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目的应用多层螺旋CT灌注成像(CT perfusion,CTP)技术,观察益气除痰方加减对非小细胞肺癌(non-small cell lung cancer,NSCLC)瘤内血流灌注的影响,同时评价CTP各项参数变化与预后的关系。方法将87例中晚期NSCLC患者按1:1随机分为中药(参一胶囊加益气除痰方)联合化疗组(治疗组,44例)和单纯化疗组(对照组,43例),两组均21天为1个疗程,共4个疗程。分别于治疗前、治疗2、4个疗程后进行常规CT(平扫+增强)检查,并对原发肿瘤进行CTP成像,测定肿瘤的大小及CTP各项灌注参数[包括血流量(blood flow,BF)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT)、到达峰值时间(time to peak,TP)及表面渗透性(permeability surface,PS)],分析比较治疗前后肿瘤大小及各项灌注参数的变化,同时评估CTP参数变化和预后及疗效的关系。结果 87例患者脱落7例,可评价80例,其中治疗组40例,对照组40例。(1)治疗后治疗组缓解率为47.5%(19/40),总稳定率为77.5%(31/40),对照组缓解率为40.0%(16/40),总稳定率为65.0%(26/40),两组缓解率及总稳定率比较,差异均无统计学意义(χ~2=0.672、1.227,P>0.05)。(2)与本组治疗前比较,治疗组治疗2、4个疗程后BF和PS值降低,MTT值升高(均P<0.05),对照组治疗2个疗程后BF和PS值降低,MTT值升高(均P<0.05)。与对照组同期比较,治疗组治疗4个疗程后BF值降低更明显(P<0.05)。(3)治疗4个疗程后,根据RECIST标准将患者分为缓解组(35例)和未缓解组(45例)。与本组治疗前比较,治疗后缓解组BV、BF和PS值均下降,MTT值升高(均P<0.05),未缓解组BF值升高(P<0.05)。(4)根据治疗后BF值的变化将患者分为BF值升高组(34例)和BF值降低组(46例),结果显示BF值升高组中位生存期246天,1年累计生存率13.0%,BF值降低组中位生存期387天,1年累计生存率53.1%;与BF值升高组比较,BF值降低组生存期延长,1年累计生存率提高,差异有统计学意义(χ~2=19.057,P<0.01)。结论参一胶囊加益气除痰方的中医药治疗可减少中晚期NSCLC的血流灌注量,改善血管的通透性,与化疗药物有良好的协同作用。CTP不仅反映了治疗前后的瘤体大小变化,而且反映了肿瘤血管的功能变化。同时,CTP参数的变化与预后关系密切,治疗后BF值下降者预后较好,生存期较长。
Objective To evaluate the effect of Yiqi Chu Tan Recipe on perfusion of intratumor in patients with non-small cell lung cancer (NSCLC) by multi-slice CT perfusion (CTP) The relationship between various parameters and prognosis. Methods 87 cases of advanced NSCLC patients were randomly divided into two groups according to the ratio of 1: 1 with traditional Chinese medicine (Shen Yi Capsule plus Yiqi Chu Tan) combined with chemotherapy (44 cases) and chemotherapy alone group (43 cases) The group was 21 days for a course of treatment, a total of 4 courses. Before treatment, after treatment for 2 and 4 courses of routine CT (plain scan + enhanced) examination, and the primary tumor CTP imaging, the size of the tumor and CTP perfusion parameters [including blood flow (blood flow, BF, blood volume (BV), mean transit time (MTT), time to peak (TP) and permeability surface (PS) Size and perfusion parameters of changes, while assessing the CTP parameters and prognosis and efficacy of the relationship. Results 87 cases of patients shed 7 cases, 80 cases can be evaluated, of which 40 cases in the treatment group and 40 cases in the control group. (1) After treatment, the remission rate of the treatment group was 47.5% (19/40), the total stability rate was 77.5% (31/40), the control group was 40.0% (16/40), the total stability rate was 65.0% 26/40). There was no significant difference in remission rate and overall stability between the two groups (χ ~ 2 = 0.672,1.227, P> 0.05). (2) BF and PS decreased and MTT increased (both P <0.05) in the treatment group after treatment for 2 and 4 courses compared with those before treatment in the treatment group. The BF and PS values decreased in the control group after 2 courses of treatment, while the MTT Value increased (all P <0.05). Compared with the control group over the same period, the treatment group after 4 courses of BF decreased more significantly (P <0.05). (3) After 4 courses of treatment, patients were divided into remission group (35 cases) and non-remission group (45 cases) according to RECIST standard. Compared with before treatment, BV, BF and PS decreased, MTT increased (all P <0.05), and non-remission BF increased (P <0.05). (4) According to the change of BF value after treatment, the patients were divided into BF increased group (34 cases) and BF decreased group (46 cases). The results showed that BF increased median median survival 246 days, 1 year cumulative The survival rate was 13.0%. The median survival time of BF group was 387 days, and the 1-year cumulative survival rate was 53.1%. Compared with the BF group, the BF group reduced the survival time and the 1-year cumulative survival rate increased Significance (χ ~ 2 = 19.057, P <0.01). Conclusion Shenyi Capsule plus TCM for Qi and Expelling Phlegm Recipe can reduce the amount of blood perfusion and improve the permeability of blood vessels in advanced NSCLC, and has a good synergistic effect with chemotherapy drugs. CTP not only reflects the size of tumor before and after treatment, but also reflects the functional changes of tumor blood vessels. At the same time, the change of CTP parameters is closely related to the prognosis. The decrease of BF value after treatment is of good prognosis and long survival.