摘要
目的观察医药护监管模式下阿帕替尼联合经肝动脉化疗栓塞术(TACE)治疗中晚期肝癌对患者免疫水平的影响。方法选取2018年1月-2019年4月中国人民解放军联勤保障部队第九一〇医院收治的中晚期肝癌患者96例,依照随机数字表法分为观察组和对照组,各48例。在医药监护模式下,对照组予TACE治疗,观察组在对照组基础上联合阿帕替尼治疗,均连续用药4周。比较2组治疗前后肝功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)]水平、T淋巴细胞(CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+))水平,不良反应及随访第4、8、12个月病死率。结果治疗4周后,2组ALT、TBil、AST水平及CD8^(+)均较治疗前降低,CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均较治疗前升高,且观察组降低或升高幅度大于对照组(P均<0.01)^(+) 2组不良反应总发生率比较差异无统计学意义(P>0.05)^(+)随访第4、8个月2组病死率比较差异无统计学意义(P>0.05),第12个月观察组病死率低于对照组(χ^(2)=7.940,P=0.005)。结论医药护监管模式下阿帕替尼联合TACE治疗中晚期肝癌效果良好,有助于改善患者肝功能指标与T淋巴细胞水平,并可有效降低远期病死率,且不会增加不良反应发生风险,值得临床推广应用。
Objective To observe the effect of apatinib combined with transcatheter arterial chemoembolization( TACE) on the immune level of patients with advanced liver cancer under the mode of medical care supervision. Methods Ninety-six patients with advanced liver cancer treated in the 910 th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army from January 2018 to April 2019 were selected. According to the random number table method,they were divided into observation group and control group,with 48 cases in each group. Under the medical care supervision mode,the control group was treated with TACE,and the observation group was treated with apatinib on the basis of the control group.Both groups were treated continuously for 4 weeks. The levels of liver function[alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( TBil) ],T lymphocyte( CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)) before and after treatment,adverse reactions and mortality at 4,8 and 12 months of follow-up were compared between the two groups.Results After 4 weeks of treatment,the levels of ALT,AST,TBil and CD8^(+)in the two groups were lower than those before treatment. Meanwhile,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were higher than those before treatment. The decrease or increase in the observation group was greater than that in the control group( all P < 0. 01). There was no significant difference in the total incidence of adverse reactions between the two groups( P > 0. 05). At the 4 th and 8 th months of follow-up,there was no significant difference in mortality between the two groups( P > 0. 05). However,at the 12 th month of follow-up,the mortality of the observation group was lower than that of the control group( χ^(+)= 7. 940,P = 0. 005). Conclusion Under the medical care supervision mode,apatinib combined with TACE is effective in the treatment of advanced liver cancer. It can not only improve the liver function index and T lymphocyte level,but also effectively reduce the lo
作者
陈德志
陈巧辉
王琦
王佳坤
CHEN Dezhi;CHEN Qiaohui;WANG Qi(The 910th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Fujian Province,Quanzhou 362000,China)
出处
《临床合理用药杂志》
2021年第35期27-29,32,共4页
Chinese Journal of Clinical Rational Drug Use
基金
泉州市科技计划项目(No:2018N131S)。
关键词
中晚期肝癌
医药护监管模式
经肝动脉化疗栓塞术
阿帕替尼
免疫水平
Advanced liver cancer
Medical care supervision mode
Transcatheter arterial chemoembolization
Apatinib
Immune level
