论文部分内容阅读
目的:探讨肝动脉化疗栓塞(transcatheterarterialchemoembolizationTACE)联合静脉滴注化学免疫治疗(chemoimmunotherapyCI)对原发性肝癌患者外周血甲胎蛋白(AFP)mRNA表达的影响及其临床意义。方法:应用巢式逆转录聚合酶链反应(nestedRTPCR)检测36例肝癌患者血液AFPmRNA表达在TACE+CI前后的变化,并与单纯接受TACE的35例患者比较。结果:在治疗后1周和4周,TACE组血AFPmRNA阳性率分别为54.3%和57.1%,与治疗前的51.4%(18/35)比较,差异无显著性(P均>0.05);而TACE+CI组血AFPmRNA阳性率各为22.2%和33.3%,分别显著低于治疗前(58.3%,21/36)和TACE组(P<0.01和P<0.05)。经过6～12个月随访,TACE+CI组平均缓解期为5.8±2.8月,有6例出现门脉癌栓或肝外转移(16.7%),而TACE组为3.7±2.6月和13例(37.1%),差异均有显著性(P<0.001和P<0.05)。结论:应用RTPCR技术检测原发性肝癌患者外周血AFPmRNA的动态变化对判断TACE等方法治疗肝癌的疗效有重要参考价值。联合静脉化学免疫治疗能显著降低肝癌患者外周血AFPmRNA的阳性率,可能对防止肝癌细胞的血行播散有积极意义。
OBJECTIVE: To investigate the effect of transcatheter arterial chemoembolization (TACE) combined with chemotherapy infusion chemotherapy (chemoimmunotherapy CI) on peripheral blood alpha-fetoprotein (AFP) mRNA expression in patients with primary liver cancer and its clinical significance. METHODS: Nested RTPCR was used to detect the changes of AFP mRNA expression in 36 patients with hepatocellular carcinoma before and after TACE+CI, and compared with 35 patients who only received TACE. Results: At 1 week and 4 weeks after treatment, the positive rates of AFP mRNA in TACE group were 54.3% and 57.1%, respectively, compared with 51.4% (18/35) before treatment, there was no significant difference (P>0.05). The positive rate of AFP mRNA in TACE+CI group was 22.2% and 33.3%, respectively, which were significantly lower than before treatment (58.3%, 21/36) and TACE group (P<0.01 and P<0.05). After 6 to 12 months of follow-up, the average remission period in the TACE+CI group was 5.8±2.8 months. There were 6 cases of portal vein tumor embolism or extrahepatic metastasis (16.7%), while the TACE group was 3.7±2.6 months and 13 cases ( 37.1%), the differences were significant (P<0.001 and P<0.05). Conclusion: The application of RTPCR to detect the dynamic changes of AFP mRNA in peripheral blood of patients with primary liver cancer has important reference value for judging the efficacy of TACE and other methods in the treatment of liver cancer. Combined venous chemical immunotherapy can significantly reduce the positive rate of AFP mRNA in peripheral blood of patients with hepatocellular carcinoma, which may have positive significance in preventing the hematopoietic dissemination of hepatoma cells.