草酸铂联合5-氟脲嘧啶/亚叶酸钙治疗晚期结直肠癌的临床研究

目的:观察草酸铂(Oxaliplation,L-OHP)联合5-氟尿嘧啶(5-Fluorouracil,5-FU)/亚叶酸钙(Leucovolin,CF)治疗晚期结直肠癌的近期疗效、毒副反应及无进展生存期.方法:经病理证实的73例晚期结直肠癌患者分为两组,分别采用5-FU/CF(35例)及L-OHP 5-FU/CF(38例)方案,进行分组对照研究,治疗方法:(1)5-FU/CF组:CF 200mg/m2,静脉滴注2小时(h),dl,之后给予5-FU 0.5g静脉推注,dl,接下来给予5-FU 3.0g/m2持续静脉滴注48h;(2)L-OHP 5-FU/CF组:L-OHP 85mg/m2,静脉滴注2h,m,之后给予5-FU/CF,用法同前,以上两种方案均2周重复,每4周为一完整周期,每个受试者均接受两个及以上周期的治疗.结果:两组治疗后有效率:L-OHP 5-FU/CF组52.6%,5-FU/CF组25.7%,(P＜0.05).无进展生存期:L-OHP 5-FU/CF组8.9月,5-FU/CF组5-3月,(P＜0.05).毒副反应主要为感觉神经末梢毒性、粘膜炎、骨髓抑制、恶心、呕吐、腹泻,但多为Ⅰ～Ⅱ度.结论:草酸铂联合5-氟脲嘧啶/亚叶酸钙治疗晚期结直肠癌有较好疗效,不良反应可耐受,值得临床推广.     

5-Fu小剂量泵二线治疗晚期胰腺癌的临床研究

目的观察5-Fu小剂量泵二线治疗晚期胰腺癌的疗效和不良反应。方法 13例晚期吉西他滨治疗失败的胰腺癌患者,5-Fu300mg/d,1～14d持续静脉泵入,DDP5mg1～5d,8～12d静点,28d为1周期。观察客观疗效、临床获益率及不良反应。结果部分缓解1例,稳定6例,10例临床获益,中位生存期5.8个月（2.2～8.3个月）,中位疾病进展时间3.0个月（1～4.5个月）,主要不良反应为菌群失调相关性腹泻。结论 5-Fu小剂量泵二线治疗可改善晚期胰腺癌患者生存,耐受性好。     

洛铂与紫杉醇联合治疗晚期卵巢癌的临床观察

目的：观察洛铂与紫杉醇联合化疗治疗晚期卵巢癌的近期疗效及不良反应。方法：50例晚期卵巢癌（Ⅲ期或Ⅳ期）患者,其中26例患者采用洛铂＋紫杉醇静脉化疗,其中洛铂30mg／m2,d1天,紫杉醇135～175mg／m。dl天。24例患者采用顺铂＋紫杉醇静脉化疗,其中顺铂25mg／m2,d1-3天,紫杉醇135～175mg／m。dl天,2～4个疗程观察疗效。结果：26例洛铂组患者中,完全缓解7例,部分缓解8例,稳定9例,进展2例,有效率为57．7％。24例顺铂组患者中,完全缓解5例,部分缓解8例,稳定6例,进展5例,有效率为54．2％。主要毒副反应为骨髓抑制、骨骼酸痛、神经毒性和脱发。结论：洛铂联合紫杉醇治疗晚期卵巢癌疗效较好,毒副反应可以耐受。     

ICE方案治疗复发难治性非霍奇金弥漫大B细胞淋巴瘤临床观察

目的:观察ICE方案(异环磷酰胺IFO,卡铂CBP,依托泊苷VP-16)治疗复发/难治性非霍奇金弥漫大B细胞淋巴瘤(Non-hodgkin's lymphoma,NHL)的疗效及安全性。方法:20例经系统化疗后复发或进展的非霍奇金弥漫大B细胞淋巴瘤(DLBCL)患者,采用ICE方案化疗至少2周期,IFO 5 g/m2,第2天,持续24小时静脉输注,CBP按AUC=5,max 800 mg,第2天,静脉输注,VP-16.100 mg/m2,第1-3天,静脉输注。结果:完全缓解(complete response,CR)5例,部分缓解(partial response,PR)8例,疾病稳定(stable disease,SD)4例,疾病进展(progress disease,PD)3例,总有效率(overall response rate,ORR,CR+PR)65%,化疗副作用主要为骨髓抑制(Ⅰ、Ⅱ度6例,Ⅲ、Ⅳ度14例),其他不良反应包括胃肠道反应、粘膜损伤、肝肾毒性及脱发等均可耐受。结论:ICE方案可用于非霍奇金弥漫大B细胞淋巴瘤的二线化疗方案。     

