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[目的]研究注射用重组人改构肿瘤坏死因子(rhu-TNF)腔内注射治疗恶性胸腔积液的疗效并探讨其可能机制。[方法]将60例恶性胸腔积液患者随机分为对照组(29例)和观察组(31例),对照组给予顺铂(DDP)治疗,观察组在对照组基础上给予rhu-TNF。收集并对比治疗前后各组胸水的Bcl-2 m RNA和Bax m RNA表达,以及治疗后的疗效(RR)、临床获益反应(CBR)、不良反应、疾病进展时间(TTP)。[结果 ]治疗前,两组Bcl-2 m RNA和Bax m RNA的表达无显著差异(P>0.05),治疗后,两组Bcl-2 m RNA均降低(P<0.05),Bax m RNA的表达增高(P<0.05);与对照组比,观察组的Bcl-2 m RNA明显降低(P<0.05),Bax m RNA的表达明显增高(P<0.05)。对照组RR、CBR分别为41.38%和48.28%,观察组RR、CBR分别为70.97%和77.41%,两组间差异有统计学意义(P<0.05)。随访3~12个月,对照组TTP为5.1个月,观察组TTP为7.1个月,差异有统计学意义(P<0.05)。两组不良反应无显著差异。[结论 ]rhu-TNF治疗恶性胸腔积液的机理之一在于降低胸腔脱落细胞Bcl-2表达,升高Bax表达,促进肿瘤细胞凋亡,且无明显的不良反应。
[Objective] To investigate the therapeutic effect of intra-articular injection of recombinant human tumor necrosis factor receptor (rhu-TNF) for the treatment of malignant pleural effusion and to explore its possible mechanism. [Methods] Sixty patients with malignant pleural effusion were randomly divided into control group (n = 29) and observation group (n = 31). The control group was given cisplatin (DDP). The observation group was given rhu-TNF on the basis of the control group. The expression of Bcl-2 mRNA and Bax m RNA in pleural effusion before and after treatment were collected and compared, as well as the therapeutic effect (RR), clinical benefit response (CBR), adverse reactions and time to progression of disease (TTP). [Results] There was no significant difference in the expression of Bcl-2 mRNA and Bax m RNA between the two groups before treatment (P> 0.05). After treatment, Bcl-2 mRNA in both groups was decreased (P <0.05) (P <0.05). Compared with the control group, the Bcl-2 mRNA in the observation group was significantly decreased (P <0.05) and the expression of Bax m RNA was significantly increased (P <0.05). The RR and CBR of the control group were 41.38% and 48.28% respectively. The RR and CBR of the observation group were 70.97% and 77.41% respectively. The difference between the two groups was statistically significant (P <0.05). The follow-up of 3 to 12 months, the control group TTP was 5.1 months, the observation group TTP was 7.1 months, the difference was statistically significant (P <0.05). There was no significant difference between the two groups. [Conclusion] One of the mechanisms of rhu-TNF in the treatment of malignant pleural effusion is to reduce the expression of Bcl-2 in exfoliated cells, increase the expression of Bax and promote the apoptosis of tumor cells without obvious adverse reactions.