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经肝动脉化疗栓塞术联合微波消融治疗中晚期原发性肝癌的效果分析
Clinical effect of transcatheter arterial chemoembolization combined with microwave ablation in treatment of advanced primary liver cancer
文章发布日期:2020年11月13日  来源:  作者:李猛,陆荫英,董景辉,等  点击次数:2992次  下载次数:44次

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【摘要】:目的 探讨经肝动脉化疗栓塞术(TACE)联合微波消融(MWA)治疗中晚期原发性肝癌的效果和安全性。方法 选取2015年4月-2019年6月在解放军总医院第五医学中心接受治疗的186例中晚期原发性肝癌患者,采用随机数字表法分为试验组、对照组各93例。两组患者均行TACE治疗,试验组患者在此基础上给予超声引导下经皮MWA治疗。比较两组患者临床疗效和并发症发生情况。采用荧光定量PCR法检测两组患者血清microRNA-202 (miR-202)水平,采用酶联免疫吸附法检测血清脆性组氨酸三联体(FHIT)和P16蛋白水平,比较上述3种指标治疗前和治疗后3个月的水平变化。计量资料两组间比较采用独立样本t检验;组内治疗前后比较采用配对样本t检验。计数资料两组间比较采用χ2检验。结果 试验组患者客观缓解率高于对照组,差异有统计学意义(47.32% vs 27.96%,χ2=7.422,P=0.006),疾病控制率比较无明显差异(P>0.05)。两组患者治疗后3个月时的血清miR-202、FHIT和P16蛋白水平均较治疗前明显升高(P值均<0.05),其中试验组患者治疗后3个月时的血清miR-202、FHIT 和P16蛋白水平均高于对照组,差异有统计学意义[0.84±0.14 vs 0.58±0.17、(1126.35±73.05)pg/ml vs (762.87±56.71)pg/ml、(52.86±6.51)pg/ml vs(39.06±5.37)pg/ml,t值分别为11.385、37.904、15.770,P值均<0.001]。结论 在TACE治疗基础上应用超声引导下MWA能够提高中晚期原发性肝癌患者的近期疗效,提升血清miR-202、FHIT、P16蛋白水平,且安全性较高。
【Abstract】:Objective To investigate the clinical effect and safety of transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) in the treatment of advanced primary liver cancer. Methods A total of 186 patients with advanced primary liver cancer who were treated in The Fifth Medical Center of Chinese PLA General Hospital from April 2015 to June 2019 were enrolled and divided into study group and control group using a random number table, with 93 patients in each group. Both groups of patients underwent TACE, and the patients in the study group were treated with ultrasound-guided percutaneous MWA. The two groups were compared in terms of clinical outcome and complications. Quantitative real-time PCR was used to measure the serum level of microRNA-202 (miR-202), ELISA was used to measure the serum levels of fragile histidine triad (FHIT) and P16 protein, and the changes in the above three indices at 3 months after treatment were compared. The two-independent-samples t test was used for comparison of continuous data between two groups, and the paired t-test was used for comparison within one group before and after treatment; The chi-square testwas used for comparison of categorical data between groups. Results The study group had a significantly higher objective response rate than the control group (47.32% vs 27.96%, χ2=7.422, P=0.006), and there was no significant difference in disease control rate between the two groups(P>0.05). Both groups had significant increases in the serum levels of miR-202, FHIT, and P16 protein at 3 months after treatment (all P<0.05), and compared with the control group, the study group had significantly higher serum levels of miR-202 (0.84±0.14 vs 0.58±0.17, t=11.385, P<0.001), FHIT (1126.35±73.05 pg/ml vs 762.87±56.71 pg/ml, t=37.904, P<0.001), and P16 protein (52.86±6.51 pg/ml vs 39.06±5.37 pg/ml, t=15.770, P<0.001). Conclusion Ultrasound-guided MWA in addition to TACE can improve the short-term response of patients with advanced primary liver cancer and increase the serum levels of miR-202, FHIT, and P16 protein, with relatively high safety.
【关键字】:肝肿瘤; 化学栓塞,治疗性; 导管消融术
【Key words】:liver neoplasms; chemoembolization,therapeutic; catheter ablation
【引证本文】:LI M, LU YY, DONG JH, et al. Clinical effect of transcatheter arterial chemoembolization combined with microwave ablation in treatment of advanced primary liver cancer[J]. J Clin Hepatol, 2020, 36(12): 2720-2724. (in Chinese)
李猛, 陆荫英, 董景辉, 等. 经肝动脉化疗栓塞术联合微波消融治疗中晚期原发性肝癌的效果分析[J]. 临床肝胆病杂志, 2020, 36(12): 2720-2724.

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