CAP方案联合艾迪注射液治疗晚期非小细胞肺癌的临床研究

摘要 目的：研究CAP方案联合艾迪注射液治疗晚期非小细胞肺癌的效果。方法：选择2016年1月～2019年1月我院的81例晚期非小细胞肺癌患者,随机分为两组。对照组的41例晚期非小细胞肺癌患者采用CAP方案,即快速静脉滴注吡柔比星50 mg/m²和环磷酰胺600 mg/m²,d1,顺铂80 mg/m²,d2-d4,1 个周期为28 d,共治疗2个周期。观察组的40例晚期非小细胞肺癌患者联合静脉滴注艾迪注射液,每次50 mL,每天1次,1个疗程为3 w,共治疗3个疗程。比较两组的免疫功能、生活质量和不良反应情况。结果：观察组的有效率明显高于对照组(P<0.05）;观察组治疗后的CD4⁺、CD3⁺及CD4⁺/CD8⁺明显升高(P<0.05）,且明显高于对照组(P<0.05）;观察组的生活质量提高17例,稳定10例,降低6例,观察组的生活质量改善率为82.50%（33/40）,明显高于对照组的53.66%（22/41）(P<0.05）;观察组的消化道反应发生率明显低于对照组(P<0.05）,两组的过敏反应、神经毒性和脱发发生率无明显差异(P>0.05）。结论：艾迪注射液联合CAP方案可以提高晚期非小细胞肺癌的化疗疗效以及生活质量,改善免疫功能,减轻化疗所致的不良反应。     

紫杉醇在治疗晚期或复发性宫颈癌中的应用分析

为了探讨紫杉醇在治疗晚期或复发性宫颈癌中的疗效和安全性,为不适合手术或者放射治疗的患者(包括晚期或复发性宫颈癌患者)注射紫杉醇170 mg/m^2、卡铂5 mg·mL^-1·min^-1、贝伐珠单抗12 mg/kg治疗,每20 d一次,并记录期间的不良反应,直至疾病有所缓解或其毒性有所限制。总共有38名患者接受了平均8个治疗周期(范围2~25),中期随访值为18.5个月(范围2~29)。结果显示,19名患者(50.0%)经历完全反应,而15名患者经历(39.4%)部分反应,平均持续时间为6个月。3级和4级血液学毒性表现为中性粒细胞减少症15例(39.4%)、白细胞减少症13例(34.2%)、贫血症13例(34.2%)、血小板减少症11例(28.9%)。1名接受过骨盆照射的患者发生了2级直肠阴道瘘。本研究表明,紫杉醇、卡铂和贝伐单抗的组合对于晚期或复发性宫颈癌患者是有效且安全的。     

黄芪多糖对暴露于苯、甲醛环境中小鼠脾脏的保护作用

目的探讨黄芪多糖对暴露于苯、甲醛环境中小鼠脾脏的保护作用。方法将40只雄性小鼠随机分成4组,即对照组、苯甲醛染毒组（苯：5 g/m^3,甲醛：50 mg/m^3）、苯甲醛染毒黄芪多糖低剂量保护组[黄芪多糖：10 mg/（kg.d）,苯：5 g/m^3,甲醛：50 mg/m^3]、苯甲醛染毒黄芪多糖高剂量保护组[黄芪多糖：20 mg/（kg.d）,苯：5 g/m^3,甲醛：50 mg/m^3]。采用静式吸入染毒,每天2 h,连续30 d,并同时采用饮水的方式给予黄芪多糖保护。末次染毒24 h内,处死小鼠,对小鼠脾中谷胱甘肽（GSH）含量及谷胱甘肽过氧化物酶（GSH-PX）活性进行测定和分析。结果苯、甲醛染毒黄芪多糖保护各组脾组织中GSH含量和GSH-PX活性均高于苯、甲醛染毒组,均有统计学意义（P〈0.01）而与对照组的差异无统计学意义（P〉0.05）,苯、甲醛染毒黄芪多糖保护组高剂量组脾组织中GSH-PX活性高于低剂量组,差异有统计学意义（P〈0.01）。结论黄芪多糖对暴露于苯、甲醛环境中小鼠脾脏具有保护作用,且对脾中GSH含量的作用有随剂量增加而增大的趋势,对脾中GSH-PX活性的作用随剂量增加而增大。     

