摘要
目的探讨程序性死亡受体⁃1(PD⁃1)/程序性死亡受体配体⁃1(PD⁃L1)抑制剂纳武利尤单抗联合红豆杉胶囊治疗对晚期非小细胞肺癌(NSCLC)患者免疫功能及乳酸脱氢酶(LDH)、中性粒细胞/淋巴细胞比值(NLR)的影响。方法选取2020年1月—2021年2月山西省阳泉市第三人民医院血液肿瘤科收治晚期NSCLC患者102例,以随机数字表法分为观察组、对照组各51例。对照组给予纳武利尤单抗治疗,观察组在对照组基础上联合红豆杉胶囊治疗,均治疗8周。比较2组治疗8周后疗效,并检测治疗前及治疗6周、8周后血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原⁃125(CA125)、细胞角蛋白19片段(CYFRA21⁃1)]、免疫功能指标(CD3+、CD4+、CD4+/CD8+)、血清LDH、NLR水平、Karnofsky功能状态评分(KPS),统计2组不良反应发生率。结果治疗8周后2组总有效率比较差异无统计学意义(P>0.05),但观察组疾病控制率显著高于对照组(70.59%vs.50.98%,χ^(2)=4.113,P=0.043)。治疗6周、8周后2组血清CEA、CA125、CYFRA21⁃1均低于治疗前,且观察组低于对照组(6周:t/P=10.775/<0.001、9.874/<0.001、9.684/<0.001;8周:t/P=11.634/<0.001、10.008/<0.001、9.887/<0.001)。治疗6周、8周后2组CD3+、CD4+、CD4+/CD8+标水平较治疗前下降(P<0.001);而观察组治疗6周、8周后均较对照组升高(6周:t/P=4.607/<0.001、7.353/<0.001、8.333/<0.001;8周:t/P=7.226/<0.001、7.660/<0.001、8.970/<0.001)。治疗6周、8周后2组血清LDH、NLR水平均较治疗前下降(P<0.001),且观察组显著低于对照组(6周:t/P=3.330/<0.001、2.687/0.008;8周:t/P=2.174/0.032、2.725/0.007)。治疗6周、8周后2组KPS评分均较治疗前升高(P<0.001),且观察组均高于对照组(t/P=6.006/<0.001、4.097/<0.001);观察组血小板减少、乏力、恶心呕吐、食欲下降等不良反应发生率均低于对照组(P<0.05)。结论纳武利尤单抗联合红豆杉胶囊可有效控制非小细胞肺癌病情进展,增强机体免疫功能,改善功能状态,调节LDH、NLR水平。
Objective To investigate the effects of programmed death receptor⁃1(PD⁃1)programmed death receptor⁃1/ligand(PD⁃L1)inhibitor Navurizumab combined with Taxus capsule therapy on lactate dehydrogenase(LDH),neu⁃trophil/lymphocyte ratio(NLR),and immune function in patients with advanced non⁃small cell lung cancer(NSCLC).Meth⁃ods One hundred and two patients with advanced NSCLC admitted to the Hematology and Oncology Department of the Third People's Hospital of Yangquan City,Shanxi Province from January 2020 to February 2021 were selected.They were randomly divided into an observation group and a control group,with 51 cases in each group.The control group was treated with navulizumab,while the observation group was treated with a combination of yew capsule on the basis of the control group,both of which were treated for 8 weeks.Compare the efficacy of two groups after 8 weeks of treatment,and detect se⁃rum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen⁃125(CA125),cytokeratin 19 fragment(CY⁃FRA21⁃1)],immune function indicators(CD3+,CD4+,CD4+/CD8+),serum LDH,NLR levels,Karnofsky functional sta⁃tus score(KPS)before treatment,and after 6 and 8 weeks of treatment.Calculate the incidence of adverse reactions in both groups.Results After 8 weeks of treatment,there was no statistically significant difference in the total effective rate between the two groups in the observation group(P>0.05),but the disease control rate was significantly higher than that of the con⁃trol group(70.59%vs.50.98%,χ^(2)=4.113,P=0.043).After 6 and 8 weeks of treatment,the serum CEA,CA125,and CY⁃FRA21⁃1 levels in both groups were lower than before treatment,and the observation group was lower than the control group(6 weeks:t/P=10.775/<0.001,9.874/<0.001,9.684/<0.001;8 weeks:t/P=11.634/<0.001,10.008/<0.001,9.887/<0.001).After 6 and 8 weeks of treatment,the levels of CD3+,CD4+,and CD4+/CD8+markers in both groups decreased compared to before treatment(P<0.001);After 6 and 8 weeks of treatment,the observation group showed higher levels than the control group(6 weeks:t/P=4.607/<0.001,7.353/<0.001,8.333/<0.001;8 weeks:t/P=7.226/<0.001,7.660/<0.001,8.970/<0.001).After 6 and 8 weeks of treatment,the serum LDH and NLR levels in both groups decreased compared to be⁃fore treatment(P<0.001),and the observation group was significantly lower than the control group(6 weeks:t/P=3.330/<0.001,2.687/0.008;8 weeks:t/P=2.174/0.032,2.725/0.007).After 6 and 8 weeks of treatment,the KPS scores of both groups increased compared to before treatment(P<0.001),and the observation group was higher than the control group(t/P=6.006/<0.001,4.097/<0.001);The incidence of adverse reactions such as thrombocytopenia,fatigue,nausea and vomiting,and decreased appetite in the observation group was lower than that in the control group(P<0.05).Conclusion The combi⁃nation of Navulizumab and Taxus capsule can effectively control the progression of non⁃small cell lung cancer,enhance im⁃mune function,improve functional status,and regulate LDH and NLR levels.
作者
范俊瑾
樊改荣
孙伟
Fan Junjin;Fan Gairong;Sun Wei(Department of Hematology and Oncology,Third People's Hospital of Yangquan City,Shanxi Province,Yangquan 045000,China)
出处
《疑难病杂志》
CAS
2023年第6期630-635,共6页
Chinese Journal of Difficult and Complicated Cases
基金
阳泉市科技计划项目(2013C0222)。
