中医药治疗中晚期肝癌的临床研究

【作者】 陈卫军；

【导师】 刘伟胜；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2001， 硕士

【摘要】 目的：观察并比较莪术油（CAO）介入治疗与TACE治疗中晚期原发性肝癌（PLC）的近期疗效以及对PLC患者生存质量的影响。 方法：将70例次（41例）中晚期PLC病人随机分为CAO组（n=36）、TACE组（n=34）。CAO组予CAO或CAO+Lip介入治疗，TACE组用化疗药或化疗药+Lip介入治疗。在介入前1～3天及介入后2周分别用“肝癌患者生存质量量表”测计生存质量积分。比较生存质量、AFP、肝功能、肾功能、骨髓造血功能、出凝血功能等的变化。 结果：CAO组与TACE组的有效率（CR+PR）分别为0％、14.71％，稳定率（CR+PR+SD）为100％、85.29％，组间均无显著性差异（P=0.0541）。治疗后CAO组生存质量提高，TACE组则降低，有显著性差异（P＜0.01）。介入后AFP、ALP、γ-GT、TBIL、RBC等变化，组间比较无显著性差异（P＞0.05）；而ALT、AST、WBC、PLT、PT、FIB、Cr、BuN等变化TACE组较大（P＜0.05）。通过二值多元Logistic回归分析，与生存质量提高5％以上正相关的有：治疗前的Karnofsky分、生存总积分、γ-GT、WBC、RBC、PLT、Cr，治疗后的γ-GT、WBC、 RBC、PLT、Cr等因子；负相关的有：治疗前的AFP、ALT、AST、ALP、TBIL、PT、FIB、BuN，治疗后的生存总积分、AFP、ALT、AST、ALP、TBIL、PT、FIB、BuN等因子。 结论：莪术油有较好的抗肿瘤作用，其介入治疗PLC的近期疗效与TACE相似；莪术油介入较TACE能更好地改善PLC患者的生存质量；莪术油对肝功能／肾功能、骨髓造血功能以及凝血功能等的损害较小，安全性更高；获术油能更好地改善PLC患者生存质量，可能与其具有抗肿瘤作用的同时，对机体的毒副作用较小有关。 关键词；获术油 介入治疗 原发性肝癌 生存质量 第二部分 中晚期肝癌综合抬疗的疗效及预后因子分析 目的：观察比较中晚期肝癌综合治疗的疗效并分析预后相关因子。 方法；回顾性调查肿瘤内科近5年收治的3℃例中晚期肝癌病人。将本组病例归纳为TACE、TAI、中药介入栓塞、全身化疗、中医辨证中药治疗、对症治疗6个治疗因子，通过卡卜兰－迈尔（KaplanMeie＊法统计分析不同治疗因子的远期疗效；选定25个预后因子，用叼X回归分析作多因素统计分析，筛选危险因子及保护因子；为今后临床治疗PLC提供参考。 结果；半年和 1年的累计生存率的比较，中医辨证中药治疗侣7．76％vs45。25％，42，12％vsZ．39％，P＜0刀5。施加与未施加比较，下同＊、TACE（89．33％ vs 80．95％，64＊9％ vs 0．31％，P＜0．05）、中药介入栓塞治疗0入43％ VS 55．90％；57、＊％VS 31．52％，P＜0．0引后相应的累计生存率均提高。而TAI（55．56％ vs89．76％，18．43％ vs44＊8％，P＜0．05）和全身化疗O0．59％。84．28％，0％VS 43．27o，P＜0．0幻未能有效提高0．5年和1年的累计生存率。 预后因于经X叫回归分析，中医辨证分型、瘤灶数目、包膜、血清AF P水平、肝功能＊hMb分级、腹水、远处转移、介入栓塞等因子对累计生存率的影响有统计学意义O功刀5人 其中包膜、介入栓塞为保护因子，其余为危险因子。介入次数、手术、局部放疗、中医辨证中药治疗亦 4为预后保护因子，但无统计学意义0邓刀5人 结论：TACE、中药介入栓塞及中医辨证中药治疗可提高中晚期PLC的累计生存率；TAI和全身化疗并不能提高中晚期PLC累计生存率；合理选择多种有效方法可望提高中晚期PLC远期疗效。中医分型、肝功能Childb分级、远处转移、腹水、AFP、瘤灶数目均为PLC预后危险因子；栓塞治疗、肿瘤包膜、介入次数、手术、局部放疗以及中医辨证中药治疗等均为PLC预后保护因子。对于不能手术切除的中晚期PLC病例，选择中西药物多次介入栓塞＋中医辨证中药治疗，可能是提高远期疗效最好的途径之一。更多还原