紫杉醇、长春瑞滨联合顺铂方案治疗晚期乳腺癌的临床疗效

目的:探讨紫杉醇(PTX)、长春瑞滨(NVB)两药与顺铂(DDP)联用方案对晚期乳腺癌的临床疗效及副反应。方法:将2009年2月至2014年2月于我院就诊的60例晚期乳腺癌患者随机分为TP方案和NP方案两组,每组30例。TP方案组:顺铂25mg/m2,d1~d3,紫杉醇175 mg/m2,d1;NP方案组:顺铂25 mg/m2,d1~d3,长春瑞滨25 mg/m2,d1和d8。比较两组患者的临床有效率并记录相关不良反应。结果:TP方案有效率56.7%(17/30),中位缓解期7.5个月。NP方案有效率53.3%(14/30),中位缓解期7.7个月。组间疗效及缓解期差异无统计学意义(P0.05)。TP与NP方案组出现血小板减少、白细胞减少、贫血、恶心呕吐的发生率分别为26.7%、76.7%、56.7%、43.3%和26.7%、76.7%、56.7%、43.3%,两方案血液毒性差异无统计学意义(P0.05)。静脉炎及关节肌肉反应的发生率分别为30.0%、13.3%和16.7%53.3%,差异有统计学意义(P0.05)。结论:紫杉醇、长春瑞滨与顺铂联用治疗晚期乳腺癌疗效相当,不良反应可耐受,都可做为晚期乳腺癌治疗的一线用药方案。     

交替放化疗对晚期鼻咽癌患者疗效与影响因素分析

目的:评估交替放化疗(CRT)对晚期鼻咽癌(NPC)患者的疗效与影响因素。方法:选取在我院耳鼻喉科治疗的102例鼻咽癌患者。交替使用放疗,化疗进行治疗。在102例患者中,83例接受顺铂(50 mg/m2/d,d1-2)和5-氟尿嘧啶(5-Fu;800 mg/m2/d,d1-5),而19例患者接受卡铂(20 mg/m2/d,d6)和5-FU。结果:72(70.6%)例患者完成全部3个化疗疗程。交替放化疗的总时间为92(82-102)天。中位随访时间54个月,5年无进展生存期(PFS)为70.5%。多因素分析显示,体重减轻和化疗疗程数对PFS有显著影响。结论:化疗与放疗交替治疗的NPC患者依从性好,适应性强,值得临床推广。     

双歧杆菌三联活菌胶囊联合莫沙比利治疗慢性功能性便秘的疗效比较

目的探讨双歧杆菌三联活菌胶囊联合莫沙比利治疗慢性功能性便秘的疗效比较。方法选取慢性功能性便秘患者72例,采用随机数字表将患者随机分为观察组（n=36例）和对照组（n=36例）。两组患者均予以多饮水、调整饮食结构与纠正不良的饮食习惯。观察组患者予以双歧杆菌三联活菌胶囊（420mg/次,3次/d,温水口服）联合莫沙比利（5 mg/次,3次/d,餐前30 min口服）治疗,对照组患者予以单纯莫沙比利治疗,剂量与方法同观察组,两组均连用6周。观察并记录两组患者治疗后的临床效果和药物不良反应,并比较治疗后6个月和1年内的复发情况。结果治疗6周后,观察组临床总有效率为94.44%,明显高于对照组的77.78%（χ2=4.18,P〈0.05）。治疗中观察组出现不良反应3例（8.33%）,对照组出现5例（13.89%）,症状均较轻,未发生严重的不良反应,两组不良反应发生率比较差异无统计学意义（χ2=0.40,P〈0.05）。治疗后随访观察6个月和1年,观察组分别复发4例（11.11%）和9例（25.00%）,对照组分别复发11例（30.56%）和18例（50.00%）,观察组的复发率明显低于对照组（χ2=4.13和4.80,P〈0.05）。结论双歧杆菌三联活菌胶囊联合莫沙比利治疗慢性功能性便秘的效果确切,可迅速改善患者临床症状,安全性较好,并可降低其复发率,具有预防病情复发作用。     

