【摘要】 目的 比较小剂量（3.5mg/kg）和常规剂量（5mg/kg）贝伐珠单抗在脑转移瘤立体定向放射外科（SRS后放射性脑坏死（CRN）中的疗效，为临床合理应用提供指导。方法 回顾性分析经甘露醇及激素治疗失败的46例CRN患者，按剂量不同分为小剂量组21例和常规剂量组25例。所有患者均给予贝伐珠单抗静脉滴注治疗，辅以20%甘露醇0.5g/kg,2次/d；地塞米松0.08mg/kg,1次/d；共治疗3天；另外，小剂量组给予贝伐珠单抗3.5mg/kg，常规剂量组给予贝伐珠单抗5mg/kg，均每21天为1个疗程，两组均治疗2个疗程后观察KPS评分和治疗前后T1WI增强病灶的体积变化和T2 FLAIR水肿体积变化。结果 （1）疗效评价：治疗前，两组KPS评分、T1WI增强体积及T2 FLAIR水肿体积差异均无统计学意义（P>0.05），治疗2个疗程后，两组卡氏评分、T1WI增强体积差异仍无统计学意义（P>0.05），而T2 FLAIR水肿体积常规剂量组小于小剂量组（P<0.05）。（2）不良反应：常规剂量组口鼻出血和脑梗死发生率高于小剂量组（P<0.01）。结论 两组治疗后KPS评分无差异，说明经过治疗，小剂量组症状已得到了改善，是预后向好的重要信号，影像学的改善可能会延迟出现，加上常规剂量组易致出血和脑梗死等严重不良反应，综合利弊认为小剂量（3.5mg/kg）贝伐珠单抗治疗即可经济、安全地改善CRN症状。更多还原

【Abstract】 Objective To compare the efficacy of small dose(3.5mg/kg)and conventional dose(5mg/kg)bevacizumab in radiation brain necrosis(CRN)after stereotactic radiosurgery(SRS),to provide guidance for rational clinical application.Methods The 46 patients with CRN who failed with mannitol and hormone therapy were divided into 21 patients in small dose group and 25 patients in conventional dose group. All patients were given bevacizumab intravenous infusion with 20%mannitol 0.5g/kg, 2 times/d, dexamethasone 0.08mg/kg, 1 dose/d; for 3 days; in addition, 3.5mg/kg and 5mg/kg for every21 days, and the volume changes of KPS score and T1WI were observed before and after 2 courses of treatment. Results(1)Efficacy evaluation: Before treatment, KPS score, T1 enhanced volume and T2FLAIR edema volume were not significant(P>0.05). After treatment, card score and T1 enhanced volume(P>0.05), while T2FLAIR edema volume was less than the low dose group(P<0.05).(2)Adverse reactions: The incidence of oroepistaxis and cerebral infarction in the conventional-dose group was higher than that in the small-dose group, and the difference was statistical significant(P<0.01).Conclusion There is no significant difference between the two groups after treatment, indicating that the symptoms of the small dose group have been improved and is an important signal of good prognosis. The improvement of imaging may be de-layed,and the conventional dose group is prone to serious adverse reactions such as bleeding and cerebral infarction, and the comprehensive advantages and disadvantages believe that the small dose(3.5mg/kg)bevacizumab treatment can economically and safely improve CRN symptoms.更多还原