消癌平注射液联合沙利度胺辅助放化疗对中晚期食管癌患者肿瘤标志物、血管内皮生长因子及其受体表达的影响
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摘要
目的:探讨消癌平注射液联合沙利度胺辅助放化疗对中晚期食管癌患者肿瘤标志物、血管内皮生长因子(VEGF)及其受体表达的影响。方法:选取2012年1月至2016年6月南阳医学高等专科学校第一附属医院收治的中晚期食管癌患者160例为研究对象,入院序号为奇数序号者为对照组,偶数序号者为观察组,每组80例。2组均给予常规化疗,对照组在常规化疗的基础上给予三维适形放疗,观察组在对照组的基础上应用消癌平注射液联合沙利度胺治疗,21 d为1个治疗周期,连续治疗3个周期,并随访2年。观察2组近期及远期疗效;比较2组治疗前后血清中肿瘤标志物、VEGF及其受体表达;统计2组治疗及随访不良反应发生情况。结果:治疗后观察组RR为75. 00%,明显高于对照组的56. 25%(P <0. 05),观察组1年生存率为96. 25%,显著高于对照组的86. 25%(P <0. 05)。治疗后2组吞咽困难、泛吐痰涎、腹痛腹泻及四肢困乏等主要中医证候积分均较治疗前显著下降,且观察组显著低于对照组,差异有统计学意义(P <0. 05)。治疗后2组血清中巨噬细胞炎性蛋白-3α(MIP-3α)、糖类抗原125(CA125)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)及细胞角质蛋白19片段(CYFRA21-1)、VEGF及内皮生长因子受体-1(VEGFR-1)表达均较治疗前显著下降,差异有统计学意义(P <0. 05),且观察组明显低于对照组,差异有统计学意义(P <0. 05)。治疗及随访中观察组呕吐、白细胞下降、放射性食管炎及骨髓抑制的发生率显著低于对照组,差异有统计学意义(P <0. 05)。结论:消癌平注射液联合沙利度胺辅助放化疗可显著降低中晚期食管癌患者血清肿瘤标志物水平,抑制VEGF及其受体表达,改善患者临床症状的同时降低不良反应发生率,提升临床疗效。
Objective: To study the effects of Xiaoaiping Injection combined with thalidomide adjuvant radiotherapy and chemotherapy on the expression of tumor markers,vascular endothelial growth factor( VEGF) and its receptors in patients with middle and late esophageal cancer. Methods: A total of 160 cases of patients with middle and late esophageal cancer treated in the First Affiliated Hospital of Nanyang Medical College from January 2012 to June 2016 were selected as the study objects,the number of odd numbers was the control group,and the even number was the observation group,with 80 cases in each group. The 2 groups were given conventional chemotherapy,and the control group was given three dimensional conformal radiotherapy on the basis of conventional chemotherapy. The observation group was treated with Xiaoaiping Injection combined with thalidomide on the basis of the control group,21 days for a treatment cycle,both had 3 consecutive cycles and follow-up for 2 years. The short-term and long-term effects of the 2 groups were observed,and the levels of the serum tumor markers,VEGF and its receptors in the 2 groups were compared before and after treatment,the occurrence of toxic side effects in treatment and follow-up in the 2 groups were statisticsed.Results: The RR of the observation group was 75. 00%,which was significantly higher than that 56. 25% of the control group after treatment( P < 0. 05); 1 year survival rate of the observation group was 96. 25%,which was significantly higher than 86. 25% of the control group( P < 0. 05). The scores of main TCM symptoms such as dysphagia,pan-sputum and salivation,abdominal pain,diarrhea and quadriplegia in the 2 groups after treatment were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group( P < 0. 05 or P < 0. 01). The expression levels of MIP-3α,CA125,CEA,NSE,CYFRA21-1,VEGF,VEGFR-1 in serum of the 2 groups were significantly lower than those before treatment( P < 0. 01),the observation group was obviously lower than the control group( P < 0. 01). The incidence of vomiting,leukopenia,radiation esophagitis and bone marrow depression in the observation group were significantly lower than those in the control group during treatment and follow-up( P < 0. 05 or P < 0. 01). Conclusion: Xiaoaiping Injection combined with thalidomide adjuvant radiotherapy and chemotherapy can significantly reduce the levels of serum tumor markers in patients with middle and late esophageal cancer,inhibit the expression of VEGF and its receptor,improve the clinical symptoms and reduce the incidence of toxic side effects and improve the clinical efficacy.
