白介素-2、顺铂治疗恶性胸腔积液的疗效

目的回顾性分析45例恶性胸腔积液(MPE)患者的临床资料,探讨白介素-2(IL-2)及顺铂(DDP)局部胸腔内注射治疗恶性胸腔积液的疗效和不良反应。方法收集安徽医科大学第一附属医院老年呼吸内科2012年1月至2014年12月45例MPE患者的临床资料。根据治疗方法的不同,分为IL-2治疗组22例(IL-2 100万U加入到生理盐水20 ml中胸腔内注射,每周注射1次,连续4周);DDP治疗组23例(顺铂40 mg加入到生理盐水20 ml中胸腔内注射,每周注射1次,治疗4周),探讨两种药物的疗效及不良反应的差异。结果 IL-2组的疗效为63.6%,DDP组的疗效为91.3%。DDP的治疗效果明显高于IL-2,差异有统计学意义(P0.05)。顺铂组的主要不良反应为恶心呕吐等胃肠道反应、骨髓抑制、肾功能损害,其中骨髓抑制及胃肠道不良反应发生率较IL-2组显著性升高(P0.05)。而IL-2组主要为发热,且较DDP组显著性升高(P0.05)。两组间肾功能损害发生率无显著性差异(P0.05)。结论顺铂胸腔内注射治疗恶性胸腔积液的疗效优于IL-2。由于顺铂组骨髓抑制及胃肠道反应等不良反应发生率与IL-2组有显著性差异,对于高龄MPE无法耐受顺铂治疗者可以考虑行IL-2局部治疗,以缓解胸水进展。

A retrospective analysis of clinical effect of interleukin-2 and cisplatin in the treatment of malignant pleural effusion through intrapleural injection

Objective To analyze the clinical data of 45 patients with malignant pleural effusion ( MPE) and to explore the therapeutic effect and adverse reactions of interleukin-2 (IL-2) and cisplatin (DDP) in the treatment of malignant pleural effusion through intrapleural injection. Methods The clinical data of 45 patients with malignant pleural effusion in the Department of Geriatric Pulmonology of the First Affiliated Hospital of Anhui Medical Universi-ty from January 2012 to December 2014 were collected. They were divided into two groups according to the therapeu-tic regimen. 22 cases were treated with IL-2 (1 million Unit IL-2 in 20 ml normal saline through intrapleural injection once a week for four consecutive weeks), and the rest 23 cases were treated with DDP (40 mg DDP in 20 ml normal saline were injected intrapleurally once a week for four consecutive weeks) . The curative effect and adverse reactions of the two groups were analyzed. Results The effective rate was 91. 3% in the DDP group, which was significantly higher than that in the IL-2 group with 63. 6% (P<0. 05). The main adverse reactions in the DDP group included gastrointestinal reaction and bone marrow suppression, which were more severe than those in the IL-2 group ( P<0. 05) . While the main adverse reaction of IL-2 group was fever whose rate was significantly higher than that in DDP group ( P<0. 05 ) . There was no significant difference in the rate of nephrotoxicity between the two groups ( P>0. 05). Conclusion DDP shows higher curative effect than Il-2 does in the treatment of patients with malignant pleural effusion through intrapleural injection. However, while taking all the adverse reactions of DDP into account, IL-2 might be an alternative therapeutic method especially for old patients who would not endure the severe side effects brought by DDP and thus may protect MPE from being rapidly.