海军医学杂志

目的分析浆膜腔内注射贝伐珠单抗治疗非小细胞肺癌合并恶性浆膜腔积液的疗效并探索其预测因素。方法回顾性分析海军军医大学第一附属医院呼吸与危重症医学科2016年3月至2019年7月收治的非小细胞肺癌并恶性浆膜腔积液的34例病例,其中使用贝伐珠单抗注射液浆膜腔内注射的病例(贝伐珠单抗组)共15例,使用注射用香菇多糖浆膜腔内注射的病例(香菇多糖组)共19例,治疗4周后记录2组恶性胸腔积液控制情况。记录贝伐珠单抗组病例治疗前血纤维蛋白降解产物(FDP)值、血D-二聚体值、表皮细胞生长因子受体(EGFR)基因是否突变、免疫组化p53表达情况。结果贝伐珠单抗组(53.33%)较香菇多糖组(21.05%)缓解率更高,2组间差异有统计学意义(P=0.030)。贝伐珠单抗组患者中,缓解组患者血FDP数值[(9.33±4.93) mg/L]高于无缓解组FDP数值[(4.13±2.09) mg/L],经t检验组间差别有统计学意义(P=0.025);血D-二聚体值经t检验,EGFR基因、免疫组化p53经χ²检验,组间比较差异无统计学意义(P>0.05)。浆膜腔内注射贝伐珠单抗的不良反应发生率为6.67%(1/15)。贝伐珠单抗组患者中有1例在治疗后第2天出现黑便,诊断上消化道出血,急诊胃镜检查提示十二指肠多发溃疡,考虑与该药相关。结论浆膜腔内注射贝伐珠单抗治疗非小细胞肺癌合并恶性浆膜腔积液疗效优于香菇多糖,是一种有效、安全性高、耐受性良好的局部治疗方法,值得在临床上推广使用。血FDP值对浆膜腔内注射贝伐珠单抗治疗非小细胞肺癌合并恶性浆膜腔积液的疗效具有潜在预测价值。

Objective To analyze the therapeutic effect of Bevacizumab injection into serous cavity in treatment of non-small cell lung cancer with malignant serous cavity effusion and to explore the predictive factors involved.Methods A retrospective analysis was made in 34 cases of non-small cell lung cancer with malignant serous cavity effusion admitted to the Department of Respiratory and Critical Care Medicine, Changhai Hospital, Navy Medical University, from March 2016 to July 2019. Of all the cases, 15 received Bevacizumab injection into the serous cavity(the Bevacizumab group) and 19 had Lentinan injection(the Lentinan group). The changes in the volumes of malignant serous cavity effusion in the 2 groups were recorded after 4 weeks of treatment. The levels of fibrin degradation products(FDP)/D-dimer, the mutation of epidermal growth factor receptor(EGFR) gene and the expression of p53 in the Bevacizumab group before injection were closely observed and recorded.Results The remission rate of the Bevacizumab group was higher than that of the Lentinan group(53.33% vs 21.05%), and statistical significance could be noted when comparisons were made between the 2 groups(P=0.030). In the Bevacizumab group, the FDP level [(9.33±4.93) mg/L] in the patients of the remission group was higher than that of the non-remission group [(4.13±2.09) mg/L], and t test indicated that there was statistical significance between the 2 groups(P=0.025). However, there was no statistical significance in the value of D-dimer, EGFR gene and p53, when comparisons were made between the groups(P>0.05). The rate of adverse reactions after injection into serous cavity with Bevacizumab was 6.67%(1:15). In the Bevacizumab group, there was one case of black stool on the second day after treatment and was diagnosed as upper gastrointestinal hemorrhage. Gastroscopy revealed that there were multiple duodenal ulcers, which was considered to be related with Bevacizumab treatment.Conclusion The efficacy of Bevacizumab injection into serous cavity in the treatment of non-small cell lung cancer with malignant serous cavity effusion was superior to Lentinan, indicating that the former was a local treatment method with good efficacy, high safety and good tolerance. For this reason, it is worth further clinical promotion. The value of FDP might have the potential to predict the efficacy of Bevacizumab injection into the serous cavity in the treatment of non-small cell lung cancer with malignant serous cavity effusion.