Objective: To study the effects of Xiaoaiping Injection combined with thalidomide adjuvant radiotherapy and chemotherapy on the expression of tumor markers,vascular endothelial growth factor( VEGF) and its receptors in patients with middle and late esophageal cancer. Methods: A total of 160 cases of patients with middle and late esophageal cancer treated in the First Affiliated Hospital of Nanyang Medical College from January 2012 to June 2016 were selected as the study objects,the number of odd numbers was the control group,and the even number was the observation group,with 80 cases in each group. The 2 groups were given conventional chemotherapy,and the control group was given three dimensional conformal radiotherapy on the basis of conventional chemotherapy. The observation group was treated with Xiaoaiping Injection combined with thalidomide on the basis of the control group,21 days for a treatment cycle,both had 3 consecutive cycles and follow-up for 2 years. The short-term and long-term effects of the 2 groups were observed,and the levels of the serum tumor markers,VEGF and its receptors in the 2 groups were compared before and after treatment,the occurrence of toxic side effects in treatment and follow-up in the 2 groups were statisticsed.Results: The RR of the observation group was 75. 00%,which was significantly higher than that 56. 25% of the control group after treatment( P < 0. 05); 1 year survival rate of the observation group was 96. 25%,which was significantly higher than 86. 25% of the control group( P < 0. 05). The scores of main TCM symptoms such as dysphagia,pan-sputum and salivation,abdominal pain,diarrhea and quadriplegia in the 2 groups after treatment were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group( P < 0. 05 or P < 0. 01). The expression levels of MIP-3α,CA125,CEA,NSE,CYFRA21-1,VEGF,VEGFR-1 in serum of the 2 groups were significantly lower than those before treatment( P < 0. 01),the observation group was obviously lower than the control group( P < 0. 01). The incidence of vomiting,leukopenia,radiation esophagitis and bone marrow depression in the observation group were significantly lower than those in the control group during treatment and follow-up( P < 0. 05 or P < 0. 01). Conclusion: Xiaoaiping Injection combined with thalidomide adjuvant radiotherapy and chemotherapy can significantly reduce the levels of serum tumor markers in patients with middle and late esophageal cancer,inhibit the expression of VEGF and its receptor,improve the clinical symptoms and reduce the incidence of toxic side effects and improve the clinical efficacy.
引文
[1]李晓宁,王澜,李润霄,等.三维适形放疗和放疗联合化疗对中晚期食管癌患者预后影响的比较[J].中国肿瘤临床,2016,43(3):111-115.
[2]蔡铭,翁鸢,王志强.术中纳米炭吸附淋巴靶向化疗对63例食管癌根治术患者的治疗效果观察[J].贵州医药,2017,41(1):44-46.
[3]陆志斌,周存荣,郑琳,等.siRNA干扰DKK1表达对食管癌ECA109细胞AL-DH1A1水平的影响及机制[J].贵州医科大学学报,2017,42(4):444-448.
[4]Shortt J,Hsu AK,Johnstone RW.Thalidomide-analogue biology:immunological,molecular and epigenetic targets in cancer therapy[J].Oncogene,2013,32(36):4191-202.
[5]马瑜瑾,李世朋.沙利度胺对肝癌细胞HepG2化疗的增敏作用[J].中国临床药理学杂志,2014,30(7):597-600.
[6]韩淑燕,郑文献,何曦冉,等.消癌平注射液联合吉非替尼对耐药非小细胞肺癌H460和H1975裸鼠移植瘤的抑制作用[J].中国药理学与毒理学杂志,2016,30(1):44-52.
[7]梅朝蓉,王恳,雷娜,等.消癌平注射液联合TP方案治疗晚期非小细胞肺癌的临床观察[J].中国药房,2015,26(11):1531-1533.
[8]赵锡江.食管癌诊断与治疗[M].天津:天津科技翻译出版公司,1999:43-152.
[9]中国华人民共和国卫生部.中国常见恶性肿瘤诊治规范[S].北京:北京医科大学、中国协和医科大学联合出版社,1991:122-126.
[10]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:10-11.
[11]索宾.恶性肿瘤TNM分期[M].天津:天津科技翻译出版公司,2012:1251-1253.
[12]丁婕,戴旭,孟宪运,等.实体瘤疗效评价标准的研究进展[J].中国肿瘤临床与康复,2015,22(9):1150-1152.
[13]Zeng H,Zheng R,Zhang S,et al.Esophageal cancer statistics in China,2011:Estimates based on 177 cancer registries[J].Thorac Cancer,2016,7(2):232-237.
