索拉菲尼治疗肝癌致皮肤反应的临床观察及护理

随着肿瘤分子生物学研究的深入,越来越多的抗肿瘤分子靶向药物应用于临床.索拉菲尼全名甲苯酸索拉菲尼片,是口服的多靶点抑制剂,属于靶向治疗药物的一种,是晚期肾癌、肝癌全身治疗的一线用药.索拉菲尼的常见不良反应是手足皮肤反应、皮疹、高血压、胃肠道反应、腹泻、易疲劳等.其中皮肤反应发生率较高,表现直观,有特征性,会引起患者心理和生理的不适,需要及时指导护理[1].我科针对口服索拉菲尼所致的皮肤反应进行了观察和护理.现报道于下.     

老年原发性高血压患者睡眠质量与家庭关怀度的相关性

目的探讨老年原发性高血压患者睡眠质量状况及其与家庭关怀度之间的相关性。方法 2014年7~10月对长春市某三所三级甲等医院342名原发性高血压患者进行问卷调查,问卷内容包括一般资料调查表、阿森斯失眠量表及家庭关怀度指数量表,分析患者的睡眠质量及其与家庭关怀度的相关性。结果患者睡眠质量平均(7.17±4.50)分,可疑失眠及失眠患者占75.74%;家庭关怀度平均分为(6.42±2.30)分;睡眠质量与家庭关怀度中的合作度、成长度、情感度、亲密度的得分均呈显著负相关(均P<0.01),与适应度无相关性,即患者的家庭关怀度水平越高,睡眠质量越好。结论老年原发性高血压患者睡眠质量总体较差,存在中、重度家庭关怀度障碍的患者较多。通过采取提高患者关怀度的相应措施可间接改善其睡眠状况,从而提高患者生活质量,促进康复。     

精神分裂症患者出院后服药依从性调查及家庭护理干预

复发是精神分裂症患者康复的大敌，服药不依从是导致精神病复发的主要原因之一。近年来，我们对87例精神分裂症患者出院后的服药依从性进行了调查并探讨家庭护理干预措施。     

索拉菲尼治疗进展期原发性肝癌患者有效性及安全性研究*

目的 探讨应用索拉菲尼治疗进展期原发性肝癌(aPLC)患者的有效性和安全性。方法 2013年4月~2016年12月我科诊治的aPLC患者82例,采用随机数字表法分为两组,每组41例。两组均给予射频消融术（RFA）治疗,观察组患者在RFA前后接受索拉菲尼治疗,观察12 w。采用ELISA法检测血清碱性成纤维细胞生长因子（bFGF）和血管内皮生长因子（VEGF）。结果 2例观察组患者被剔除,3例对照组患者失访;在治疗12 w末,观察组疾病控制率为61.5%,与对照组的52.6%比,差异无统计学意义（P>0.05）,但观察组肿瘤客观有效率为48.7%,显著高于对照组的26.3%,差异有统计学意义（P<0.05）;观察组血清AFP、bFGF和VEGF水平分别为（184.7±10.5）μg/L、（3.8±1.3） pg/mL和（172.3±25.4） pg/mL,均显著低于对照组的（213.6±11.6） μg/L、（6.4±2.0） pg/mL和（210.5±28.3） pg/mL,差异有统计学意义（P<0.05）;观察组中位无进展生存期（PFS）为10.2个月（95%CI为7.4~11.5）,对照组为7.9个月（95%CI为 6.0~10.1）,经Log-rank检验显示两组差异有统计学意义（P<0.05）;观察组在服药过程中手足综合征、皮疹、白细胞减少、口腔黏膜炎、脱发和肝功能异常发生率分别为43.6%、25.6%、17.9%、20.5%、25.6%和23.1%,显著高于对照组的0.0%、2.6%、0.0%、0.0%、0.0%和5.3%,差异有统计学意义（P<0.05）。结论 索拉菲尼可控制aPLC患者实体瘤扩散,延长无进展生存期,但索拉菲尼可引起多种不良反应,在用药过程中应注意观察并及时采取相应处理措施,以防止发生严重不良反应。     

老年脑血管疾病患者家庭关怀度与焦虑的相关性

目的 了解脑血管疾病患者家庭关怀度及其与焦虑的相关性.方法 使用家庭关怀指数量表与焦虑自评量表对120例脑血管疾病患者进行测评.结果 脑血管疾病患者的家庭关怀度得分为(8.63±2.28)分,家庭功能良好者占80％,且家庭关怀度5个维度分别与焦虑状况呈负相关.结论 脑血管疾病患者家庭功能良好,且家庭关怀度各维度与焦虑呈负相关,提高患者家庭关怀度对预防和减轻脑血管疾病患者焦虑状况,提高其生活质量,具有重要意义.     

