刘人杰

【摘要】 目的：探討索拉菲尼治疗原发性肝癌（PLC）的效果及对患者血清热休克蛋白90α（HSP90α）、血管内皮生长因子（VEGF）水平的影响。方法：选取2018年1-12月本院收治的不可手术切除的PLC患者63例为观察对象。按照治疗方式分为对照组（n=31）和观察组（n=32）。对照组采用肝动脉化疗栓塞术（TACE）治疗，观察组在TACE基础上口服索拉菲尼治疗。比较两组疗效、瘤体体积、血清HSP90α、VEGF、安全性、生存情况、总生存期。结果：两组ORR比较，差异无统计学意义（P>0.05）;观察组DCR为81.25%，高于对照组的58.06%，差异有统计学意义（P<0.05）。随着治疗时间延长，两组瘤体体积均减小，差异均有统计学意义（P<0.05）。治疗4、12周后，观察组瘤体体积均小于对照组，差异均有统计学意义（P<0.05）。治疗12周后，两组血清HSP90α、VEGF水平均下降，且观察组均低于对照组，差异均有统计学意义（P<0.05）。两组胃肠道反应、骨髓抑制发生率比较，差异均无统计学意义（P>0.05）;观察组高血压、皮肤黏膜反应发生率均高于对照组，差异均有统计学意义（P<0.05）。观察组1、2年生存率均高于对照组，总生存期较对照组延长，差异均有统计学意义（P<0.05）。结论：索拉菲尼治疗原发性肝癌能提高疾病控制效果，降低血清HSP90α、VEGF水平，减小病灶，减轻肿瘤负荷，提高生存率，延长生存期，但会增加高血压、皮肤黏膜反应，应密切观察，及时控制，确保治疗顺利进行。

【关键词】 索拉菲尼 原发性肝癌 HSP90α VEGF 安全性 生存期

Effect of Sorafenib in the Treatment of Primary Liver Cancer and Its Influence on Serum HSP90α and VEGF Levels/LIU Renjie. //Medical Innovation of China， 2021， 18（14）： 0-019

[Abstract] Objective： To investigate the effect of Sorafenib in the treatment of primary liver cancer （PLC） and its influence on the serum levels of heat shock protein 90α （HSP90α） and vascular endothelial growth factor （VEGF）. Method： A total of 63 unresectable PLC patients admitted to our hospital from January to December 2018 were selected as the observation objects. According to the treatment methods， they were divided into control group （n=31） and observation group （n=32）. The control group was treated with hepatic arterial chemoembolization （TACE）， and the observation group was treated with oral Sorafenib on the basis of TACE. The curative effect， tumor volume， serum HSP90α， VEGF， safety， survival， median survival and overall survival were compared between the two groups. Result： There was no significant difference in ORR between the two groups （P>0.05）. The DCR of the observation group was 81.25%， higher than 58.06% of the control group， the difference was statistically significant （P<0.05）. With the prolongation of treatment time， the tumor volume of both groups decreased， the differences were statistically significant （P<0.05）. After 4 and 12 weeks of treatment， the tumor volume in the observation group were smaller than those in the control group， the differences were statistically significant （P<0.05）. After 12 weeks of treatment， serum levels of HSP90α and VEGF were decreased in both groups， and the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. There were no significant differences in the incidence of gastrointestinal reactions and bone marrow suppression between the two groups （P>0.05）. The incidence of hypertension and skin mucosal reaction in the observation group was higher than that in the control group， the differences were statistically significant （P<0.05）. 1 year and 2 years survival rates of the observation group were higher than those of the control group， overall survival time of the observation group was longer than that of the control group， the differences were statistically significant （P<0.05）. Conclusion： Sorafenib treatment of primary liver cancer can improve the disease control effect， reduce serum HSP90α and VEGF levels， reduce the focus， reduce the tumor load， improve the survival rate， prolong the survival period， but will increase hypertension， skin mucosal reaction， should be closely observed， timely control， to ensure the smooth treatment.

[Key words] Sorafenib Primary liver cancer HSP90α VEGF Safety Survival time

First-authors address： Jiamusi Tuberculosis Hospital， Jiamusi 154007， China

doi：10.3969/j.issn.1674-4985.2021.14.004

原发性肝癌（PLC）为我国常见的恶性肿瘤之一，据报道2018年我国肝癌发病率（9.20%）、死亡率（12.90%）分别居恶性肿瘤的第4位、第3位[1]。由于PLC起病隐匿，不易发现，多数患者确诊时已发展为中晚期，错失了最佳手术治疗机会，手术切除效果差，难以达到根治的效果[2-3]。目前对不可手术的PLC患者，标准治疗方法是肝动脉化疗栓塞术（TACE），其通过使用栓塞剂封闭肿瘤的主要供血血管，抑制肿瘤生长，促进肿瘤坏死，达到治疗目的[4-5]。但经TACE治疗后的PLC患者预后仍欠佳，其中重要原因是TACE难以完全阻断肿瘤供血血管，而且栓塞后肿瘤局部发生缺血缺氧会刺激大量血管内皮生长因子（VEGF）产生，促进新生血管形成，继续向肿瘤供血，最终导致PLC患者的病情恶化[6-7]。索拉菲尼是一种肿瘤靶向治疗药物，本研究观察了索拉菲尼治疗PLC的效果及对患者血清热休克蛋白90α（HSP90α）、VEGF水平的影响，现报道如下。