Application of sodium hyaluronate in intravesical instillation of pirarubicin hydrochloride in the treatment of bladder cancer
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摘要: 目的 分析透明质酸钠联合盐酸吡柔比星膀胱灌注治疗膀胱癌患者的效果。方法 选取2020年1月—2021年3月廊坊市人民医院膀胱癌患者88例，采用随机分组法，分为观察组(44例)和对照组(44例)。两组均行经尿道膀胱肿瘤电切术，术后对照组采用盐酸吡柔比星膀胱灌注治疗，观察组在对照组基础上联合透明质酸钠膀胱灌注。治疗前、治疗4周、治疗8周评估膀胱过度活动症状改善情况，同时以酶联免疫法检测尿白细胞介素-6(IL-6)、CXC趋化因子配体-10(CXCL-10)及血清血管内皮生长因子(VEGF)、成纤维细胞生长因子(FGF)水平，以视觉模拟评分法评估疼痛程度，统计治疗期间不良反应发生情况及复发率。结果 治疗4周、8周观察组膀胱过度活动症状较对照组轻微(P < 0.05)；治疗4周、8周两组尿IL-6、CXCL-10水平均降低，观察组低于对照组(P < 0.05)；治疗4周观察组疼痛程度较对照组轻微(P < 0.05)；观察组泌尿系统异常发生率低于对照组(P < 0.05)；治疗4周、8周两组血清VEGF、FGF水平均低于治疗前，且治疗8周低于治疗4周(P < 0.05)，但组间比较差异无统计学意义(P>0.05)；观察组复发率为2.27%(1/44)，对照组复发率为4.55%(2/44)，比较差异无统计学意义(P>0.05)。结论 透明质酸钠联合盐酸吡柔比星膀胱灌注治疗膀胱癌患者，可降低不良反应发生率，缩短尿痛缓解时间，抑制炎症反应，缓解膀胱过度活动症状，安全可靠。Abstract: Objective To analyze the effect of sodium hyaluronate combined with pirarubicin hydrochloride intravesical instillation in patients with bladder cancer.Methods A total of 88 patients with bladder cancer in Langfang People's Hospital from January 2020 to March 2021 were selected and they were randomly divided into observation group (n=44) and control group (n=44). Both groups underwent transurethral resection of bladder tumor. After the operation, the control group was treated with intravesical infusion of pirarubicin hydrochloride, and the observation group was treated with intravesical infusion of sodium hyaluronate on the basis of the control group. The improvement of symptoms of overactive bladder was evaluated before treatment, 4 weeks after treatment, and 8 weeks after treatment. At the same time, enzyme-linked immunosorbent assay was used to detect urinary interleukin-6 (IL-6), CXC chemokine ligand-10 (CXCL-10) and serum vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) level. The degree of pain was assessed by visual analog scale, and the incidence of adverse reactions and recurrence rate during the treatment period were counted.Results The symptoms of overactive bladder in the observation group were milder than those in the control group for 4 weeks and 8 weeks after treatment (P < 0.05). The levels of urinary IL-6 and CXCL-10 in the two groups decreased after 4 weeks and 8 weeks of treatment, and the observation group were lower than the control group (P < 0.05). After 4 weeks of treatment, the pain degree in the observation group was milder than that in the control group (P < 0.05). The incidence of urinary system abnormalities in the observation group was lower than that in the control group (P < 0.05). The levels of serum VEGF and FGF in the two groups were lower than those before treatment at 4 and 8 weeks of treatment, and the 8-week treatment was lower than the 4-week treatment (P < 0.05), but there was no significant difference between the groups (P > 0.05). The recurrence rate of the observation group was 2.27% (1/44) and the control group was 4.55% (2/44), and there was no significant difference (P > 0.05).Conclusion Sodium hyaluronate combined with pirarubicin hydrochloride intravesical instillation in the treatment of bladder cancer patients can reduce the incidence of adverse reactions, shorten the relief time of odynuria, inhibit inflammatory response, and relieve symptoms of overactive bladder, so it is safe and reliable.