广西白裤瑶族原发性高血压患者服药行为意向及服药依从性初探

目的 探讨广西白裤瑶族原发性高血压患者服药行为意向及服药依从性的影响因素,为采取科学的干预措施提供参考。方法 从宗教文化、地域环境、生活方式、受教育程度等方面分析广西白裤瑶族原发性高血压患者服药行为意向及服药依从性的影响因素。结果 宗教文化、地域环境、生活方式、文化教育水平等会通过不同的形式对广西白裤瑶族原发性高血压患者的服药行为意向及服药依从性产生重要影响。结论 了解白裤瑶族人群的高血压患病情况,从宗教文化、地域环境、生活方式等角度探讨白裤瑶族原发性高血压患者服药行为意向及服药依从性的影响因素,可为有效防控我国少数民族的原发性高血压等慢性病提供重要参考。     

老年慢性病患者居家服药依从性的调查分析

目的探讨福田区老年慢性病患者服药依从性的影响因素。方法采用自行设计的老年慢性病患者服药依从性调查问卷对244例老年慢性病患者进行调查。结果发现住院2次以上的老年慢性病患者,家居服药依从性明显提高,影响依从性与自我感觉病情好转,经济原因,缺乏家属支持和疾病相关知识、药物不良反应等有关。结论提高老年慢性病患者服药依从性必须多从人文着手。     

肝细胞癌的分子靶向治疗

肝细胞癌(hepatocellular carcinoma,HCC)是人类第5大恶性肿瘤,死亡率极高.在我国,HCC的治疗已取得显著进展,但总体发病率和死亡率尚无明显改观,对于不适宜手术切除的晚期HCC,现有的药物治疗并不能改善患者预后,进一步提高疗效仍面临严峻挑战.所以,发现新的靶向治疗药物或新的靶点对HCC的早期诊断、化学预防以及治疗显得尤为重要.目前从对HCC发生、发展的分子机制的研究中,人类已发现了多个潜在分子靶点.这些靶点大部分为酪氨酸激酶受体激活的信号传导通路,包括:Raf/MEK/ERK,PI-3K/Akt/mTOR和Jak/Stat等.以索拉菲尼、舒尼替尼等为药物代表的多靶点、多激酶抑制剂治疗HCC更是受到高度关注.本文主要介绍HCC潜在的分子靶点以及常用靶向药物的临床进展.     

Sorafenib response in hepatocellular carcinoma: MicroRNAs as tuning forks

Hepatocellular carcinoma (HCC) is the primary liver malignancy that contributes towards the second most common cause of cancer‐related mortality. The targeted chemotherapeutic agent, sorafenib, is known to show a statistically significant but limited overall survival advantage in advanced HCC. However, the individual patient response towards sorafenib varies drastically, with most experiencing stable disease and few with partial response; complete response is very rare. Progressive disease despite the treatment is also evident in many patients, indicating drug resistance. These varied responses have been linked with the modulation of several intracellular signaling pathways. Notably, the regulation of these pathways through diverse operating biomolecules, including microRNAs (miRNAs), is the focus of recent studies. MicroRNAs are tiny, non‐coding RNA molecules that regulate the expression of several target genes. In addition, miRNAs are known to play a role in the progression of HCC carcinogenesis. Interestingly, miRNAs have also been identified to play differential roles in terms of sorafenib response in HCC such as biomarkers and functional modulation of cellular response to sorafenib, hence, they are also being therapeutically evaluated. This review outlines the role of reported miRNAs in different aspects of sorafenib response in HCC.     