Recent results of irinotecan therapy in colorectal cancer

New results presented at ASCO Conference in 2003 added further important data to our knowledge on successful use of irinotecan in colorectal cancer (CRC). Irinotecan - just like oxaliplatin - given as neoadjuvant therapy with 5-FU - folinic acid (FUFA) can render originally unresectable liver or lung metastases of CRC resectable, giving the hope of long-term survival for a proportion of patients. Irinotecan combined with 5-FU is an essential part of the most successful palliative sequential chemotherapy of stage IV CRC. Sequential FOLFIRI before or after FOLFOX combination ensures the longest possible progression-free and overall survival for metastatic CRC patients in the palliative setting. In order to achieve the longest survival time, sequential use of both 5-FU, irinotecan and oxaliplatin is necessary. The French GERCOR Group achieved 26 months median overall survival with the sequential use of continuous infusional FUFA, oxaliplatin and irinotecan combinations in stage IV CRC. The analysis of large phase III trials using 5-FU, irinotecan and oxaliplatin revealed that the higher proportion of patients was treated with all three drugs, the longer overall survival was achieved. If applied with caution, toxicity and efficacy of irinotecan in elderly patients is not significantly different from that seen in younger population. The anti-VEGF bevacizumab increases the efficacy of first-line irinotecan therapy, while the addition of cetuximab restores irinotecan sensitivity in second line treatment of stage IV CRC. The combination of irinotecan with oral capecitabine is safe and effective in advanced CRC.     

贝伐单抗二线治疗转移性结直肠癌的临床观察

目的:观察贝伐单抗二线治疗转移性结直肠癌患者的临床疗效和毒副反应。方法:回顾性分析2008年8月至2011年10月我院经组织病理学证实的转移性结直肠癌患者21例,一线治疗进展后,二线治疗方案中加用贝伐单抗,用法为5mg/kg,每2-3周1次,与化疗方案同步。化疗方案以奥沙利铂及伊立替康为基础,完成2-3周期治疗后评定疗效,观察毒副反应。结果:21例患者中PR1例,SD11例,PD9例,客观缓解率为4.8%,疾病控制率为57.1%,中位TTP为3.7个月。患者出现的不良反应有骨髓抑制、皮疹、恶心呕吐、腹泻、肝功能损害、神经毒性等,贝伐单抗所致高血压的发生率为14.3%(3/21),鼻衄发生率为4%(2/21)。结论:二线治疗中使用贝伐单抗,对一线治疗进展后的转移性结直肠癌疗效有限,毒副反应可耐受。     

注射液胸腺法新（日达仙）辅助希罗达联合奥沙利铂（XELOX方案）治疗 晚期胃癌的临床疗效观察

目的:探讨注射液胸腺法新(日达仙)辅助希罗达联合奥沙利铂治疗晚期胃癌的临床疗效和对患者免疫功能及生活质量的影响。方法:选择2010-2013入院治疗的晚期胃癌患者116例,随机平均分为实验组(58例)和对照组(58例)。对照组给予卡培他滨片(希罗达)联合奥沙利铂,试验组在对照组的基础上辅用注射液胸腺法新(日达仙)治疗。每治疗两到三个周期后进行一次系统疗效评估,评估项目包括影像学腹部CT、胸片、腹部彩超、血常规、尿常规、肝功、肾功,肿瘤标记物癌胚抗原(CEA)、糖类抗原(CA19-9,CA72-4)、免疫指标CD3+、CD8+、CD4/CD8、NK细胞,总治疗周期为6-8个周期。结果:实验组疾病治疗有效率为48%,对照组有效率为29%,两组比较差异具有统计学意义(p=0.041),实验组患者中位无疾病进展期(PFS)为12.5月,显著高于对照组10.1月,两组比较具有统计学意义(P0.05)。实验组患者生活质量评分、外周血CD3+、CD8+、CD4/CD8、NK细胞数量均显著优于对照组(P0.05)。结论:注射液胸腺法新(日达仙)辅助希罗达联合奥沙利铂(XELOX方案)能够提高晚期胃癌的临床疗效,改善患者的生活质量和免疫力,减少患者化疗用药的毒副反应。     

