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动脉灌注化疗栓塞术介入治疗联合放射性粒子对原发性肝癌患者CT灌注参数的影响

Influence of transcatheter arterial chemoembolization combined with radioactive particle implantation on CT perfusion imaging parameters in patients with primary liver cancer

    摘要
  • 摘要:
      目的  探讨动脉灌注化疗栓塞术(TACE)介入治疗联合放射性粒子对原发性肝癌患者的CT灌注参数的影响。
      方法  选取104例原发性肝癌患者按随机数字表法分为对照组和实验组, 各52例。对照组采用TACE治疗，观察组采用TACE联合放射性粒子植入术治疗，对比2组患者治疗后的客观缓解率以及治疗前后的甲胎蛋白(AFP)、癌胚抗原(CEA)、外周血T淋巴细胞亚群和自然杀伤细胞(NK)水平，比较2组患者治疗前后CT灌注参数的变化及不良反应发生情况。
      结果  治疗1个月后，观察组客观缓解率显著高于对照组(P < 0.05); 2组患者血清CEA和AFP水平较治疗前显著降低(P < 0.05), 且观察组血清CEA和AFP水平显著低于对照组(P < 0.05); 观察组CD4+、CD3+、CD4+/CD8+及NK细胞水平显著高于对照组(P < 0.05), 而观察组CD8+水平显著低于对照组(P < 0.05); 2组患者的血容量(BV)、表面通透性(PS)、血流量(BF)、肝动脉分数(HAF)、平均通过时间(MTT)较治疗前显著下降(P < 0.05), 且观察组上述指标水平显著低于对照组(P < 0.05); 治疗期间, 2组患者不良反应发生率无显著差异(P>0.05), 未出现严重不良反应。
      结论  TACE介入治疗联合放射性粒子可提高原发性肝癌患者的客观缓解率, 降低AFP及CEA水平，提高T淋巴细胞及NK细胞水平，提高患者免疫能力，并可增强对肿瘤组织血管生长的抑制作用，降低CT灌注参数。

     

    Abstract:
      Objective  To explore the influence of transcatheter arterial chemoembolization (TACE) combined with radioactive partial implantation on CT perfusion imaging parameters in patients with primary liver cancer (PLC).
      Methods  Totally 104 patients with PLC were randomly divided into control group and experimental group, with 52 cases in each group. The control group was treated with TACE, while the observation group was treated with TACE combined with radioactive seed implantation. The objective remission rate, alpha fetoprotein (AFP) and carcinoembryonic antigen (CEA), the levels of peripheral blood T lymphocyte subsets and natural killer cells (NK) after treatment were compared between two groups. Changes of CT perfusion parameters and incidence of adverse reactions before and after treatment were compared between two groups.
      Results  One month after treatment, the objective remission rate of the observation group was significantly higher than that of the control group (P < 0.05). The serum CEA and AFP levels of the two groups were significantly lower than those before treatment (P < 0.05), and the serum CEA and AFP levels of the observation group were significantly lower than those of the control group (P < 0.05). The levels of CD4+, CD3+, CD4+/CD8+ and NK cells of the observation group were significantly higher than those of the control group (P < 0.05), while the level of CD8+ in the observation group was significantly lower than that in the control group (P < 0.05). The blood volume (BV), surface permeability (PS), blood flow (BF), hepatic artery fraction (HAF) and mean transit time (MTT) in both groups were significantly lower than those before treatment (P < 0.05), and the above indexes in the observation group were significantly lower than those in the control group (P < 0.05). During treatment, there was no significant difference in the incidence rate of adverse reactions between the two groups (P>0.05), and no severe adverse reactions occurred.
      Conclusion  TACE interventional therapy combined with radioactive particles can improve the objective remission rate of patients with PLC, reduce the levels of AFP and CEA, increase the levels of T lymphocyte and NK cell, improve the immune ability, enhance the inhibition of angiogenesis of tumor tissue, and reduce CT perfusion parameters.

     

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