鞘注不同剂量甲氨蝶呤治疗脑膜癌病的疗效及安全性临床观察及脑膜癌病肿瘤微环境初探索

《鞘注不同剂量甲氨蝶呤治疗脑膜癌病的疗效及安全性临床观察及脑膜癌病肿瘤微环境初探索》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、授予单位代码10089学号或申请号20153210中国图书分类号R739.45HebeiMedicalUniversity硕士学位论文专业学位鞘注不同剂量甲氨蝶呤治疗脑膜癌病的疗效及安全性临床观察及脑膜癌病肿瘤微环境初探索研究生：韩玮欣导师：卜晖教授何俊瑛教授专业：神经病学二级学院：河北医科大学第二医院2018年3月目录中文摘要···················································································1英文摘要·························

2、··························································2英文缩写···················································································4研究论文鞘注不同剂量甲氨蝶呤治疗脑膜癌病的疗效及安全性临床观察及脑膜癌病肿瘤微环境初探索····················································5前言································

3、····················································5材料与方法···········································································6结果····················································································8附图·······················································

4、·····························15讨论····················································································29结论····················································································33参考文献···································································

5、···········33附录····················································································37综述脑膜癌病的转移机制及诊治现状·············································38致谢·························································································56个人简历·················

6、··································································57中文摘要鞘注不同剂量甲氨蝶呤治疗脑膜癌病的疗效及安全性临床观察及脑膜癌病肿瘤微环境初探索摘要目的:本研究旨在探讨鞘注不同剂量甲氨蝶呤（methotrexate,MTX）治疗脑膜癌病的临床疗效、安全性及生存期，以提高诊治水平，并探索脑膜癌病肿瘤微环境。方法：对72例脑膜癌病患者的临床资料及脑脊液实验室检查进行回顾性分析，分析鞘注不同剂量MTX的疗效、不良反应及预后，以及脑脊液中激活性单核细胞增多与腰穿压力、蛋白、肿瘤细

7、胞含量、KPS评分之间的相关性。结果：72例患者中，鞘注15mgMTX组临床症状缓解率（71.4%）高于10mg组（36.8%）（P=0.005），但脑脊液压力、常规及生化改变两者间无统计学差异。住院期间86.4%患者鞘注后无不适症状，6.1%分别出现恶心、呕吐、发热、大汗或癫痫，7.6%出现了血白细胞降低，但均同时接受了放化疗治疗。本组患者总中位生存期为15.57周，鞘内化疗联合靶向药物组患者生存率高于未联合靶向药物组患者（P=0.008）。脑脊液中肿瘤细胞含量与激活性单核细胞含量之间的spearman相关系数为r=-0.337，P=0.024，有

8、统计学意义。结论：1.鞘内化疗治疗脑膜癌病安全有效，同时鞘注15mg甲氨蝶呤联合口服靶向药物更能有效缓解患者