切换至 "中华医学电子期刊资源库"

中华脑科疾病与康复杂志(电子版) ›› 2021, Vol. 11 ›› Issue (04) : 204 -208. doi: 10.3877/cma.j.issn.2095-123X.2021.04.004

脑科疾病与康复

贝伐单抗治疗难治性脑水肿临床效果研究
程龙阳1, 李韶雅1, 陈春雷1, 王娟1, 徐曼曼1, 代海滨1, 赵鹏来1,()   
  1. 1. 210008 南京,南京大学医学院附属鼓楼医院神经外科
  • 收稿日期:2021-08-11 出版日期:2021-08-15
  • 通信作者: 赵鹏来
  • 基金资助:
    南京市卫生青年人才培养工程(QRX17084)

Clinical study of bevacizumab in the treatment of refractory cerebral edema

Longyang Cheng1, Shaoya Li1, Chunlei Chen1, Juan Wang1, Manman Xu1, Haibin Dai1, Penglai Zhao1,()   

  1. 1. Department of Neurosurgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
  • Received:2021-08-11 Published:2021-08-15
  • Corresponding author: Penglai Zhao
引用本文:

程龙阳, 李韶雅, 陈春雷, 王娟, 徐曼曼, 代海滨, 赵鹏来. 贝伐单抗治疗难治性脑水肿临床效果研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2021, 11(04): 204-208.

Longyang Cheng, Shaoya Li, Chunlei Chen, Juan Wang, Manman Xu, Haibin Dai, Penglai Zhao. Clinical study of bevacizumab in the treatment of refractory cerebral edema[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(04): 204-208.

目的

观察贝伐单抗治疗难治性脑水肿的临床效果。

方法

选择南京大学医学院附属鼓楼医院神经外科重症监护病房自2020年7月至2021年6月收治的8例经常规脱水和激素等处理1周后仍表现为难治性脑水肿患者为研究对象。所有患者予以贝伐单抗200 mg,于无菌技术下采用生理盐水250 mL稀释至0.8 mg/mL,持续静脉滴注维持90 min以上。比较患者用药前后脑水肿量及GCS评分改善情况。

结果

对于难治性脑水肿患者,贝伐单抗可明显改善脑水肿,用药后2 d影像学检查提示脑水肿较前改善;用药1周后测量脑水肿量较用药前缓解,GCS评分高于用药前。

结论

贝伐单抗治疗神经外科难治性脑水肿效果显著,可减轻脑水肿,改善患者临床预后。

Objective

To observe the clinical effect of bevacizumab in the treatment of refractory brain edema.

Methods

Eight patients with refractory brain edema who were treated with regular dehydration and hormone for one week in the neurosurgical intensive care unit of Neurosurgery Department of Nanjin Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from July 2020 to June 2021 were selected as the research objects. All patients were given bevacizumab 200 mg, diluted to 0.8 mg/mL with 250 mL normal saline under sterile technology, and continued intravenous drip for more than 90 min. The amount of brain edema and the improvement of GCS score were compared before and after treatment.

Results

For patients with refractory brain edema, bevacizumab could significantly improve brain edema. Imaging examination showed that brain edema was improved 2 d after treatment. The amount of brain edema measured 1 week after treatment of all patients were relieved compared with that before treatment, and the GCS score of all patients were higher than that before treatment.

Conclusion

Bevacizumab is effective in the treatment of neurosurgical refractory brain edema, which can reduce brain edema and improve the clinical prognosis.

表1 患者基本情况及用药前脑水肿体积
图1 大面积脑梗死患者治疗前后头颅CT图
图2 缺血血氧性脑病患者治疗前后头颅CT图
图3 胶质瘤术后患者治疗前后头颅CT图
表2 患者基本情况及用药后脑水肿体积
[1]
中国医师协会神经外科医师分会,中国神经创伤专家委员会. 中国颅脑创伤颅内压监测专家共识[J]. 中华神经外科杂志, 2011, 27(10): 1073-1074.
[2]
Klatzo I. Pathophysiological aspects of brain edema[J]. Acta Neuropathol, 1987, 72(3): 236-239.
[3]
Cook AM, Morgan Jones G, Hawryluk GWJ, et al. Guidelines for the acute treatment of cerebral edema in neurocritical care patients[J]. Neurocrit Care, 2020, 32(3): 647-666.
[4]
王浩,胡深,冯诣, 等. 贝伐单抗靶向治疗重度脑水肿临床研究及评估[J]. 临床军医杂志, 2016, 44(9): 904-906.
[5]
Stokum JA, Gerzanich V, Simard JM. Molecular pathophysiology of cerebral edema[J]. J Cereb Blood Flow Metab, 2016, 36(3): 513-538.
[6]
Simons M, Gordon E, Claesson-Welsh L. Mechanisms and regulation of endothelial VEGF receptor signalling[J]. Nat Rev Mol Cell Biol, 2016, 17(10): 611-625.
[7]
Rattner A, Williams J, Nathans J. Roles of HIFs and VEGF in angiogenesis in the retina and brain[J]. J Clin Invest, 2019, 129(9): 3807-3820.
[8]
Zhuang H, Shi S, Yuan Z, et al. Bevacizumab treatment for radiation brain necrosis: mechanism, efficacy and issues[J]. Mol Cancer, 2019, 18(1): 21.
[9]
Naikoo NA, Dil-Afroze , Rasool R, et al. Upregulation of vascular endothelial growth factor (VEGF), its role in progression and prognosis of non-small cell lung carcinoma[J]. Cancer Genet, 2017, 216-217: 67-73.
[10]
Gonzalez J, Kumar AJ, Conrad CA, et al. Effect of bevacizumab on radiation necrosis of the brain[J]. Int J Radiat Oncol Biol Phys, 2007, 67(2): 323-326.
[11]
Tripathi M, Ahuja CK, Mukherjee KK, et al. The safety and efficacy of bevacizumab for radiosurgery-induced steroid-resistant brain edema; not the last part in the ship of theseus[J]. Neurol India, 2019, 67(5): 1292-1302.
[12]
Voss M, Wenger KJ, Fokas E, et al. Single-shot bevacizumab for cerebral radiation injury[J]. BMC Neurol, 2021, 21(1): 77.
[13]
Rahbari NN, Kedrin D, Incio J, et al. Anti-VEGF therapy induces ECM remodeling and mechanical barriers to therapy in colorectal cancer liver metastases[J]. Sci Transl Med, 2016, 8(360): 360ra135.
[14]
Zhan Q, Miao F, Huang R, et al. Efficacy and safety of bevacizumab combined with chemotherapy in symptomatic brain metastases from lung adenocarcinoma: a retrospective analysis[J]. J Thorac Dis, 2019, 11(11): 4725-4734.
[15]
赵儒钢,孟祥颖,申戈, 等. 贝伐珠单抗治疗脑转移瘤难治性瘤周水肿的疗效分析?[J]. 临床肿瘤学杂志, 2016, 21(3): 233-237.
[16]
Halstead MR, Geocadin RG. The medical management of cerebral edema: past, present, and future therapies[J]. Neurotherapeutics, 2019, 16(4): 1133-1148.
[17]
杨三虎,高红祥,崔立春, 等. 贝伐珠单抗治疗非小细胞肺癌脑转移伴顽固性瘤周水肿的临床分析[J]. 中华肺部疾病杂志(电子版), 2020, 13(5): 676-678.
[1] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[2] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[3] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[4] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[5] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[6] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[7] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[8] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[9] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[10] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[11] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[12] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[13] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?