小牛血清去蛋白联合美沙拉嗪栓剂灌肠预防和治疗急性放射性直肠炎的研究
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摘要
目的探索小牛血清去蛋白提取物联合美沙拉嗪对急性放射性肠炎的防治作用,寻找能够有效防治各级放射性直肠炎的理想药物。方法选择2017年1-7月在我院就诊的114例直肠癌术前新辅助治疗患者,随机分为观察组和对照组,每组57例。观察组行放疗+小牛血清去蛋白提取物联合美沙拉嗪保留灌肠,对照组行放疗+美沙拉嗪栓剂保留灌肠。观察两组治疗前后相关血液指标和临床指标的变化。结果治疗后2～5周,观察组C反应蛋白水平低于对照组,两组比较差异有统计学意义(P<0.05)。观察组和对照组的轻度放射性肠炎(Ⅰ～Ⅱ级)发生率分别为22.8%(13/57)和52.7%(30/57),重度放射性肠炎(Ⅲ～Ⅳ级)发生率分别为1.7%(1/57)和12.3%(7/57),两组比较差异有统计学意义(P<0.05)。观察组和对照组因不良反应致治疗中断的比例分别为1.7%(1/57)和12.3%(7/57),两组比较差异有统计学意义(P<0.05)。结论小牛血清去蛋白联合美沙拉嗪栓剂灌肠给药较单用美沙拉嗪栓剂灌肠明显减少了放射性直肠炎的发生,并且降低了C反应蛋白水平,保证了治疗的延续性。
Objective To explore the preventive and therapeutic effects of deproteinized extract of calf blood(DECB) combined with mesalazine on radiation proctitis,and to find an ideal combination of drugs that can effectively prevent and treat various radiation proctitis.Methods Totally 114 patients with rectal cancer treated with neoadjuvant therapy in our hospital from January to July 2017 were selected.They were randomly divided into observation group and control group,57 cases in each group.Patients in observation group received radiotherapy + DECB + mesalazine suppository retention enema,while patients in control group received radiotherapy combined with mesalazine suppository retention enema.The changes of blood and clinical indexes before and after treatment in the two groups were observed.Results The level of C-reactive protein(CRP) of observation group was lower than that of control group at 2～5 weeks after treatment(P<0.05).The incidence rate of mild acute proctitis(levelⅠ～Ⅱ) in observation group and control group were 22.8%(13/57) and 52.7%(30/57),and those of severe acute proctitis(level Ⅲ～Ⅳ) were 1.7%(1/57) and 12.3%(7/57),there being significant difference between the two groups(P<0.05).The proportion of treatment interruption due to adverse reactions in observation group and control group was 1.7%(1/57) and 12.3%(7/57),respectively,and there being significant difference between the two groups(P<0.05).Conclusion Compared with mesalazine suppository retention enema,DECB combined with mesalazine suppository retention enema can significantly reduce the occurrence of radiation proctitis and decrease the level of CRP,and therefore,guarantee the continuity of treatment.
Objective To explore the preventive and therapeutic effects of deproteinized extract of calf blood(DECB) combined with mesalazine on radiation proctitis,and to find an ideal combination of drugs that can effectively prevent and treat various radiation proctitis.Methods Totally 114 patients with rectal cancer treated with neoadjuvant therapy in our hospital from January to July 2017 were selected.They were randomly divided into observation group and control group,57 cases in each group.Patients in observation group received radiotherapy + DECB + mesalazine suppository retention enema,while patients in control group received radiotherapy combined with mesalazine suppository retention enema.The changes of blood and clinical indexes before and after treatment in the two groups were observed.Results The level of C-reactive protein(CRP) of observation group was lower than that of control group at 2～5 weeks after treatment(P<0.05).The incidence rate of mild acute proctitis(levelⅠ～Ⅱ) in observation group and control group were 22.8%(13/57) and 52.7%(30/57),and those of severe acute proctitis(level Ⅲ～Ⅳ) were 1.7%(1/57) and 12.3%(7/57),there being significant difference between the two groups(P<0.05).The proportion of treatment interruption due to adverse reactions in observation group and control group was 1.7%(1/57) and 12.3%(7/57),respectively,and there being significant difference between the two groups(P<0.05).Conclusion Compared with mesalazine suppository retention enema,DECB combined with mesalazine suppository retention enema can significantly reduce the occurrence of radiation proctitis and decrease the level of CRP,and therefore,guarantee the continuity of treatment.
引文
[1] Linard C,Busson E,Holler V,et al. Repeated autologous bone marrow derived mesenchymal stem cell injections improve radiation-induced proctitis in pigs[J].Stem Cells Transl Med,2013,2:916-927.
[2] Sauer R,Becker H,Hohenberger W,et al.Peroperative versus postoperative chemoradiotherapy for rectal cancer[J].N Engl J Med,2004,351:1731-1740.
[3] Hong JJ,Park W,Ehrenpreis ED.Review article:current therapeutic options for radiation proctopathy[J].Aliment Pharmacol Ther,2001,15:1253-1262.
[4] Bondesen S,Rasmussen SN,Rask-Madsen J,et al.5-Aminosalicylic acid in the treatment of infammatory bowel disease[J].Acta Med Scand,1987,221:227-242.
