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目的研究影像生物标志物联合贝伐珠单抗在胶质母细胞瘤诊断及治疗中的应用及其价值。方法选取2011年1月至2013年6月在衡水市第四人民医院和哈励逊国际和平医院住院并接受手术治疗的胶质母细胞瘤患者38例,随机分为两组。术后两组均给予放疗,同时观察组20例同步采用静脉滴注贝伐珠单抗进行治疗,对照组18例同步采用口服替莫唑胺治疗。对比分析两组患者在不同时相(T_0、T_1、T_2、T_3)的相对脑血容量(r CBV,动态磁敏感对比磁共振成像检查获得)、容积转换常数(K~(trans),磁共振动态增强成像检查获得)和18氟标记的半乳糖化精氨酸-甘氨酸-天冬氨酸多肽正电子发射断层显像扫描获得的最大标准摄取值(SUV_(max))、平均标准摄取值(SUV_(mean))和靶比本值(T/NT)等各指标的变化,并分析两组患者的疗效及中位无进展生存期(PFS)、总体生存期(OS)。结果 T_0时,两组间r CBV、K~(trans)、SUV_(mean)、SUV_(max)和T/NT水平比较,差异无统计学意义(P均>0.05);随着T_0→T_1→T_2→T_3的时间推移,两组rCBV、K~(trans)、SUV_(mean)、SUV_(max)和T/NT水平呈降低趋势,差异有统计学意义(P<0.01,P<0.05),且T_1、T_2、T_3时观察组各指标水平均低于对照组(P<0.05,P<0.01)。在随访6、12和24个月时,观察组患者的客观缓解率(ORR)均较对照组有所提高,但差异无统计学意义(P均>0.05)。观察组患者的中位PFS为14.1个月,明显高于对照组的8.4个月(P<0.05)。两组患者的中位OS相当(P>0.05)。结论观察影像生物标志物的改变,可对胶质母细胞瘤患者的病情做出较为准确的评估。同时联合贝伐珠单抗治疗,可一定程度延长胶质母细胞瘤患者的生存期。
Objective To study the application of image biomarker combined with bevacizumab in the diagnosis and treatment of glioblastoma and its value. Methods Thirty-eight patients with glioblastoma who were hospitalized and treated surgically in Hengshui Fourth People’s Hospital and Harrison International Peace Hospital from January 2011 to June 2013 were randomly divided into two groups. Radiotherapy was given to both groups after operation. In the observation group, 20 cases were treated with intravenous bevacizumab simultaneously, and 18 cases in the control group were treated with oral temozolomide simultaneously. The relative cerebral blood volume (r CBV, dynamic magnetic resonance contrast-enhanced magnetic resonance imaging examination), volume transmissibility constants (K trans, and magnetic resonance imaging) of the two groups at different time phases (T 0, T 1, T 2, Dynamic enhanced imaging test) and 18 fluoro-labeled galactosylated arginine-glycine-aspartic acid peptide positron emission tomography scans (SUV max), the average standard uptake value ( SUV mean and target value of T / NT, and analyzed the curative effect, median progression-free survival (PFS) and overall survival (OS) of the two groups. Results There was no significant difference of r CBV, trans, SUV, SUV max and T / NT between the two groups at T 0 (P> 0.05). With T 0 → T 1 → The levels of rCBV, K trans, SUV, SUV max and T / NT in the two groups showed a decreasing trend with a significant difference between the two groups (P <0.01, P <0.05) The levels of T_1, T_2 and T_3 in the observation group were lower than those in the control group (P <0.05, P <0.01). The objective response rate (ORR) in observation group was higher than that in control group at 6, 12 and 24 months after follow-up, but the difference was not statistically significant (all P> 0.05). The median PFS in observation group was 14.1 months, significantly higher than that in control group (P <0.05). The median OS in both groups was comparable (P> 0.05). Conclusion Observing the changes of imaging biomarkers can make a more accurate assessment of the condition of glioblastoma patients. Combined with bevacizumab treatment, to a certain extent, extend the survival of patients with glioblastoma.