鸦胆子油乳剂联合经导管肝动脉化疗栓塞术治疗原发性肝癌28例临床观察

目的：观察经导管肝动脉化疗栓塞术（TACE）联合鸦胆子油乳剂对原发性肝癌（HCC）的疗效及安全性。方法：将2009年7月-2010年7月在丽水市中心医院确诊的56例患者随机分为TACE联合鸦胆子油乳剂组（联合组）和单纯TACE组（TACE组），每组各28例。两组患者均治疗至少3个周期，并随访6-37个月，采用Kaplan-Meier方法进行生存期分析，比较两种治疗方法对HCC的疗效及其对患者体力状态评分、免疫功能影响的差异，并评价两种疗法的安全性。结果：按mRECIST标准，联合组有效率为71．4％，TACE组治疗有效率57．1％，两组比较差异有显著性意义（P〈0．05）。联合组及TACE组中位TTP（至疾病进展时间）分别10个月和8个月，差异有统计学意义（P〈0．05）。联合组及TACE组1、2、3年总生存率分别为96．3％、62．4％、23．7％和92．2％、70．3％、21．3％，差异无统计学意义（P=0．67）。治疗后联合组患者外周血CD4＋阳性T细胞绝对值、CD4＋／CD8＋比值分别为（652．68±167．01）个／μl和2．16±0．78，显著高于TACE组的（416．71±170．57）个／μl和1．48±0．77（P〈0．05）；治疗后联合组和TACE组患者卡氏生存质量评分（KPS评分）分别为95．36±6．37和88．57±9．71，差异有统计学意义（P〈0．05）；两组患者均出现1-2度恶心、呕吐、低热及肝功能损害，两组比较，差异无统计学意义（P〉0．05）。结论：鸦胆子油乳剂联合TACE治疗HCC可以提高近期疗效和患者生活质量，改善免疫状态，并能延缓TTP时间，是治疗HCC的一种安全、有效的方法。

Twety-eight cases of primary liver cancer treated by bruceolic oil emulsion combined with TACE

Objective： To observe the efficacy and safety of the transcatheter hepatic arterial chemoembolization （TACE） combined with bruceolic oil emulsion for hepatocellular carcinoma. Methods： Fifty-six patients diagnosed with primary liver cancer in Lishui central hospital from July 2009 to July 2010 were randomly divided into TACE combined with bruceolic oil emul- sion group （ combination group, n = 28） and TACE alone group （TACE group, n = 28） . All of the patients were treated for at least three cycles. And the follow up ranged from 6 to 37 months. Survival probabilities were estimated with the Kaplan-Meier method, and differences between survival curves were evaluated with the Log-rank test. The performance status and immune function was compared between the two groups. The therapeutic effect and the safety of the two modalities were also evaluated. Results： According to mRECIST criteria, effective rate in combined treatment group and TACE groups were 71.4% and 57.1% , respectively, which was significantly different （P 〈 0. 05） . The median TTP time in combined treatment group and TACE group was 10 months and 8 months respectively, which also was significantly different （P 〈 0. 05） . The 1-, 2- and 3- year overall survival rates in combined treatment group were 96. 3%, 62. 4%, and 23.7%, and in TACE group were 92. 2%, 70. 3%, and 21.3%, which was not statistically significant （P =0. 179） . After treatment, the number of CD4＋ cells, the ra- tio of CD4＋/CD8＋ were 652. 68±167. 01/μl and 2. 16±0. 78, respectively, which was significantly higher than that in the TA-CE group （P 〈 0. 05） ; After treatment, KPS scores in combined treatment group and TACE group were 95.36 ± 6. 37 and 88.57 ± 9. 71, respectively, which was significantly different （P 〈 0.05 ） ; Both groups appeared grade 1 -2 nausea, vomiting, fever and liver dysfunction, which was no significant difference （P 〉 0. 05） . Conclusion. Javanica oil emulsion combined TACE treatment of primary liver cancer can improve the efficacy and quality of life, improve the immune status, and can extend TTP time, which is a safe and effective method.