吉西他滨联合奥沙利铂对晚期胰腺癌合并肝转移的临床疗效观察

目的:探讨吉西他滨联合奥沙利铂对晚期胰腺癌合并肝转移的临床疗效及其安全性。方法:回顾性研究84例晚期胰腺癌伴有肝转移的患者,根据化疗方案分为实验组和对照组,每组42例,实验组给予吉西他滨联合奥沙利铂化疗(GEMOX方案),对照组给予5-FU化疗,治疗4周后,比较两组临床受益率、治疗有效率、无疾病进展生存期、1年生存率和不良反应的发生情况。结果:当转移癌体积小于肝体积75%时,对照组的临床受益率为6.06%,有效率为12.12%,而实验组的临床受益率为32.26%,有效率为58.06%,与对照组的患者相比均显著升高(P<0.05)。实验组中位无疾病进展生存期为18个周,21%的患者2年内达到无疾病进展,患者的平均生存期为37个周,在1年生存率为35%;而对照组中,中位无疾病进展生存期为9个周,1年生存率为0,实验组1年生存率显著高于对照组者(P<0.05)。两组不良反应发生情况无明显差别。结论:吉西他滨联合奥沙利铂治疗晚期胰腺癌合并肝转移的疗效优于以5-FU为主的化疗,且二组相比不良反应无明显差别,值得临床进一步研究。     

黄连素四联方案补救治疗幽门螺杆菌感染的有效性和安全性

目的:探索黄连素四联方案用于幽门螺杆菌感染根除失败患者补救治疗的有效性及安全性。方法:将经四联方案初次根除治疗失败并自愿接受补救治疗的130例患者按纳入顺序,以1:1的比例分配治疗,随机接受14天黄连素四联(埃索美拉唑20mg+胶体果胶铋200 mg+阿莫西林1000 mg,2/d+黄连素300 mg 3/d)或四环素四联(埃索美拉唑20 mg+胶体果胶铋200 mg+四环素750 mg+呋喃唑酮100 mg,2/d)方案的治疗。所有患者均于治疗14天及治疗结束至少28天后随诊,详细记录患者症状及不良反应情况。治疗结束至少28天后进行13C尿素呼气试验来判断幽门螺杆菌根除情况。结果:65例接受黄连素四联根除治疗,65例接受四环素四联方案治疗。两组分别有6例和4例患者因不良反应服药依从性小于80%,其余患者均完成了14天的治疗。黄连素组和四环素组的幽门螺杆菌根除率ITT分析分别为76.9%(50/65)和81.5%(53/65),P=0.520;PP分析分别为84.7%(50/59)和86.9%(53/61),P=0.739。黄连素组和四环素组不良事件总体发生率分别为49.2%和41.5%,P=0.370。结论:黄连素四联疗法用于幽门螺杆菌感染的二次根除治疗,根除率较高,未明显增加不良事件发生率,是有效及安全的补救治疗方案。     

Impact of Quadruple Regimen of Clarithromycin Added to Metronidazole-Containing Triple Therapy Against Helicobacter pylori Infection Following Clarithromycin-Containing Triple-Therapy Failure

Background: The establishment of an optimal second-line regimen for Helicobacter pylori infection is required. Although quadruple therapy should overcome resistance to either clarithromycin or metronidazole, the effects of a quadruple regimen in second-line therapy are unknown. This study aims to evaluate the efficacy of triple therapy composed of proton pump inhibitor/amoxicillin plus metronidazole with the combined additive effects of clarithromycin as a second-line quadruple therapy against H. pylori infection.
Materials and Methods: Participants were 104 patients in whom first-line therapy containing proton pump inhibitor-amoxicillin-clarithromycin failed. Before starting second-line therapy, patients underwent endoscopy to obtain H. pylori strain for antibiotic susceptibility tests. Patients were randomized to receive rabeprazole (10 mg), amoxicillin (750 mg), and metronidazole (250 mg), either with clarithromycin (200 mg; RAMC group) or without (RAM group); all treatments were administered twice daily for 7 days. H. pylori eradication was confirmed by ¹³C-urea breath tests performed 2 to 3 months post-therapy.
Results: As shown by intention-to-treat/per-protocol analyses, the cure rates for H. pylori infection were 88.5%/93.9% and 82.7%/84.3% for the RAMC and RAM groups. Although the study probably had an insufficient power to show a significant difference between the cure rates of the two regimens, the eradication rates showed a clear trend in favor of the RAMC group. There were no severe side-effects in any group.
Conclusions: In Japan, the RAMC regimen is thought to be a promising alternative strategy for second-line eradication of H. pylori infection.     

