摘要
探讨白蛋白结合型紫杉醇(nanoparticle albumin-bound paclitaxel,NAB-P)联合曲妥珠单抗、吡咯替尼治疗人表皮生长因子受体2(human epidermalgrowth factor receptor-2,HER2)阳性局部晚期和晚期乳腺癌的疗效及安全性。选取2021年1月—2023年1月于本院就诊的126例HER2阳性局部晚期和晚期乳腺癌患者分为对照组(n=63)、观察组(n=63)。对照组给予NAB-P联合曲妥珠单抗治疗,观察组给予NAB-P联合曲妥珠单抗、吡咯替尼治疗。比较两组临床疗效、临床症状缓解情况及治疗前后肿瘤标志物[骨桥蛋白(osteopontin,OPN)、糖链抗原153(cancer antigen 153,CA153)、β2-微球蛋白(β2-microglobulin,β2-MG)、组织多肽特异性抗原(tissue polypeptide specific antigen,TPS)]、病情相关指标[同型半胱氨酸(homocysteine,Hcy)、神经元特异性烯醇化酶(neuron specific enolase,NSE)、血清果糖胺(serum fructosamine,FA)、血管内皮生长因子(vascular endothelial growth factor,VEGF)]、耐药情况、免疫指标、不良反应发生率、治疗后1年生存情况。观察组客观缓解率、疾病控制率分别为84.13%、95.24%,均高于对照组的53.97%、84.13%(P<0.05);观察组临床症状缓解时间短于对照组(P<0.05);观察组治疗后血清OPN、CA153、β2-MG、TPS水平分别为(93.57±27.14)ng/ml、(11.56±2.08)U/mL、(0.58±0.14)mg/L、(11.26±2.28)μg/L,低于对照组的(135.24±30.29)ng/mL、(17.68±3.47)U/mL、(0.95±0.31)mg/L、(18.65±3.47)μg/L(P<0.05);观察组治疗后血清Hcy、NSE、FA、VEGF水平分别为(10.05±2.15)μmol/L、(2.19±0.38)ng/mL、(214.68±21.27)μmol/L、(12.05±2.24)ρg/mL,低于对照组的(15.36±3.89)μmol/L、(3.97±0.75)ng/mL、(265.64±30.76)μmol/L、(16.79±3.28)ρg/mL(P<0.05);观察组治疗后P-糖蛋白、P170、谷胱甘肽-S-转移酶-π阳性率低于对照组(P<0.05);观察组治疗后CD3^(+)、CD4^(+)/CD8^(+)、CD4^(+)高于对照组(P<0.05);两组不良反应对比无明显差异(P>0.05);观察组治疗后1年生存率高于对照组(P<0.05)。NAB-P联合曲妥珠单抗、吡咯替尼治疗HER2阳性局部晚期和晚期乳腺癌的疗效确切,可改善临床症状,控制病情进展,降低耐药性发生率,减轻机体免疫抑制,提高生存率,且具有一定安全性。
To investigate the efficacy and safety of nanoparticle albumin-bound paclitaxel(NAB-P)combined with trastuzumab and pyrotinib in the treatment of human epidermal growth factor receptor 2(HER2)positive locally advanced and advanced breast cancer,a total of 126 patients with HER2-positive locally advanced and advanced breast cancer who were treated in the hospital from January 2021 to January 2023 were selected and divided into a control group(n=63)and an observation group(n=63).The control group was treated with NAB-P combined with trastuzumab,and the observation group was treated with NAB-P combined with trastuzumab and pyrotinib.The clinical efficacy and remission of clinical symptoms of the two groups were compared,as well as tumor markers[osteopontin(OPN),cancer antigen 153(CA153),β2-microglobulin(β2-MG),tissue polypeptide-specific antigen(TPS)],disease-related indicators[homocysteine(Hcy),neuron-specific enolase(NSE),serum fructosamine(FA),vascular endothelial growth factor(VEGF)],drug resistance and immune indicators before and after treatment.The incidence of adverse reactions and 1 year survival after treatment were also compared between the two groups.The objective remission rate and disease control rate in the observation group were 84.13%and 95.24%,respectively,which were higher than 53.97%and 84.13%in the control group(P<0.05).The remission time of clinical symptoms in the observation group was shorter than that in the control group(P<0.05).After treatment,the serum OPN,CA153,β2-MG and TPS levels in the observation group were(93.57±27.14)ng/mL,(11.56±2.08)U/mL,(0.58±0.14)mg/L and(11.26±2.28)μg/L,respectively,which was lower than that of control group(135.24±30.29)ng/mL,(17.68±3.47)U/ml,(0.95±0.31)mg/L,(18.65±3.47)μg/L(P<0.05);After treatment,the serum levels of Hcy,NSE,FA and VEGF in the observation group were(10.05±2.15)μmol/L,(2.19±0.38)ng/ml,(214.68±21.27)μmol/L and(12.05±2.24)ρg/mL,respectively.It was lower than that of control group(15.36±3.89)μmol/L,(3.97±0.75)ng/mL,(265.64±30.76)μmol/L,(16.79±3.28)ρg/mL(P<0.05).After treatment,the positive rates of P-glycoprotein,P170 and glutathione S-transferase-πin observation group were lower than those in control group(P<0.05).After treatment,CD3^(+),CD4^(+)/CD8^(+)and CD4^(+)in observation group were higher than those in control group(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).The 1-year survival rate of the observation group was higher than that of the control group(P<0.05).NAB-P combined with trastuzumab and pyrotinib was exact curative effect in the treatment of HER2-positive locally advanced and advanced breast cancer,which could be improved clinical symptoms,to control the progression of the disease,to reduce the incidence of drug resistance,to alleviate immune suppression,to improve the survival rate,and have a certain safety.
作者
陈苏
潘华
狄咏赟
CHEN Su;PAN Hua;DI Yongyun(Liyang People's Hospital,Liyang 213300,China)
出处
《药物生物技术》
2025年第3期342-348,共7页
Pharmaceutical Biotechnology
基金
吴阶平医学基金会临床科研专项资助基金项目(No.320.6750.2023-18-47)。
