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[血管紧张素诱导性高血压化疗(IHC)的临床研究]

[Clinical study on angiotensin-induced hypertension chemotherapy (IHC)].

作者信息

Sato H, Hoshi M, Wakui A

出版信息

Gan To Kagaku Ryoho. 1986 Apr;13(4 Pt 2):1439-47.

PMID:3729461
Abstract

It has been found in experiments using rats that there is a lack of autoregulation of blood flow in tumor vessels and a selective increase of blood flow under angiotensin II-induced hypertension when the arterial blood pressure dose not exceed 150 mmHg, while there is no increase in normal tissues (Suzuki et al., JNCI:1981). On the basis of the functional difference of microcirculation, IHC has been developed clinically since 1978. In the procedure of treatment, the mean blood pressure of the patients was maintained at 140-150 mmHg when anti-cancer drugs were administered along with the continuous intravenous infusion of angiotensin II. In a randomized controlled study on gastric carcinoma treated with an AFM regimen, the response rate was 42.5% (8/21) in IHC vs. 10.5% (2/19) in non-IHC (p less than 0.05). The "initial response time" (15.5 vs. 28.8 days) and the "effective tumor reduction time" (36.7 vs. 57.5 days) were significantly shorter (p less than 0.01) in the IHC group. Frequency and grade of side effects were not different statistically. In an open trial, the overall response rate was 39.6% (54/134) and each response was closely related to the difference of drug sensitivity of tumor types. For example, it was 90.0% (9/10) in cancers of the head & neck, 66.7% (4/6) in the breast, 42.8% (12/28) in the stomach, 46.2% (6/13) in the pancreas, 23.1% (3/13) in the colon and 23.8% (5/21) in the lung. The effect on metastatic lymphnodes was 79.4% (27/34), which was higher than that of primary (48.1% : 26/54) and other organ metastases (34.6% : 18/52). Finally, this paper dealt with the problem of clinical evaluation of tumor lesions with a lot of fibrous granulation tissue and coagulative necrosis, and of the investigation of differential imaging.

摘要

在使用大鼠的实验中发现,肿瘤血管中存在血流自身调节缺失的情况,并且在动脉血压不超过150 mmHg时,血管紧张素II诱导的高血压会导致肿瘤血流选择性增加,而正常组织中血流并无增加(铃木等人,《美国国家癌症研究所杂志》:1981年)。基于微循环的功能差异,免疫组织化学自1978年起已应用于临床。在治疗过程中,当抗癌药物与血管紧张素II持续静脉输注同时给药时,患者的平均血压维持在140 - 150 mmHg。在一项关于采用AFM方案治疗胃癌的随机对照研究中,免疫组织化学组的缓解率为42.5%(8/21),而非免疫组织化学组为10.5%(2/19)(p小于0.05)。免疫组织化学组的“初始反应时间”(15.5天对28.8天)和“有效肿瘤缩小时间”(36.7天对57.5天)显著更短(p小于0.01)。副作用的频率和分级在统计学上没有差异。在一项开放试验中,总体缓解率为39.6%(54/134),且每种反应与肿瘤类型的药物敏感性差异密切相关。例如,在头颈部癌症中为90.0%(9/10),在乳腺癌中为66.7%(4/6),在胃癌中为42.8%(12/28),在胰腺癌中为46.2%(6/13),在结肠癌中为23.1%(3/13),在肺癌中为23.8%(5/21)。对转移性淋巴结的疗效为79.4%(27/34),高于对原发性肿瘤(48.1%:26/54)和其他器官转移灶(34.6%:18/52)的疗效。最后,本文探讨了伴有大量纤维肉芽组织和凝固性坏死的肿瘤病变的临床评估问题以及鉴别成像的研究。

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