索拉非尼联合顺铂对人肝癌裸鼠移植瘤生长的抑制作用

目的探讨多靶点酪氨酸激酶抑制剂索拉非尼联合顺铂（DDP）对人肝癌裸鼠皮下移植瘤生长的抑制作用。方法构建人肝癌细胞HepG2裸鼠皮下移植瘤模型,随机分为空白对照组、溶剂对照组、索拉非尼组、DDP组和联合用药组。观察用药前后肿瘤大小,测体质量,并计算瘤重,绘制肿瘤生长曲线;应用免疫组化检测肿瘤微血管密度（MVD）。结果索拉非尼和DDP单药均能抑制肿瘤生长,两药联合疗效明显增强（P〈0．05）。与对照组和顺铂组相比,索拉非尼组和联合用药组能明显抑制肿瘤血管生成,MVD值均明显降低,以联合用药组最为明显（P均〈0．05）。结论索拉非尼联合DDP能增强抑制人肝癌裸鼠移植瘤的生长及微血管生成。     

索拉菲尼在肝癌治疗中的不良反应

索拉菲尼可以显著改善晚期肝癌患者的预后,它主要通过拮抗血管内皮生长因子受体和血小板衍生生长因子受体抗血管源性靶点及通过抑制Raf/MEK/ERK信号传导通路直接抑制肿瘤生长而发挥抗肿瘤作用。然而,频发的索拉菲尼相关的不良反应将影响患者的生活质量。文中简述了小分子靶向药物索拉菲尼治疗肝癌的药理机制,归纳总结了索拉菲尼相关常见不良反应的发生率、特点、预防和治疗措施,并指出索拉菲尼相关的不良反应和抗肿瘤疗效相关,认为临床医生应该充分权衡索拉菲尼在治疗肝癌患者中不良反应的利与弊。     

Sorafenib, a systemic therapy for hepatocellular carcinoma

Hepatocellular carcinoma is a lethal disease that requires a multidisciplinary approach and management. Surgical therapy offers long-term survival; however, few patients are candidates. There has been no accepted systemic therapy for this disease until recently. This article briefly discusses the role of RAS/RAF/MEK/ERK signaling pathway in the pathogenesis of the disease and the promising role of sorafenib for advanced disease.     

Sorafenib in a hepatocellular carcinoma patient with end‐stage renal failure: A pharmacokinetic study

The efficacy of sorafenib against hepatocellular carcinoma (HCC) has been extensively reported. However, there is little information available about the use of sorafenib for HCC patients with end‐stage renal failure. We herein report the safe introduction of sorafenib therapy for a HCC patient on hemodialysis. A 63‐year‐old man had received multidisciplinary treatments, including transarterial chemoembolization (TACE) and radiofrequency ablation, for HCC since 1996, and had been undergoing hemodialysis since 2005. He also underwent TACE for multiple liver recurrence of HCC in 2011. Sorafenib therapy (200 mg/day) started 8 days after the TACE. The pharmacokinetic parameters of sorafenib and its active metabolite, M‐2, were within the reference levels observed in patients with normal renal function 8 and 9 days after the initiation of sorafenib. The dose of sorafenib was reduced to 200 mg every other day on day 154 due to hypertension and general fatigue. Because of the progression of disease after 5 months, sorafenib was withdrawn on day 180. He was admitted to the emergency department because of a high fever during hemodialysis on day 201, and died of septic shock induced by Staphylococcus lugdunensis on day 203. Sorafenib was well tolerated at an initial dose of 200 mg/day for a HCC patient undergoing hemodialysis, thus indicating that renal failure is not necessarily a contraindication for sorafenib therapy.     

Clinical course of sorafenib treatment in patients with hepatocellular carcinoma

Abstract

Objective. Sorafenib has been shown to improve survival of patients with advanced hepatocellular carcinoma (HCC). However, its tolerance in clinical practice has not been well evaluated, and whether sorafenib should be continued in cases of tumor progression or intolerance has not been established. The authors retrospectively assessed sorafenib tolerability, and evaluated the clinical course in patients who showed progression during sorafenib treatment. Material and methods. Between March 2008 and July 2010, 80 patients with advanced HCC were treated with sorafenib. Results. With a median of 78.5 days of treatment, 15% discontinued sorafenib due to adverse events. The duration was significantly longer in patients with Child–Pugh class A liver function (233 ± 240 days) than in those with Child–Pugh class B (100 ± 136 days; p = 0.006). The overall progression rate was 53% (43/80), with a median time to progression of 105 days (95% confidence interval, 59–150 days). After progression, 14 patients received conservative care only (group 1), 14 continued sorafenib monotherapy (group 2), 6 changed to treatment without sorafenib (group 3) and 9 underwent additional treatment with concomitant sorafenib (group 4). Survival after progression was significantly better in groups 2, 3 and 4 than in group 1 (p = 0.001). Conclusions. Sorafenib was tolerable for most patients in clinical practice and may be continued in patients who show progression during sorafenib therapy. However, it was less well tolerated in patients with Child–Pugh class B liver function and should be used with caution in these patients.