聚维酮在阿霉素膀胱灌注化疗中的临床疗效和作用机制

目的：探讨聚维酮联合阿霉素膀胱灌注预防浅表膀胱癌术后复发的临床疗效和抗肿瘤机制.方法：对231例浅表膀胱癌患者术后随机膀胱灌注聚维酮加阿霉素（实验组）或生理盐水加阿霉素（对照组）,观测预防复发效果.对50例患者术前膀胱灌注聚维酮联合阿霉素（实验组）或生理盐水加阿霉素（对照组）,免疫组化法检测Bcl-2、Bax蛋白的表达.紫外荧光法检测聚维酮对尿中阿霉素浓度和 24 h 尿药回收率的影响.结果：194例患者获随访,实验组与对照组相比复发率明显降低,复发时间明显延长（P＜0.01）.实验组与对照组相比Bax的表达明显上调（P＜0.01）,Bcl-2/Bax比率下调（P＜0.05）.聚维酮与生理盐水作溶剂相比膀胱内阿霉素的排泄时间延长2～4倍,但不影响尿中阿霉素回收率.结论：聚维酮联合阿霉素膀胱灌注对预防浅表性膀胱癌术后复发具有良好的疗效,且副作用少.其机制可能与聚维酮联合阿霉素诱导膀胱癌细胞凋亡和延长药物在膀胱内驻留时间有关.

Mechanisms of polyvinylpyrrolidone combined with adriamycin against bladder cancer and its clinical use for preventing tumor recurrence

AIM:To investigate the clinical effects of polyvinylpyrrolidone and adriamycin in preventing postoperative recurrence of superficial bladder cell cancer and its mechanism.METHODS: 231 postoperative cases received intravesical instillation with adriamycin combined with polyvinylpyrrolidone(experiencial group) or isotonic Na chloride combined with adriamycin(control group).Bcl-2 and Bax protein expression was examined by immunohistochemistry after 50 cases received intravesical instillation in such way before operation.Concentration and callback rate of adriamycin combined with polyvinylpyrrolidone were examined by ultraviolet analysis.RESULTS: 194 cases were followed.In experimental group,recurrence was found in 24 cases((18.6)%),hematuria in 2 cases and bladder irritation in 3 cases.In control group,recurrence was found in 39 cases((60.0)%).Compared with control group,Bcl-2 expression in experimental group has no difference(P>(0.05)),Bax expression was up-regulated significantly(P<(0.01)) and Bcl-2/Bax expression was down-regulated(P<(0.05)).Polyvinylpyrrolidone and adriamycin could prolong evacuation time 2-4 times as long as NS and adriamycin in bladder.CONCLUSION: Intravesical instillation of polyvinylpyrrolidone and adriamycin are effective for prevention of postoperative recurrence of superficial bladder cell cancer with fewer side effects Polyvinylpyrrolidone combined with adriamycin can induce bladder cancer cell apoptosis and prolong medication time in bladder.