胸腔灌注姑息治疗老年云锡矿工NSCLC恶性胸腔积液的临床研究(1)
【摘要】 目的：评价rmhTNF(重组改构人肿瘤坏死因子)联合PDD姑息治疗老年云锡矿工非小细胞肺癌的恶性胸膜腔积液的效果及毒副反应。方法：将2014年3月-2015年6月笔者所在科室收治的39例老年云锡矿工非小细胞肺癌并恶性胸腔积液病例随机分为治疗组和对照组，排尽胸腔积液后，治疗组胸膜腔内灌注rmhTNF 100万单位加PDD 40 mg/m2；对照组胸膜腔内灌PDD 40 mg/m2。结果：治疗组总有效率为71.42%，生存时间为5～16个月，平均(8.0±4.2)个月；对照组总有效率为 55.56%，生存时间为3～12个月，平均(6.0±3.7)个月，差异均有统计学意义(P<0.05)；两组病例均未出现Ⅲ～Ⅳ级严重不良反应。主要不良反应有Ⅰ～Ⅱ级胸痛、发热、恶心及呕吐，发热不超过48 h，体温最高不超过38.5 ℃，常规对症治疗可缓解。结论：排尽积液后胸膜腔内灌注rmhTNF联合PDD姑息治疗老年云锡矿工非小细胞肺癌所致恶性胸膜腔积液有一定临床效果，不良反应可耐受，是控制积液的安全而有效的方法。
【关键词】 恶性胸腔积液； 重组改构人肿瘤坏死因子； 老年云锡矿工； 非小细胞肺癌
, http://www.100md.com
doi：10.14033/j.cnki.cfmr.2017.7.007 文献标识码 B 文章编号 1674-6805(2017)07-0015-03
【Abstract】 Objective：To evaluate the response and adverse reactions of rmhTNFand PDD in the treatment of malignant pleural effusion caused by non small cell lung cancer in the elderly Yunnan tin miners.Method：59 elderly Yunnan tin miners with non small cell lung cancer patients with malignant pleural effusion in the author’s department from March 2014 to June 2015 were divided into two groups randomly.The patients in study group were treated by intracavity injection of rmhTNF with 1 millton units and PDD with 40 mg/m2，and those in the control group were treated by intracavity injection of PDD with 40 mg/m2.
, http://www.100md.com
Result：The overall response rate of study group was 96.67%，the survival time for 5-16 months， average (8.0±4.2) months，and the control group was 82.14%， the survival time for 3-12 months， average(6.0±3.7) months，the differences were statistically significant(P<0.05).There were no Ⅲ-Ⅳ level serious adverse reaction cases of two groups.The main adverse reactions wereⅠ-Ⅱ chest pain， fever，nausea and vomiting，conventional symptomatic treatment can alleviate.Conclusion：After draining completely the pleural fluid，the intracavity injection of rmhTNF and PDD is more safe and effective for the treatment of malignant pleural effusion that patients with non small cell lung cancer in the elderly Yunnan tin minners.
