance status, energy, mood or pain in either group. These data indicate that there was a significant increase in appetite in anorexic patients with advanced cancer treated with MPA which was reflected in increases in rapid turnover proteins reported to reflect nutritional status. However, this apparent increase in appetite did not result in improved weight, performance status, energy levels, mood or relief of pain. Further studies to investigate the effect of higher doses of MPA are indicated.     

甲孕酮对改善癌症患者化疗期间生活质量的临床观察

目的为了改善癌症患者化疗期间生活质量。方法1991年12月至1994年12月期间,对30例癌症患者进行了甲孕酮（MPA）治疗的临床观察,设对照组30例。结果口服MPA的癌症患者普遍反映精神、食欲好转,体重有所增加,生活质量综合指数NPS评分较治疗前明显提高（80％,对照组为36．7％,P＜0．01）,伴有痛疼的患者（计18例）的癌痛改善率治疗组为83．3％,显著高于对照组的41％。结论甲孕酮（MPA）可以广泛用于各种肿瘤的化疗期间,来改善患者生活质量。     

A prospective study of the impact of weight loss and the systemic inflammatory response on quality of life in patients with inoperable non-small cell lung cancer

The relationship between weight loss, the systemic inflammatory response and quality of life in patients with inoperable non-small cell lung cancer (NSCLC) was studied. The extent of weight loss, the systemic inflammatory response (C-reactive protein) and quality of life (EORTC-QLQ-C30) was measured in 106 patients with inoperable NSCLC (stage III and IV). Approximately 40% had more than 5% weight loss and almost 80% had elevated circulating C-reactive protein concentrations (>10 mg/l). The functional scale scores of the EORTC-QLQ-C30 were poor (50 or less) and the fatigue symptom score was also poor (50 or more). When patients were grouped according to whether or not they had experienced more than 5% weight loss, Karnofsky performance status and global quality of life were lower (P<0.05) and symptom scores fatigue (P<0.05) and pain (P<0.01) were greater in the weight-losing group. When the weight-stable cancer patients were grouped according to whether or not they had evidence of a systemic inflammatory response, the symptom fatigue was higher in the inflammatory group (P<0.05). In the weight-stable cancer patients C-reactive protein concentration was correlated with fatigue r=0.31 (P<0.05). The results of the present study indicate that both weight loss and the systemic inflammatory response impact on different aspects of quality of life. In particular, fatigue is associated with the presence of a systemic inflammatory response independent of weight loss.     

顺铂和奈达铂为基础联合吉西他滨治疗非小细胞肺癌合并胸腔积液的疗效比较

目的 探讨顺铂联合吉西他滨、奈达铂联合吉西他滨在非小细胞肺癌合并胸腔积液治疗中的疗效.方法 纳入非小细胞肺癌合并胸腔积液患者60例,用双盲法分为A组和B组.A采用奈达铂联合吉西他滨治疗,B组采用顺铂联合吉西他滨治疗.对比2组治疗有效率、控制率、1年生存率、进展期(TTP)时间;对比2组不良反应发生情况和6个月生活质量Karnofsky分值.结果A组治疗有效率(40.00%)、控制率(60.00%)、1年生存率(40.00%)、MTPP与B组均无统计学差异,P均>0.05.A组血红蛋白降低发生率、恶心呕吐发生率、体重降低发生率均较B组低,P均<0.05.6个月A组Karnofsky分值较B组高,P<0.05.结论两种联合用药效果相当,但奈达铂联合吉西他滨安全性更好,更利于患者生活质量的改善.     

甲孕酮伍用止吐药预防化疗引起的恶心呕吐

 止吐药已基本能控制化疗呕吐，但化疗引起的食欲不振和恶心尚末引起充分注意。本文旨在观察甲孕酮与胃复安、地塞米松联合应用是否可进一步减轻这些化疗反应。结果表明，加用甲孕酮的病人，63%末出现恶心，而对照组仅29%（P<0.05）；对预防化疗引起的呕吐有一定增强效果，但无统计学意义；对食欲的保护最为明显，化疗期间及化疗后食欲不减或有所增加者占73%，对照组仅19%（P<0.05）。即使发生食欲者，其幅度和持续时间也明显低于对照组。作者认为，甲孕酮与止吐药合用可进一步减少化疗的消化道并发症，对提高病人的生活质量、保证抗肿瘤治疗顺利进行具有重要意义。     

Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy

BACKGROUND: Adequate prediction of survival is important in deciding on treatment for patients with symptomatic spinal metastases. The authors reviewed 342 patients with painful spinal metastases without neurologic impairment who were treated conservatively within a large, prospectively randomized radiotherapy trial. Response to radiotherapy and prognostic factors for survival were studied. METHODS: The data base of the Dutch Bone Metastasis Study was used. Response to treatment and prognostic factors for overall survival (OS) were studied using a Cox regression model. A scoring system was developed to predict OS. RESULTS: Responses were noted in 73% of patients. In 3% of patients, spinal cord compression was reported a mean of 3.5 months after randomization. The median OS was 7 months, and significant predictors for survival were Karnofsky performance score, primary tumor (multivariate analysis; both P < 0.001), and the absence of visceral metastases (multivariate analysis; P = 0.02). A scoring system based on these predictors was developed, and 34% of patients were in Group A (median OS = 3.0 months), 48% of patients were in Group B (median OS = 9.0 months), and 18% of patients were in Group C (median OS = 18.7 months). Group C was comprised of patients with breast carcinoma, a good performance, and no visceral metastases. CONCLUSIONS: Most patients with spinal metastases have a limited life expectancy and should be treated with caution regarding surgical procedures. Radiotherapy is a safe and effective, noninvasive treatment modality for pain. The new scoring system will enable physicians to select patients who may survive long enough to benefit from more radical treatment.     

放疗联合唑来磷酸治疗转移性骨痛的临床研究

目的:评价放疗联合唑来磷酸治疗恶性肿瘤骨转移引起的骨痛及不适。方法:114例恶性肿瘤骨转移骨痛的患者,采用随机分组方法,分为联合治疗组(A组,n=38),采用放疗联合唑来磷酸;放疗组(B组,n=42),采用6MVX线30Gy/10次,唑来磷酸组(C组,n=34),采用唑来磷酸4mg 生理盐水100mL静脉滴注大于15min,每3～4周重复。采用视觉模拟评分法(VAS)对疼痛进行评分,0～10数字疼痛强度分级法,测定疼痛强度。结果:A组VAS评分下降程度较B、C组明显(P<0.01)。医师总体评价,组A疼痛控制有效率也高于其他两组(P<0.05)。结论:放疗联合唑来磷酸治疗恶性肿瘤转移性骨痛疗效优于单独放疗或单用唑来磷酸。     

密钙息联合化疗治疗骨转移瘤的临床应用

目的探讨密钙息(Miacacic)联合化疗治疗骨转移瘤的临床疗效。方法对139例有骨转移的恶性肿瘤患者,随机分为2组,密钙息并化疗组(A组)和单纯化疗组(B组)。A组采用密钙息配合化疗,B组为单纯化疗。治疗28天后观察疼痛好转程度及Karnofsky评分变化,血清ALP及Ca2+水平的变化及不良反应。结果两组止痛效果及Karnofsky评分变化,血清ALP及Ca2+水平的变化经统计学处理,有显著性差异(P<0.05),且无明显不良反应。结论密钙息治疗和预防恶性肿瘤骨转移有方便、安全、有效、耐受性良好的特点,具有良好的临床应用前景。