杨本鑫 杜园 聂双发 李磊 费建东

[摘要] 目的 分析循環腹腔热灌注化疗（CHPPC）联合静脉化疗对老年胃癌患者治疗的临床效果及对患者血清骨桥蛋白（OPN）、nm23H1蛋白表达的影响。 方法 选取2016年1月～2017年1月河北北方学院附属第一医院收治的80例老年胃癌患者，并采用随机信封法分为观察组和对照组，每组40例。对照组采用常规静脉化疗方案进行治疗，观察组采用CHPPC联合静脉化疗方案进行治疗，在治疗结束8周后对治疗短期效果进行评估，并比较两组血清中癌胚抗原（CEA）、糖链抗原（CA242）、糖链抗原19-9（CA199）、OPN、nm23H1蛋白表达水平。 结果 治疗后，观察组治疗总有效率显著高于对照组，差异有高度统计学意义（P < 0.01）；治疗后，两组患者清中CEA、CA199及CA242水平均低于治疗前（P < 0.05），且观察组低于对照组（P < 0.05）；治疗后，两组患者血清中OPN水平低于治疗前（P < 0.05），nm23H1蛋白表达水平高于治疗前（P < 0.05），且观察组血清中OPN水平低于对照组（P < 0.05），nm23H1蛋白表达水平高于对照组（P < 0.05）。 结论 老年胃癌患者采用CHPPC联合静脉化疗方案治疗后可有效提高临床疗效，并改善血清中OPN及nm23H1水平，具有广泛临床意义。

[关键词] 循环腹腔热灌注化疗；静脉化疗；老年胃癌；骨桥蛋白；nm23H1

[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0171-04

[Abstract] Objective To analyze the effect of continuous hyperthermic peritoneal perfusion chemotherapy （CHPPC） combined with intravenous chemotherapy on the treatment of elderly patients with gastric cancer and the influence of expression of OPN and nm23H1 protein in the serum of the patients. Methods From January 2016 to January 2017， 80 elderly patients with gastric cancer in the First Affiliated Hospital of Hebei North University were selected， and divided into observation group and control group by random envelope method， with 40 cases in each group. The control group was treated with conventional intravenous chemotherapy， observation group was treated with CHPPC combined with intravenous chemotherapy， and the short-term efficacy of the treatment was evaluated 8 weeks after treatment， the serum CEA CA242， CA199， OPN， nm23H1 protein expression level between two groups were compared. Results After treatment， the total effective rate in observation group was higher than control group， the difference was highly statistically significant （P < 0.01）. After treatment， the serum CEA CA242， CA199 level of patients in both groups were lower than those before treatment （P < 0.05）， and observation group were lower than those control group （P < 0.05）. After treatment， the serum OPN level of patients in both groups was lower than before treatment （P < 0.05）， nm23H1 protein expression level was higher than before treatment （P < 0.05）， and the serum OPN level in the observation group was lower than control group （P < 0.05）， nm23H1 protein expression level was higher than control group （P < 0.05）. Conclusion Elderly patients with gastric cancer treated with CHPPC combined with intravenous chemotherapy can effectively improve the clinical efficacy and improve serum OPN and nm23H1 levels， and it has extensive clinical significance.

[Key words] CHPPC； Intravenous chemotherapy； Elderly gastric cancer； OPN； Nm23H1

有研究指出，在全球恶性肿瘤中胃癌是发病率及死亡率均较高的肿瘤之一，可能严重影响人类健康[1]。此外，随着人口老龄化趋势加剧，及生活方式改变，使得胃癌发病率及死亡率呈增加趋势[2]。由于我国肿瘤诊断技术有限，早期筛查起步晚，使得多数患者在确诊后多以处于中晚期[3]。进展期胃癌患者可采用规范肿瘤根治术与合理的辅助治疗，虽然具有较好的临床疗效，但仍有40%患者可能出现腹腔内复发转移，大大降低患者5年生存率[4]。目前临床中常采用循环腹腔热灌注化疗（continuous hyperthermic peritoneal perfusion chemotherapy，CHPPC）方案对术后腹腔内复发转移患者进行治疗，具有实质性疗效[6]。采用CHPPC治疗时不仅可通过高热有效抑制肿瘤细胞生长，还有利于通过热动力学效应辅助肿瘤药物扩散。……