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表 1 两组一般资料比较
X±S 项目 观察组(44例) 对照组(44例) t/Z/χ2 P 性别/例(%) 0.210 0.647 男 31(70.45) 29(65.91) 女 13(29.55) 15(34.09) 年龄/岁 57.84±7.12 56.21±6.73 1.104 0.273 肿瘤分期/例(%) 0.481 0.488 Ta 29(65.91) 32(72.73) T1 15(34.09) 12(27.27) 肿瘤直径/cm 3.08±0.65 2.89±0.71 1.309 0.194 体重指数/(kg·m-2) 22.76±3.14 22.35±3.43 0.545 0.560 肿瘤病灶/例(%) 0.202 0.653 单发 28(63.64) 30(68.18) 多发 16(36.36) 14(31.82) 分化程度/例(%) 0.189 0.910 高分化 20(45.45) 22(50.00) 中分化 15(34.09) 14(31.82) 低分化 9(20.45) 8(18.18) 
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表 2 两组膀胱过度活动症状比较
例(%) 组别 治疗前 治疗4周 治疗8周 观察组(44例) 轻度 3(6.82) 19(43.18) 32(72.73) 中度 20(45.45) 16(36.36) 12(27.27) 重度 21(47.73) 9(20.45) 0(0) 对照组(44例) 轻度 4(9.09) 8(18.18) 18(40.91) 中度 22(50.00) 22(50.00) 25(56.82) 重度 18(40.91) 14(31.82) 1(2.27) Z 0.613 2.140 2.635 P 0.540 0.032 0.008
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表 3 两组疼痛程度比较
例(%) 组别 治疗前 治疗4周 治疗8周 观察组(44例) 优 8(18.18) 31(70.45) 41(93.18) 良 27(61.36) 13(29.55) 3(6.82) 可 9(20.45) 0(0) 0(0) 差 0(0) 0(0) 0(0) 对照组(44例) 优 11(25.00) 20(45.45) 38(86.36) 良 25(56.82) 23(52.27) 6(13.64) 可 8(18.18) 1(2.27) 0(0) 差 0(0) 0(0) 0(0) Z 0.592 2.086 0.554 P 0.554 0.037 0.580
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表 4 两组炎症递质比较
X±S 组别 IL-6/(pg·mL-1) CXCL-10/(pg·mL-1) 治疗前 治疗4周 治疗8周 治疗前 治疗4周 治疗8周 观察组(44例) 28.45±4.14 16.78±3.291)3) 10.58±2.151)2)3) 86.37±9.48 59.44±6.371) 45.38±5.111)2)3) 对照组(44例) 27.83±4.46 19.56±3.811) 13.62±2.631)2) 84.16±10.04 66.39±6.841) 50.21±6.031)2) F组间/时间/交互 8.061/9.583/7.441 9.572/10.675/8.124 P组间/时间/交互 0.001/ < 0.001/0.003 < 0.001/ < 0.001/0.001 与同组治疗前比较，1)P < 0.05；与同组治疗4周比较，2)P < 0.05；与同期对照组比较，3)P < 0.05。
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表 5 两组不良反应发生情况比较
例(%) 指标 观察组(44例) 对照组(44例) χ2 P 1~2级 3~4级 1~2级 3~4级 泌尿系统异常 5.091 0.024 血尿 1(2.27) 0 3(6.82) 1(2.27) 尿频 1(2.27) 0 4(9.09) 1(2.27) 骨骼抑制 4(9.09) 0 6(13.64) 0 0.451 0.502 消化系统异常 5(11.36) 1(2.27) 4(9.09) 1(2.27) 0.104 0.747 心血管系统异常 2(4.55) 0 1(2.27) 0 < 0.001 1.000
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表 6 两组细胞生长因子比较
X±S 组别 VEGF/(μg·L-1) FGF/(pg·L-1) 治疗前 治疗4周 治疗8周 治疗前 治疗4周 治疗8周 观察组(44例) 335.18±41.06 176.34±26.781) 89.65±10.371)2) 18.52±3.11 13.62±2.871) 9.19±2.051)2) 对照组(44例) 329.61±44.12 180.24±29.151) 93.44±14.121)2) 18.31±3.29 13.75±2.941) 9.54±2.181)2) F组间/时间/交互 1.873/5.764/1.249 2.037/6.158/1.386 P组间/时间/交互 0.149/0.011/0.164 0.132/0.009/0.161 与同组治疗前比较，1)P < 0.05；与同组治疗4周比较，2)P < 0.05。
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