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目的:观察腹腔内灌注重组人血管内皮抑素联合5-氟尿嘧啶治疗恶性腹腔积液的临床疗效,检测治疗前后腹腔积液中内皮细胞数量的变化,探讨内皮细胞在恶性腹腔积液治疗中的应用价值。方法:39例恶性腹腔积液患者接受腹腔内重组人血管内皮抑素联合5-氟尿嘧啶灌注治疗2个周期,观察临床疗效、生活质量的改善情况以及不良反应。应用流式细胞术检测治疗前后腹腔积液中内皮细胞百分率的变化。结果:39例患者的客观有效率为43.6%(17/39),生活质量改善率为53.8%(21/39)。3~4级不良反应较少,包括白细胞减少(5.1%,2/39)、血小板减少(2.6%,1/39)、贫血(5.1%,2/39)、恶心(10.3%,4/39)和腹泻(2.6%,1/39)。临床治疗有效患者治疗前恶性腹腔积液中的内皮细胞百分率[(0.22±0.06)%]明显高于治疗后[(0.12±0.08)%],差异有统计学意义(P=0.005);生活质量改善患者治疗前恶性腹腔积液中的内皮细胞百分率[(0.19±0.08)%]也明显高于治疗后[(0.13±0.08)%],差异有统计学意义(P=0.032)。临床治疗无效者和生活质量无改善患者治疗前后恶性腹腔积液中的内皮细胞百分率差异均无统计学意义(P=0.114,P=0.359)。结论:腹腔内灌注重组人血管内皮抑素联合5-氟尿嘧啶可以有效地控制恶性腹腔积液,并且改善患者的生活质量。恶性腹腔积液中游离的内皮细胞可能成为一种较好的疗效预测指标。
Objective: To observe the clinical efficacy of intraperitoneal perfusion of recombinant human endostatin combined with 5-fluorouracil in the treatment of malignant ascites and to detect the changes of endothelial cells in ascites before and after treatment, and to explore the application of endothelial cells in the treatment of malignant ascites value. Methods: Thirty-nine patients with malignant ascites received intraperitoneal injection of recombinant human endostatin combined with 5-fluorouracil for 2 cycles. The clinical efficacy, quality of life improvement and adverse reactions were observed. Flow cytometry was used to detect the percentage of endothelial cells in the ascites before and after treatment. Results: The objective efficiency of 39 patients was 43.6% (17/39), and the quality of life improvement rate was 53.8% (21/39). Grade 3 to 4 had fewer adverse reactions including leukopenia (5.1%, 2/39), thrombocytopenia (2.6%, 1/39), anemia (5.1%, 2/39) ) And diarrhea (2.6%, 1/39). The percentage of endothelial cells in patients with malignant ascites before treatment was significantly higher than that before treatment [(0.22 ± 0.06)%] [(0.12 ± 0.08)%], the difference was statistically significant (P = 0.005) The percentage of endothelial cells in patients with malignant ascites ([0.19 ± 0.08]%] before treatment was also significantly higher than that after treatment [(0.13 ± 0.08)%], the difference was statistically significant (P = 0.032). The percentage of endothelial cells in malignant ascites before and after treatment was not significantly different between patients with clinically ineffective and those with no improvement of quality of life (P = 0.114, P = 0.359). Conclusion: Intraperitoneal injection of recombinant human endostatin combined with 5-fluorouracil can effectively control malignant ascites and improve the quality of life of patients. Malignant ascites in the free endothelial cells may become a better predictor of efficacy.