, http://www.100md.com
【Key words】 Malignant pleural effusion； Reconbinant mutant human tumor necrosis factor(rmhTNF)； Elderly Yunnan tin minners； NSCLC
First-author’s address： The First People’s Hospital of Red River State，Mengzi 661199，China
肺癌嚴重威胁着人类健康与生命。在云南锡矿工人死因中肺癌排第一位。云南锡矿工人肺癌具有显著的职业特征，发生率和死亡率都很高，而且其SMR高达6.54%。近年来，在各种预防措施的干预下，云锡矿工肺癌的发病率有下降趋势，但死亡率仍保持稳定水平，死亡发病比值呈直线上升趋势。云锡矿工肺癌的发病年龄已经由50年代的42.5岁延迟至目前的68.43岁[1]。非小细胞肺癌(non small cell lung cancer，NSCLC)在肺癌中占比大于80%，恶性胸膜腔积液(malignant pleural effusion MPE)是NSCLC患者的常见并发症，约60%的腺癌患者合并MPE[2]。随着人口老龄化及发病年龄的上升，老年NSCLC患者越来越多。老年NSCLC患者是一个高度个体化的群体，由于老龄化的因素，合并症多，治疗困难，治疗耐受性差。由于身体状况、经济等多方面原因，部分老年NSCLC患者不愿接受全身抗肿瘤治疗(如化疗、放疗)。近年来胸腔内灌注细胞因子(如IL-2、TNF等)、PDD等姑息治疗恶性胸腔积液取得一定临床效果。笔者所在科室自2014年3月-2015年6月应用rmhTNF联合PDD灌注姑息治疗老年云锡矿工NSCLC所致恶性胸膜腔积液，与单独灌注PDD进行对照观察。现报告如下。, http://www.100md.com(张华 彭静进 何丽芬)
【关键词】 恶性胸腔积液； 重组改构人肿瘤坏死因子； 老年云锡矿工； 非小细胞肺癌
, http://www.100md.com
doi：10.14033/j.cnki.cfmr.2017.7.007 文献标识码 B 文章编号 1674-6805(2017)07-0015-03
【Abstract】 Objective：To evaluate the response and adverse reactions of rmhTNFand PDD in the treatment of malignant pleural effusion caused by non small cell lung cancer in the elderly Yunnan tin miners.Method：59 elderly Yunnan tin miners with non small cell lung cancer patients with malignant pleural effusion in the author’s department from March 2014 to June 2015 were divided into two groups randomly.The patients in study group were treated by intracavity injection of rmhTNF with 1 millton units and PDD with 40 mg/m2，and those in the control group were treated by intracavity injection of PDD with 40 mg/m2.
, http://www.100md.com
Result：The overall response rate of study group was 96.67%，the survival time for 5-16 months， average (8.0±4.2) months，and the control group was 82.14%， the survival time for 3-12 months， average(6.0±3.7) months，the differences were statistically significant(P<0.05).There were no Ⅲ-Ⅳ level serious adverse reaction cases of two groups.The main adverse reactions wereⅠ-Ⅱ chest pain， fever，nausea and vomiting，conventional symptomatic treatment can alleviate.Conclusion：After draining completely the pleural fluid，the intracavity injection of rmhTNF and PDD is more safe and effective for the treatment of malignant pleural effusion that patients with non small cell lung cancer in the elderly Yunnan tin minners.
, http://www.100md.com
【Key words】 Malignant pleural effusion； Reconbinant mutant human tumor necrosis factor(rmhTNF)； Elderly Yunnan tin minners； NSCLC
First-author’s address： The First People’s Hospital of Red River State，Mengzi 661199，China
肺癌嚴重威胁着人类健康与生命。在云南锡矿工人死因中肺癌排第一位。云南锡矿工人肺癌具有显著的职业特征，发生率和死亡率都很高，而且其SMR高达6.54%。近年来，在各种预防措施的干预下，云锡矿工肺癌的发病率有下降趋势，但死亡率仍保持稳定水平，死亡发病比值呈直线上升趋势。云锡矿工肺癌的发病年龄已经由50年代的42.5岁延迟至目前的68.43岁[1]。非小细胞肺癌(non small cell lung cancer，NSCLC)在肺癌中占比大于80%，恶性胸膜腔积液(malignant pleural effusion MPE)是NSCLC患者的常见并发症，约60%的腺癌患者合并MPE[2]。随着人口老龄化及发病年龄的上升，老年NSCLC患者越来越多。老年NSCLC患者是一个高度个体化的群体，由于老龄化的因素，合并症多，治疗困难，治疗耐受性差。由于身体状况、经济等多方面原因，部分老年NSCLC患者不愿接受全身抗肿瘤治疗(如化疗、放疗)。近年来胸腔内灌注细胞因子(如IL-2、TNF等)、PDD等姑息治疗恶性胸腔积液取得一定临床效果。笔者所在科室自2014年3月-2015年6月应用rmhTNF联合PDD灌注姑息治疗老年云锡矿工NSCLC所致恶性胸膜腔积液，与单独灌注PDD进行对照观察。现报告如下。, http://www.100md.com(张华 彭静进 何丽芬)