甲基泼尼松冲击对小细胞肺癌神经系统副肿瘤综合征的疗效分析  

Effect of Methylprednisone Shock on Nervous System Paraneoplastic Syndrome of Small Cell Lung Cancer

作　　者：冯会方 肖彩霞 颜立坤 FENG Huifang;XIAO Caixia;YAN Likun(Anyang People's Hospital,Anyang,455000)

机构地区：[1]河南安阳市人民医院,455000 [2]河南省特种设备安全检测研究院安阳分院,455000

出　　处：《实用癌症杂志》2021年第12期1996-2000,2014,共6页The Practical Journal of Cancer

基　　金：河南省医学科技攻关计划项目(编号:2018081229)。

摘　　要：目的分析甲基泼尼松冲击疗法对小细胞肺癌神经系统副肿瘤综合症的应用效果。方法采用整体随机抽样法,最终纳入62例小细胞肺癌神经系统副肿瘤综合症患者作为观察样本量。将纳入样本随机分为观察组和对照组(各31例)。对照组针对神经系统副肿瘤综合症连续静脉注射丙种球蛋白,观察组在对照组基础上联合甲基泼尼松冲击疗法;并比较两组样本治疗前(T0)、治疗1个月(T1)及治疗结束后7天(T2)血清抗-Hu抗体、抗普肯野细胞抗体(抗-Yo抗体)、抗神经元骨架蛋白抗体(抗-Ri抗体)水平和美国国立卫生院神经功能缺损评分(NHISS)、日常生活活动能力评分(ADL)及T细胞亚群、活化、调节性T细胞水平。结果T0时,两组样本血清抗-Hu抗体、抗-Yo抗体、抗-Ri抗体和NHISS、ADL评分水平比较,差异无统计学意义(P>0.05);随着治疗进展(T0-T1-T2),两组样本血清抗-Hu抗体、抗-Yo抗体、抗-Ri抗体水平和NHISS评分逐渐下降,ADL评分升高,差异有统计学意义(P<0.05);且在T1、T2各时刻,观察组样本血清抗-Hu抗体、抗-Yo抗体、抗-Ri抗体水平及NHISS评分低于对照组,ADL评分高于对照组,差异有统计学意义(P<0.05)。T0时,两组样本CD_(4)^(+)T细胞、CD_(8)^(+)T细胞、总活化T细胞、活化CD_(4)^(+)T细胞、调节性T细胞水平比较,差异无统计学意义(P>0.05);T1较T0时,两组样本CD_(4)^(+)T细胞、调节性T细胞水平升高,总活化T细胞、活化CD_(4)^(+)T细胞水平下降,差异有统计学意义(P<0.05);T1时,观察组样本CD_(4)^(+)T细胞、调节性T细胞水平高于对照组,总活化T细胞、活化CD_(4)^(+)T细胞水平低于对照组,差异有统计学意义(P<0.05)。结论甲基泼尼松冲击疗法在小细胞肺癌神经系统副肿瘤综合症治疗中应用效果满意,能有效调节患者机体免疫状态,缓解神经系统症状;但研究并未进行长期随访活动,致研究结论具有一定局限性,因此延长观察时间并对Objective To analyze the application effect of methylprednisone pulse therapy in the treatment of small cell lung cancer nervous system paraneoplastic syndrome.Methods A total of 62 patients with small-cell carcinoma in the region were included in the study.The included samples were randomly divided into the observation group and the control group(31 cases each).In the control group,Gamma Globulin was injected intravenously for paraneoplastic syndrome of nervous system.In the observation group,methylprednisolone pulse therapy was used.Before treatment(T0),treatment for 1 month(T1)and 7 days after treatment(T2),serum anti-Hu antibody,anti-Prukinje cell antibody(anti-Yo antibody)and anti-neuronal skeleton protein antibody(anti-Ri antibody)levels and the National Institutes of Health Neurological Impairment Score(NHISS),Activity of Daily Living Score(ADL)and T cell subsets,activated,and regulatory T cell levels of the 2 groups were compared.Results At T0,there was no significant difference in serum anti-Hu antibody,anti-Yo antibody,anti-Ri antibody,NHISS and ADL score levels between the 2 groups of samples(P>0.05);as the treatment progressed(T0-T1-T2),the serum anti-Hu antibody,anti-Yo antibody,anti-Ri antibody levels and NHISS score of the 2 groups of samples gradually decreased,and the ADL score increased,and the difference was statistically significant(P<0.05);and at T1,T2,the serum levels of anti-Hu antibody,anti-Yo antibody,anti-Ri antibody and NHISS score of the observation group were lower than those of the control group,and the ADL score was higher than that of the control group,the difference was statistically significant(P<0.05).At T0,there was no statistically significant difference in the levels of CD_(4)^(+)T cells,CD_(8)^(+)T cells,total activated T cells,activated CD_(4)^(+)T cells,and regulatory T cells between the 2 groups of samples(P>0.05);at T1 compared with T0,The levels of CD_(4)^(+)T cells and regulatory T cells in the 2 groups of samples increased,and the levels of total activated T cells and

关 键 词：甲基泼尼松 冲击疗法 小细胞肺癌 神经系统副肿瘤综合症 免疫 抗体 

分 类 号：R734.2[医药卫生—肿瘤]