【Abstract】 ABSTRACTPAR I: 1MPROVED QUALITY-OF-LIFE OF MEDIUM OR LATESTAGE LIVER CANCER PATIENTS BY CURCUMA AROMATICAOIL (CAO) INTERWNT1ONALTHERAPYObjectivc: To study recent therapeutic effects of CAO interventonal therapfOr medium or late stage of PLC as well as Quality-of life(QOL) ialluence ofPrimary Liver Cancer (PLC) patients compared with transcatheter ederialchemoembolization (TACE).Method:70 PLC cases (41 patients) of medium or late Stage were edmlydivided into CAO grouP (n==36) and TACE grouP(n=34).The CAO grouP wertreated with CAO or CAO+Lip iboonal theraPy While the TACE grouPwere treated with cheInotheraPelltics or chemotheraPeutcs+Lip interventionaltheraPy. The points of QOL wee respectvely measured l-3 days before and 2weeks after interventional theraPy according to "Quality of life Scale forpatiellts of liver cancer .. QOL, AFP, liver fullotion, lddney function,hematoPOietic function of marrow and cruor fimction were observed andcomPared.Results: The effective ratCs of the CAO grouP and the TACE grouP arerespeCtively o% and l4.7l%, and the StCady ndes are resPectively l00% and85.29%. There is no statistical diffeence between the two grouPs re=0.054l).The alterationS of AFP,ALP, Y -GT,TBIL and RBC are no statisticaldifference bforeen the tWo grouPs after the tfeatInent, While the alterations ofALT, AST, WBC, PLT, PT, FIB, Cr and BuN of TACE grOuP are grCater thanthe CAO grouP(P<0.05). According to Binny Logistic Regression, Whichhave positive relation with imProved QOL more than 5% are the Kamofskypoinis, the totai QOL poinis, Y -GT, WBC, RBC, PLT and Cr beforetrCdriellt, Y -GT, WBC, RBC, PLT, and Cr after tretheellt: Which havenegative relation are: AFP, ALT, AST, ALP, rsIL, PT, FIB and BuN beforetrCthellt, the total poinis of QOL, AFP, ALT, AST, ALP, TBIL, PT, FIB andBuN after trCtheent.ConcIusion: CAO has good antinoplastic effects. The recent therapeoticeffects of CAO interVenona therapy Wth PLC are similar to TACE. CAOdoes less lesion to liver function, lddney fhaction, hematpoietic function ofmarrow and cruor funCtion, and is safer than TACE. The probable mechanismsof CAO imPrving QOL of PLC pati0lls are the anineoplastic effeets and less6side-effect tO orgbosm of CAO.Kepoords: Cureuma Aromatica Oil(CAO), InterVentional TheraPy, PrimaryLiver Cancer(PLC), Quality of lif0(QOL)PART ll: THE OBSERVAION OF THERAPEUTIC EFFECTS ANDhoYSES OF PsoGNOSIS FACTOas FOR THECOMPREHENSIVE TasATMwiT OF MEDIUM OR LATE STAGEOF LIrsRCANCcaObjeCtive:TO observe and comPare the thprapeutic effects of thecHsive trCbe of Meditnn-stage or late-Stage PLC, and analyse theprognO5is hars.MethOds: 322 PLC cases of mediwn or late stage treated by MedicaiDePartInent of oncology of Traditional Chinese Medical HosPital ofGUangdon Provipoe were rthespectivly researched. It 6theraPeutic faCtors: TACE, TAI, chemotheraPy, Traditionsl Chinese Medicine(TCM) intervene embolism and the diaieGtical Of TCM. The cumulativeProportion sUrViving of each theraPeutic factOr was analysed by theKaPlan-Meier statistical method. 25 prognosis factors were selected, and wereanalysed by the cox regression method. Then doperous factors and protCctivefaCtors were screened out, which may offer referece for clinical trCtheent ofPLC in the for.Result: 0.5 and 1 yCar cumulative PropOrtion surviving were rased by thedialecticaltreaAnentofTCM (87.76% vs 45.25%, 42.l2% vs 2.39%,P<0.05 ), TACE (89.33 % vs 80.95%, 64.09 % vs 0.3l%, P<0.05 ), and TCMintervene embolism (95.43 % vs 55.90%, 57.l4% vs 3l.52%, P<0.05 ), butnduced byTAI (55.56% vs 89.76%, l8.43% vs44.08%, P<0.05) andchemotheraP (70.59% vs 84.28%, 0% vs43.27%, P<0.05).25 prognosis faCtrs were analysed by the cox regression method, theresult shows: the dialectical tyPe TCM, tUmour focus number,theour enveloPe,AFP level in serum, the Child’s ghe of 1iver boion, ascites, foranembois and lnttwe emboIism effect the curnulative Prop更多还原