去甲斑蝥素片辅助ERCP治疗食管癌的应用研究

doi:10.3760/cma.j.issn.1007-1245.2023.23.012

摘要/Abstract

摘要：

目的　观察去甲斑蝥素片辅助内镜逆行胰胆管造影术（retrograde cholangiopancreatography，ERCP）治疗食管癌对术后胆道感染的防治效果。方法　本文为前瞻性研究。选取2021年5月至2022年12月南阳医学高等专科学校第一附属医院收治的115例食管癌患者为研究对象，采用电脑随机分组法将入组患者分为对照组（57例）和观察组（58例）。对照组男34例、女23例，年龄（61.22±5.32）岁，采用ERCP治疗；观察组男35例、女23例，年龄（60.45±5.17）岁，采用去甲斑蝥素片辅助ERCP治疗。对比两组患者炎症因子、免疫功能指标、血清肿瘤标志物水平及术后不良事件发生情况。采用t检验、χ²检验。结果　治疗前，两组患者炎症因子、免疫功能指标及血清肿瘤标志物水平比较，差异均无统计学意义（均P>0.05）。治疗后，观察组肿瘤坏死因子-α（TNF-α）［（3.52±0.46）ng/L］、白细胞介素-6（IL-6）［（135.45±10.69）ng/L］、IL-8 ［（15.22±5.24）μg/L］均低于对照组［（4.79±1.24）ng/L、（140.77±10.88）ng/L、（18.44±5.27）μg/L］，差异均有统计学意义（t=7.306、2.645、3.286，均P<0.05）。治疗后，观察组总T细胞（CD3）［（65.29±10.76）%］、干扰素-γ（IFN-γ）［（10.21±3.44）ng/L］、IL-12 ［（61.25±10.71）μg/L］均高于对照组［（60.77±10.31）%、（8.24±2.39）ng/L、（56.25±10.15）μg/L］，差异均有统计学意义（t=2.300、3.561、2.569，均P<0.05）。治疗后，观察组癌胚抗原（CEA）［（4.24±1.36）μg/L］、糖类抗原19-9（CA19-9）［（7.49±2.11）U/ml］、糖类抗原50（CA50）［（5.11±1.27）μg/L］均低于对照组［（5.82±1.25）μg/L、（10.61±4.24）U/ml、（7.25±2.14）μg/L］，差异均有统计学意义（t=6.483、5.009、6.535，均P<0.05）。治疗后，观察组不良事件发生率为6.90%（4/58），低于对照组［17.54%（10/57）］，差异有统计学意义（χ²=5.277，P<0.05）。结论　去甲斑蝥素片辅助ERCP能有效缓解食管癌患者炎症反应并增强机体免疫功能，同时还可下调肿瘤标志物水平并降低胆道感染等不良事件发生风险。

关键词:

食管癌, 逆行胰胆管造影术, 去甲斑蝥素片, 胆道感染, 免疫功能

Abstract:

Objective　To observe the control efficiency of norcantharidin tablets assisted endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of esophageal cancer on postoperative biliary tract infection. Methods　This study selected 115 esophageal cancer patients admitted to the First Affiliated Hospital of Nanyang Medical College from May 2021 to December 2022 as the research subjects. The enrolled patients were randomly divided into an observation group [58 cases, 35 males and 23 females, aged (60.45±5.17) years] and a control group [57 cases, 34 males and 23 females, aged (61.22±5.32) years] using computer randomization. The control group was treated with ERCP, and the observation group was treated with norcantharidin tablets as an adjunct to ERCP. The inflammatory indexes, immune function indexes, tumor markers, and postoperative adverse events were compared between the two groups. t test and χ² test were used. Results　Before treatment, there were no statistically significant differences in the levels of inflammatory indexes, immune function indexes, and tumor markers between the two groups (all P>0.05). After treatment, the levels of tumor necrosis factor-α (TNF-α) [(3.52±0.46) ng/L], interleukin-6 (IL-6) [(135.45±10.69) ng/L], and IL-8 [(15.22±5.24) μg/L] in the observation group were lower than those in the control group [(4.79±1.24) ng/L, (140.77±10.88) ng/L, and (18.44±5.27) μg/L], with statistically significant differences (t=7.306, 2.645, and 3.286; all P<0.05). After treatment, the levels of total T cells (CD3) [(65.29±10.76)%], interferon-γ (IFN-γ) [(10.21±3.44) ng/L], and IL-12 [(61.25±10.71) μg/L] in the observation group were higher than those in the control group [(60.77±10.31)%, (8.24±2.39) ng/L, and (56.25±10.15) μg/L], with statistically significant differences (t=2.300, 3.561, and 2.569; all P<0.05). After treatment, the levels of carcinoembryonic antigen (CEA) [(4.24±1.36) μg/L], carbohydrate antigen 19-9 (CA19-9) [(7.49±2.11) U/ml], and carbohydrate antigen 50 (CA50) [(5.11±1.27) μg/L] in the observation group were lower than those in the control group [(5.82±1.25) μg/L, (10.61±4.24) U/ml, and (7.25±2.14) μg/L], with statistically significant differences (t=6.483, 5.009, and 6.535; all P<0.05). After treatment, the incidence of adverse events in the observation group was 6.90% (4/58), which was lower than that in the control group [17.54% (10/57)], with a statistically significant difference (χ²=5.277, P<0.05). Conclusion　Norcantharidin tablets assisted with ERCP can effectively alleviate the inflammatory response and enhance the immune function in patients with esophageal cancer, while also can downregulate the tumor marker levels and reduce the risk of adverse events such as biliary tract infection.

Key words:

Esophageal cancer, Retrograde cholangiopancreatography, Norcantharidin tablets, Biliary tract infection, Immunity

冯冬冬杨明真.

去甲斑蝥素片辅助ERCP治疗食管癌的应用研究 [J]. 国际医药卫生导报, 2023, 29(23): 3374-3378.

Feng Dongdong, Yang Mingzhen.

Application of norcantharidin tablets in assisted ERCP surgery for esophageal cancer [J]. International Medicine and Health Guidance News, 2023, 29(23): 3374-3378.

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