A pilot study evaluating sequential administration of a PPI-amoxicillin followed by a PPI-metronidazole-tetracycline in Turkey

BACKGROUND: There is no effective regimen for the eradication of Helicobacter pylori in our country. It may be due to the increasing prevalence of resistance to antibiotics used for the treatment of H. pylori. Recently, a study from Turkey has revealed that a new treatment scheme consisting of sequential administration of pantoprazole plus amoxicillin for 7 days followed by pantoprazole plus metronidazole, and tetracycline for the remaining 7 days was effective in the first-line treatment of H. pylori. Therefore, we aimed to confirm efficacy of a new therapy scheme in the first-line H. pylori eradication. MATERIAL AND METHODS: This is a prospective, open label, single center, pilot study and included 32 patients infected with H. pylori diagnosed by both histologic examinations, rapid urease test and (13)C-urea breath test (UBT). The patients received a 14-day sequential regimen (pantoprazole 40 mg b.d. plus amoxicillin 1000 mg b.d. for 7 days and pantoprazole 40 mg b.d., metronidazole 500 mg b.d. and tetracycline 500 mg q.d. for the remaining 7 days). Eradication was assessed with (13)C-UBT 4 weeks after completion of the therapy. Intention-to-treat and per-protocol eradication rates were determined. RESULTS: At intention-to-treat analysis, the eradication rate was 50% (16/32). For the per protocol analysis, the eradication rate was 57% (16/28). There were no significant adverse effects and treatment compliance was good. CONCLUSION: A new therapy consisting of sequentially administered drugs for 14 days yielded unacceptably low eradication rates. This scheme was not efficient for H. pylori eradication in our region. Further investigations are needed to determine the effectiveness of this scheme in other regions of Turkey.     

Neo-adjuvant chemotherapy ± immunotherapy with s.c. IL 2 in advanced squamous cell carcinoma of the head and neck: A pilot study

We carried out a pilot nonrandomized phase II study to compare the neo-adjuvant chemotherapic regimen with cisplatin, 5-FU and vinorelbine with the same combination plus s.c. IL 2 in advanced head and neck squamous cell carcinoma (HNSCC). The primary goals of the trial were to evaluate the feasibility and response rates of the two regimens. The study design consisted of a patient's assignment to either of the two following arms: Arm A: Cisplatin 80 mg/m² i.v. on day 1; 5-FU 600 mg/m² i.v. on days 2–5; and vinorelbine 20 mg/m² i.v. on days 2 and 8, Arm B: the same chemotherapic regimen plus recombinant IL 2 (Proleukin, Eurocetus) 9 MIU s.c. daily from day 9 to 13 and from day 16 to 20 for every cycle. From March 1993 to November 1993 twenty three patients with Stage III–IV HNSCC were enrolled in the study. Patients could be evaluated for response to treatment if they had received at least 2 complete cycles of therapy. The overall response rate (ORR) was 63% in Arm A and 100% in Arm B. The differences for ORR and CR rates were statistically significant in favor of Arm B. The analysis for each of the three drugs included in the chemotherapy schedule shows that both the actually received average dose-intensity and the actually delivered average cumulative doses/patient were higher for Arm B (chemo- plus IL 2 therapy) (approximately 80% of programmed dose-intensity) than for Arm A (approximately 70% of programmed dose-intensity). Both the actually received average dose-intensity and the actually delivered average cumulative doses/patient for IL 2 were more than 80%. In both arms the most frequent side effects were myelosuppression, phlebitis and electrolyte disturbances. There were 2 toxic deaths, 1 in Arm A and 1 in Arm B, both for hematologic toxicity. Our pilot study suggests that the combination of cisplatin, 5-FU, vinorelbine plus IL 2 is a highly active, but rather toxic, neo-adjuvant treatment in advanced HNSCC with very high ORR and CR rates.