Ito Tetsuya, Hanafusa Norio, Iwase Satoru, Noiri Eisei, Nangaku Masaomi, Nakagawa Keiichi, Miyagawa Kiyoshi
Department of Palliative Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan,
Int J Clin Oncol. 2015 Jun;20(3):623-8. doi: 10.1007/s10147-014-0750-y. Epub 2014 Sep 20.
It is expected that cell-free and concentrated ascites reinfusion therapy (CART) will relieve the symptoms caused by ascites. To date, however, no report of objective changes in patients' symptoms has been published. We have therefore evaluated symptom management by CART.
From April 2011 to July 2012, 37 patients at our hospital, most of whom had malignancies, received CART. Symptom severity was evaluated in each patient 24 h before and after the first CART procedure using a numerical rating scale for abdominal tension and the Japanese version of the M. D. Anderson Symptom Inventory (MDASI-J) for various symptoms.
CART significantly improved the scores for abdominal tension and the symptom and interference scores of the MDASI-J within 24 h of the procedure. The abdominal tension scores decreased from 7.19 to 3.81 (p < 0.001), the symptom scores of the MDASI-J decreased from 4.73 to 2.75 and the interference scores of the MDASI-J decreased from 7.05 to 5.12. Detailed investigation revealed many symptoms, including fatigue and gastric symptoms, which are the usual targets of paracentesis, as well as general symptoms. No significant correlation between improved scores and the amount of reinfused protein or ascites removed was observed. Patients experienced no severe adverse event.
Among the 37 patients receiving CART, various symptoms related to malignant ascites, especially fatigue, improved within the 24-h period following CART. Factors that ameliorate these symptoms remain to be elucidated.
无细胞浓缩腹水回输疗法（CART）有望缓解腹水所致症状。然而，迄今为止，尚无关于患者症状客观变化的报道。因此，我们对CART的症状管理进行了评估。
2011年4月至2012年7月，我院37例患者接受了CART治疗，其中大多数患有恶性肿瘤。在首次CART治疗前和治疗后24小时，使用腹内压数字评分量表和日本版安德森症状问卷（MDASI-J）评估每位患者的症状严重程度。
CART在治疗后24小时内显著改善了腹内压评分以及MDASI-J的症状和干扰评分。腹内压评分从7.19降至3.81（p<0.001），MDASI-J的症状评分从4.73降至2.75，MDASI-J的干扰评分从7.05降至5.12。详细调查发现，许多症状包括疲劳和胃部症状（这些是通常进行腹腔穿刺术的目标症状）以及全身症状均有改善。改善的评分与回输蛋白量或抽出腹水的量之间未观察到显著相关性。患者未发生严重不良事件。
在接受CART治疗的37例患者中，与恶性腹水相关的各种症状，尤其是疲劳，在CART治疗后的24小时内有所改善。改善这些症状的因素仍有待阐明。
