摘要
目的:观察高强度聚焦超声热疗联合中药消积止痛散对胰腺癌患者血清可溶性白细胞介素2受体的影响。方法:于2001-01/2004-12选择常州中医院、常州第一人民医院肿瘤科门诊或入院胰腺癌患者61例为观察对象。随机数字表法分为观察组31例(高强度聚焦超声热疗联合中药消积止痛散)和对照组30例(吉西他滨化疗),患者均知情同意。观察组:热疗采用俯卧位,机载B超确定癌灶部位、大小、治疗层面数量,输入治疗参数后由计算机自动执行治疗计划,治疗全过程实时监控。两次治疗间隔48h以上。每例患者接受3～12次高强度聚焦超声热疗治疗,平均6次。治疗期间配合服用中药消积止痛散,由全蝎0.5g,蛇六谷3.0g,仙鹤草2.0g,土鳖虫1.0g,粉防己0.5g组成,3.5g/次,2次/d,连用28d。对照组:第1,8,15天单用吉西他滨(商品名泽菲,江苏豪森药业股份有限公司)1.0g/m2或第1,8天用吉西他滨1.0g/m2联合5-氟尿嘧啶350mg/m2,连用1～5d,每4周重复1次,至少2个周期。采用双抗体夹心ELISA法测定治疗前后血清可溶性白细胞介素2受体的变化,同时观察近期客观疗效(完全缓解:肿块消失并至少维持4周以上,部分缓解:肿块缩小>50%并维持4周以上,稳定:肿块缩小<50%或增大<25%,无新病灶出现,进展:肿块增大>25%或有新病灶出现,肿瘤CT值减低)、有效率(有效率=完全缓解+部分缓解)、进展率、生存期(患者入组参加治疗至死亡或随访之日)。结果:纳入患者61例,均进入结果分析。①治疗前两组血清可溶性白细胞介素2受体无明显差异;观察组治疗后较治疗前明显降低,差异有显著性意义[分别为(97.14±9.01),(132.54±70.20)ng/L,t=2.26,P<0.05];对照组治疗后较治疗前略升高,差异无显著性意义;观察组治疗后较对照组明显降低,差异有显著性意义[分别为(97.14±9.01),(141.62±70.08)ng/L,t=0.16,P<0.01]。②观察组有效率较对照组略高,差异无显著性意义(分别为38.7%,23.3%,P>0.05)。观察组肿瘤进展率较对照组明显降低,差异有显著性意义(分别为9.7%,46.7%,P<0.01)。③观察组中位生存期较对照组明显延长,差异有显著性意义[分别为(15.6±11.7),(8.3±7.0)个月,P<0.01]。观察组3,6个月,1,2,3年生存率分别为93.5%,77.4%,51.6%,38.7%,3.2%;对照组分别为83.3%,56.7%,26.7%,6.7%,0,其中观察组1,2年生存率明显优于对照组,差异有显著性意义(P<0.05)。结论:高强度聚焦超声热疗联合中药消积止痛散治疗胰腺癌可明显降低患者血清可溶性白细胞介素2受体水平,改善患者的免疫功能,控制肿瘤进展,提高生存率、延长生存期。
AIM： To investigate the effect of integrated therapy of high intensity focased ultrasound （HIFU） and traditional Chinese medicine of relieving dyspepsia and pain powder on sei＇um dissolvable interleukin-2 receptor （SIL-2R） of patients with pancreatic carcinoma.
METHODS： Sixty-one inpatients and outpatients with pancreatic carcinoma between January 2001 and December 2004 were selected from the Department of Oncology, Changzhou Hospital of Traditional Chinese Medicine and Changzhoa First People＇s Hospital, who were randomly divided into observation group （n=31, treated by integrated therapy of HIFU and traditional Chinese medicine of relieving dyspepsia and pain powder） and control group （n=30, treated by chemotherapy with gemcitabine）. All patients knew and agreed with the experiment. Patients in the observation group received thermotherapy in prone position, and brightness mode ultrasonic wave was adopted to determine the position, size and quantities of treatment storey of tumor. The treatment parameter was input into the computer, which would automatically execute the treatment plan under realtime monitoring of whole process. There was an interval of 48 hours between each two therapies. Each patient was treated by HIFU for 3-12 times with an average of 6 times. Based on the treatment, patients took traditional Chinese powder of relieving dyspepsia and pain, which was composed of quaaxie （0.5 g）, sheliugu （3.0 g）, xianhecao （2.0 g）, tubiechong （1.0 g） and fenfangji （0.5 g）, 3.5 g for each time and twice a day for 28 continuous days. Patients in the control group were treated by gemcitabine （1.0 g/m^2） only （which is named Zefei, manufactured by Jiangsu Haosen Pharmaceutical Co., Ltd.） respectively on the 1^st, 8^th and 15^th day or treated by integrated therapy of gemcitabiue （1.0 g/m^2） and 5-fluorouracil （350 mg/m^2） respectively on the 1^st and 8^th day for 1-5 continuous days and repeated once every 4 weeks for at least two cycles. The changes of SIL-2R was examined by double-antibody-sandwich ELISA technique before and after treatment. Meanwhile, recent objective therapeutic effect were observed： （complete remission： the tumor disappeared for more than 4 weeks. Partial remission： the decrease of tumor 〉 50% and maintained for more than 4 weeks. Stable： the decrease of tumor 〈 50% or increase of tumor 〈 25% without new tumor. Progressing： the increase of tumor 〉 25% or new tumor appeared with decreased CT value）, effective rate （effective rate = complete remission ＋ partial remission）, the progressing rate and survival time （ from grouping to death or follow-up）.
RESULTS： A total of 61 patients were involved in the analysis of results.①there were no significant differences in SIL-2R between the two groups before the treatment, while it was obviously decreased in the observation group after treatment than that before treatment with remarkable differences [（97.14±9.01）,（132.54±70.20） ng/L,t=2.26,P 〈 0.05], while it was a little increased in the control group after treatment than that before treatment, and it was markedly decreased in the observation group after treatment group than the control group without significant differences [（97.14±9.01）, （141.62±70.08） ng/L,t=0,16,P 〈 0.01], ②The effective rate was a little higher in the observation group than the control group with no significant differences （38.7%, 23,3% ,P 〉 0.05）. Compared with the control group the progressing rate of tumor in the observation group was markedly decreased （9.7%,46.7%,P 〈 0,01）. ③The median survival time was obviously prolonged in the observation group than in the control group [（15,6±11.7）, （8.3±7.0）months,P 〈 0.01]. The survival rates in the observation group were 93.5%, 77.4%, 51.6%, 38.7% and 3.2% respectively at the 3^rd month, 6^th month, 1^st year, 2^nd year and 3^rd year, while those in the control group were 83.3%, 56.7%, 26,7%, 6.7% and zero respectively, The survival rate atthe 1^st and 2^nd year were obviously higher in the observation group than control group with significant differences （P 〈 0.05）. newspaper CONCLUSION： Integrated therapy of HIFU and traditional Chinese medicine of relieving dyspepsia and pain powder can obviously decrease the level of SIL-2R, ameliorate the immune function, control the development of tumor, enhance the survival rate as well as prolong the survival time of patients with pancreatic carcinoma.
出处
《中国临床康复》
CSCD
北大核心
2006年第31期123-125,共3页
Chinese Journal of Clinical Rehabilitation
基金
江苏省中医药管理局基金资助项目(苏卫中医科(2001)19号H-064)~~
作者简介
王缨，女，1970年生，江苏省常州市人，汉族，南京中医药大学在读博士，副主任中医师，主要从事中西医结合血液肿瘤基础及临床的研究。
