微波消融治疗晚期肺腺癌临床分析

doi:10.3969/j.issn.1005-6483.2021.08.008

摘要/Abstract

摘要： 目的;观察微波消融治疗对晚期肺腺癌病人免疫炎性反应及预后的影响。方法:2016年2月～2019年2月我院收治的驱动基因阴性的晚期肺腺癌病人86例，按随机数字表法分为微波消融组和对照组，每组各43例。对照组接受吉西他滨+卡铂化疗，微波消融组接受吉西他滨+卡铂+微波消融治疗。观察两组病人治疗前后应激指标、炎症指标、免疫指标变化情况及近期疗效。对病人进行随访(随访至2020年4月)，观察两组病人生存情况。结果:微波消融组客观缓解率(58.14%)和疾病控制率(83.71%)高于对照组(34.88%、65.12%），差异有统计学意义P＜0.05)。治疗4周后微波消融组丙二醛为(135.1±11.0)mg/L、超氧化物歧化酶为(5.4±2.2)U/L、C反应蛋白为(8.3±2.5)mg/L、白细胞介素6为(76.9±7.1)pg/ml、降钙素原为(5.9±1.5)ng/ml，对照组分别为(129.6±10.9)mg/L、(5.2±2.0)U/L、(8.6±2.9)mg/L、(75.8±8.9)pg/ml、(5.1±2.0)ng/ml，两组比较差异无统计学意义（P>0.05），治疗后微波消融组CD8+为(44.9±5.1)%、CD4+/CD8+为(1.49±0.58)，对照组分别为(30.8±4.9)%、(1.31±0.52)，两组比较差异有统计学意义（P＜0.05）。随访时间13~48个月，平均随访时间为(29.4±4.9)个月，成功随访率为94.2%，KaplanMeier法并对数秩检验显示，微波消融组累积生存率高于对照组，差异有统计学意义(P＜0.05)。结论:微波消融治疗可显著改善晚期肺腺癌近期疗效及生存情况，安全性高，不影响应激反应和炎症反应，且可改善免疫功能。

关键词: 微波消融, 晚期肺腺癌, 炎症反应, 应激反应, 免疫功能

Abstract: Objective:To observe the effect of microwave ablation on immune inflammatory response and prognosis in patients with advanced lung adenocarcinoma.Methods:A total of 86 driver genenegative patients with advanced lung adenocarcinoma who were admitted to Hefei Second People's Hospital from February 2016 to February 2019 were selected and divided into a microwave ablation group and a control group according to the random number table method,43 cases each.The control group received gemcitabine + carboplatin chemotherapy,and microwave ablation treatment was added to the microwave ablation group.The changes of stress indexes,inflammation indexes,immune indexes and shortterm efficacy in both groups were observed.The patients were followed up to April 2020 to observe the survival of the two groups of patients.Results:The objective response rate(58.14%) and disease control rate(83.71%) of the microwave ablation group were higher than those of the control group(34.88%,65.12%,P＜0.05).After 4 weeks of treatment,the microwave ablation group MDA[(135.1±11.0)mg/L],SOD[(5.4±2.2)U/L],CRP[(8.3±2.5)mg/L],IL6[(76.9± 7.1)pg/ml],PCT[(5.9±1.5)ng/ml] were not statistically different from the control group[(129.6±10.9)mg/L,(5.2±2.0)U/L,(8.6±2.9) mg/L,(75.8±8.9)pg/ml,(5.1±2.0)ng/ml,P>0.05],CD4+[(44.9±5.1)%],CD4+/CD8+(1.49±0.58) in microwave ablation group after treatment were higher than the control group[(30.8±4.9)%,(1.31±0.52),P＜0.05].The followup time was 1348 months.The average followup time was(29.4±4.9) months.The successful followup rate was 94.2%.The KaplanMeier method and log rank test showed that the cumulative survival rate of the microwave ablation group was higher than that of the control group(P＜0.05).Conclusion:Microwave ablation therapy can significantly improve the shortterm efficacy and survival of advanced lung adenocarcinoma.It has high safet,improve immune function and does not affect the stress response.

Key words: microwave ablation, advanced lung adenocarcinoma, inflammatory response, stress response, immune function

岳晖, 裴韶华. 微波消融治疗晚期肺腺癌临床分析[J]. 临床外科杂志, 2021, 29(8): 722-725.

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