[14]Berry MF.Esophageal cancer:staging system and guidelines for staging and treatment[J].J Thorac Dis,2014,6 Suppl 3:S289-297.
[15]雷蕾,王娴,王晓稼.沙利度胺治疗常见非血液系统肿瘤的研究进展[J].国际肿瘤学杂志,2016,43(9):711-714.
[16]章永红,叶丽红,彭海燕,等.论“全力扶正、尽力攻毒”的抗癌基本原则[J].中华中医药杂志,2015,30(12):4230-4232.
[17]熊林,孟以秀,李丹.消癌平注射液用于晚期胃癌化疗患者效果观察[J].山东医药,2015,55(14):71-72.
[18]Wei H,Liang F,Cheng W,et al.The mechanisms for lung cancer risk of PM2.5:Induction of epithelial-mesenchymal transition and cancer stem cell properties in human non-small cell lung cancer cells[J].Environ Toxicol,.2017,32(11):2341-2351.
[19]阮立为,邓甬川.消癌平对乳腺癌新辅助化疗疗效的增强作用及其机制探讨[J].中国中药杂志,2015,40(4):749-752.
[20]王美鑑,杜丹玉,范薇,等.消癌平注射液抗血管生成作用及其机制研究[J].药学学报,2016,51(2):309-315.
[2]蔡铭,翁鸢,王志强.术中纳米炭吸附淋巴靶向化疗对63例食管癌根治术患者的治疗效果观察[J].贵州医药,2017,41(1):44-46.
[3]陆志斌,周存荣,郑琳,等.siRNA干扰DKK1表达对食管癌ECA109细胞AL-DH1A1水平的影响及机制[J].贵州医科大学学报,2017,42(4):444-448.
[4]Shortt J,Hsu AK,Johnstone RW.Thalidomide-analogue biology:immunological,molecular and epigenetic targets in cancer therapy[J].Oncogene,2013,32(36):4191-202.
[5]马瑜瑾,李世朋.沙利度胺对肝癌细胞HepG2化疗的增敏作用[J].中国临床药理学杂志,2014,30(7):597-600.
[6]韩淑燕,郑文献,何曦冉,等.消癌平注射液联合吉非替尼对耐药非小细胞肺癌H460和H1975裸鼠移植瘤的抑制作用[J].中国药理学与毒理学杂志,2016,30(1):44-52.
[7]梅朝蓉,王恳,雷娜,等.消癌平注射液联合TP方案治疗晚期非小细胞肺癌的临床观察[J].中国药房,2015,26(11):1531-1533.
[8]赵锡江.食管癌诊断与治疗[M].天津:天津科技翻译出版公司,1999:43-152.
[9]中国华人民共和国卫生部.中国常见恶性肿瘤诊治规范[S].北京:北京医科大学、中国协和医科大学联合出版社,1991:122-126.
[10]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:10-11.
[11]索宾.恶性肿瘤TNM分期[M].天津:天津科技翻译出版公司,2012:1251-1253.
[12]丁婕,戴旭,孟宪运,等.实体瘤疗效评价标准的研究进展[J].中国肿瘤临床与康复,2015,22(9):1150-1152.
[13]Zeng H,Zheng R,Zhang S,et al.Esophageal cancer statistics in China,2011:Estimates based on 177 cancer registries[J].Thorac Cancer,2016,7(2):232-237.
[14]Berry MF.Esophageal cancer:staging system and guidelines for staging and treatment[J].J Thorac Dis,2014,6 Suppl 3:S289-297.
[15]雷蕾,王娴,王晓稼.沙利度胺治疗常见非血液系统肿瘤的研究进展[J].国际肿瘤学杂志,2016,43(9):711-714.
[16]章永红,叶丽红,彭海燕,等.论“全力扶正、尽力攻毒”的抗癌基本原则[J].中华中医药杂志,2015,30(12):4230-4232.
[17]熊林,孟以秀,李丹.消癌平注射液用于晚期胃癌化疗患者效果观察[J].山东医药,2015,55(14):71-72.
[18]Wei H,Liang F,Cheng W,et al.The mechanisms for lung cancer risk of PM2.5:Induction of epithelial-mesenchymal transition and cancer stem cell properties in human non-small cell lung cancer cells[J].Environ Toxicol,.2017,32(11):2341-2351.
[19]阮立为,邓甬川.消癌平对乳腺癌新辅助化疗疗效的增强作用及其机制探讨[J].中国中药杂志,2015,40(4):749-752.
[20]王美鑑,杜丹玉,范薇,等.消癌平注射液抗血管生成作用及其机制研究[J].药学学报,2016,51(2):309-315.