[5] Baum CA,Biddle WL,Miner PB Jr.Failure of 5-aminosalicylic acid enemas to improve chronic radiation proctitis[J].Dig Dis Sci,1989,34:758-760.
[6] 张罗生,何本夫,罗显荣,等.小牛血清去蛋白提取物防治急性放射性直肠炎的临床研究[J].实用医学杂志,2012,28(9):1519-1522.
[7] 张学成,肖锋,魏丽春,等.爱维治防治急性放射性口咽黏膜损伤的临床研究[J].实用口腔医学杂志,2006,12(4):496-498.
[8] Venkitaraman R,Price A,Coffey J,et al.Pentoxifylline to treat radiation proctitis:a small and inconclusive randomised trial[J].Clin Oncol (R Coll Radiol),2008,20:288-292.
[9] Mendenhall NP,Li Z,Hoppe BS,et al.Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer[J].Int J Radiat Oncol Biol Phys,2012,82:213-221.
[10] Sauer R,Liersch T,Merkel S,et al Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer:results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-Up of 11 years[J].J Clin Oncol,2012,30:1926-1933.
[11] Gerard JP,Conroy T,Bonnetain F,et al.(2006) Preoperativeradiotherapy with or without concurrent fluorouracil and leu-covorin in T3-4 rectal cancers:results of FFCD 9203[J].J Clin Oncol,24,4620-4625.
[12] Rubinstein E,IBsen T,Rasmussen RB,et al.Formalin treatment of radiation-induced hemorrhagic proctitis[J].The American Journal of Gastroenterology,1986,81(1):44-45.
[13] Seow-Choen MF,Goh HS,Eu KW,et al.A simple and effective treatment for hemorrhagic radiation proctitis using formalin[J].Diseases of the Colon & Rectum,1993,3(2):135-138.
[14] Hofheinz RD,Wenz F,Post S,et al.Chemoradiotherapy with capecitabine versus fluorouracil for locally advancedrectal cancer:a randomised,multicentre,non-inferiority,phase 3 trial[J].Lancet Oncol,2012,13:579-588.
[15] Seo EH,Kim TO,Kim TG,et al.The efficacy of the combination therapy with oral and topical mesalazine for patients with the first episode of radiation proctitis [J].Digestive Diseases and Sciences,2011,56(9):2672-2677.
[2] Sauer R,Becker H,Hohenberger W,et al.Peroperative versus postoperative chemoradiotherapy for rectal cancer[J].N Engl J Med,2004,351:1731-1740.
[3] Hong JJ,Park W,Ehrenpreis ED.Review article:current therapeutic options for radiation proctopathy[J].Aliment Pharmacol Ther,2001,15:1253-1262.
[4] Bondesen S,Rasmussen SN,Rask-Madsen J,et al.5-Aminosalicylic acid in the treatment of infammatory bowel disease[J].Acta Med Scand,1987,221:227-242.
[5] Baum CA,Biddle WL,Miner PB Jr.Failure of 5-aminosalicylic acid enemas to improve chronic radiation proctitis[J].Dig Dis Sci,1989,34:758-760.
[6] 张罗生,何本夫,罗显荣,等.小牛血清去蛋白提取物防治急性放射性直肠炎的临床研究[J].实用医学杂志,2012,28(9):1519-1522.
[7] 张学成,肖锋,魏丽春,等.爱维治防治急性放射性口咽黏膜损伤的临床研究[J].实用口腔医学杂志,2006,12(4):496-498.
[8] Venkitaraman R,Price A,Coffey J,et al.Pentoxifylline to treat radiation proctitis:a small and inconclusive randomised trial[J].Clin Oncol (R Coll Radiol),2008,20:288-292.
[9] Mendenhall NP,Li Z,Hoppe BS,et al.Early outcomes from three prospective trials of image-guided proton therapy for prostate cancer[J].Int J Radiat Oncol Biol Phys,2012,82:213-221.
[10] Sauer R,Liersch T,Merkel S,et al Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer:results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-Up of 11 years[J].J Clin Oncol,2012,30:1926-1933.
[11] Gerard JP,Conroy T,Bonnetain F,et al.(2006) Preoperativeradiotherapy with or without concurrent fluorouracil and leu-covorin in T3-4 rectal cancers:results of FFCD 9203[J].J Clin Oncol,24,4620-4625.
[12] Rubinstein E,IBsen T,Rasmussen RB,et al.Formalin treatment of radiation-induced hemorrhagic proctitis[J].The American Journal of Gastroenterology,1986,81(1):44-45.
[13] Seow-Choen MF,Goh HS,Eu KW,et al.A simple and effective treatment for hemorrhagic radiation proctitis using formalin[J].Diseases of the Colon & Rectum,1993,3(2):135-138.
[14] Hofheinz RD,Wenz F,Post S,et al.Chemoradiotherapy with capecitabine versus fluorouracil for locally advancedrectal cancer:a randomised,multicentre,non-inferiority,phase 3 trial[J].Lancet Oncol,2012,13:579-588.
[15] Seo EH,Kim TO,Kim TG,et al.The efficacy of the combination therapy with oral and topical mesalazine for patients with the first episode of radiation proctitis [J].Digestive Diseases and Sciences,2011,56(9):2672-2677.