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目的探讨伊立替康联合西妥昔单抗对晚期结直肠癌(colorectal cancer,CC)肝转移患者肝功能和组织学的影响。方法选取2010年5月至2014年5月陕西省榆林市第二医院收治的110例晚期CC肝转移患者,按照随机数字表法随机分为观察组和对照组,每组55例。对照组患者给予晚期CC常规治疗联合伊立替康治疗,观察组患者在对照组的基础上加用西妥昔单抗。观察两组患者治疗前后肿瘤标记物、肝转移灶直径、肝功能变化和非肿瘤肝组织病理表现,分析伊立替康联合西妥昔单抗的治疗效果和安全性。结果两组患者治疗后癌胚抗原(CEA)、CA19-9水平和转移灶直径均显著降低,观察组降低更为明显,差异有统计学意义(P<0.05)。两组患者疗程结束后凝血酶原时间(PT)、白蛋白(ALB)均显著降低,谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)均显著升高,观察组变化更为明显,差异有统计学意义(P<0.05)。对照组用药时间显著高于观察组,差异有统计学意义(P<0.05)。疗程结束后,观察组有效率为29.1%,疾病控制率为76.4%;对照组疾病控制率为58.2%,观察组有效率、疾病控制率均显著高于对照组,差异有统计学意义(P<0.05)。观察组非肿瘤肝组织外观淤血、水肿和窦状隙扩张伴肝萎缩、坏死发生率显著高于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。观察组患者2年生存率为58.2%(32/55),显著高于对照组的43.6%(24/55),差异有统计学意义(P<0.05)。结论伊立替康联合西妥昔单抗对患者肝功能可造成一定影响,随着患者肝脏细胞损伤的修复,该影响可逐渐降低。该方案在晚期CC肝转移的治疗中安全、有效,对改善患者预后、提高生活质量均有良好的效果,值得临床推广应用。
Objective To investigate the effects of irinotecan combined with cetuximab on liver function and histology in patients with advanced liver metastasis of colorectal cancer (CC). Methods From May 2010 to May 2014, 110 patients with advanced CC liver metastasis admitted to the Second Hospital of Yulin City, Shaanxi Province were randomly divided into observation group and control group according to the random number table method, with 55 cases in each group. Patients in the control group were treated with conventional CC combined with irinotecan. Patients in the observation group were given cetuximab on the basis of the control group. Before and after treatment, the tumor markers, the diameter of liver metastases, the changes of liver function and the pathological changes of non-tumor liver tissue were observed. The therapeutic effect and safety of irinotecan combined with cetuximab were analyzed. Results The CEA, CA19-9 levels and metastatic diameter of the two groups were significantly decreased after treatment. The reduction in the observation group was more obvious with significant difference (P <0.05). Prothrombin time (PT) and albumin (ALB) in both groups were significantly decreased after treatment, and the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (TBIL) The change was more obvious, the difference was statistically significant (P <0.05). Control group medication time was significantly higher than the observation group, the difference was statistically significant (P <0.05). After the treatment, the effective rate of the observation group was 29.1% and the disease control rate was 76.4%. The control rate of the control group was 58.2%. The effective rate of the observation group and the disease control rate were significantly higher than the control group (P <0.05). Observation group non-tumor liver tissue congestion, edema and sinusoidal dilatation with hepatic atrophy and necrosis was significantly higher than the control group, the difference was statistically significant (P <0.05). Two groups of patients with adverse reactions, the difference was not statistically significant (P> 0.05). The 2-year survival rate was 58.2% (32/55) in the observation group, which was significantly higher than that in the control group (43.6%, 24/55). The difference was statistically significant (P <0.05). Conclusion Irinotecan combined with cetuximab may have an impact on the liver function in patients with liver cell damage in patients with the restoration, the impact can be gradually reduced. The scheme is safe and effective in the treatment of advanced hepatic metastases, and has a good effect on improving the prognosis of patients and improving the quality of life, and is worthy of clinical application.