伊立替康联合XELOX方案对晚期胃癌患者预后及血清CD细胞、miR-34a和let-7i含量的影响  

Effects of irinotecan combined with XELOX regimen on prognosis and serum CD cells,miR-34a and let-7i in patients with advanced gastric cancer

作　　者：汪蕾 龚志敏 Wang Lei;Gong Zhimin(Department of Oncology,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang 441021,China;Institute of Oncology,Hubei University of Arts and Science,Xiangyang 441021,China)

机构地区：[1]湖北文理学院附属医院,襄阳市中心医院肿瘤科,襄阳441021 [2]湖北文理学院肿瘤研究所,襄阳441021

出　　处：《中国医师杂志》2022年第5期676-681,共6页Journal of Chinese Physician

基　　金：国家自然科学基金项目(31971166);湖北省微循环学会科研资助基金(HBWXH 2020(1)-1)。

摘　　要：目的探讨伊立替康结合XELOX方案对晚期胃癌患者预后及血清CD细胞、miR-34a和let-7i含量的影响。方法前瞻性选取襄阳市中心医院2015年1月至2020年1月收治的晚期胃癌患者共72例,将72例患者采用随机数字表法分为对照组和观察组,每组36例。对照组接受XELOX方案治疗,观察组在对照组的基础上联合伊立替康治疗。对比两组患者的疗效、血清免疫水平、血清miR-34a及let-7i含量、毒副反应发生率以及生存周期。结果观察组客观缓解率为33.33%,显著高于对照组的13.89%(P<0.05)。治疗前两组患者血清免疫水平、miR-34a、let-7i水平差异均无统计学意义(均P>0.05),治疗后,两组患者的CD3^(+)、CD4^(+)、CD8^(+)水平显著上升(均P<0.05),且观察组患者的CD3^(+)、CD4^(+)、CD8^(+)水平改善程度显著优于对照组(均P<0.05)。治疗后两组患者血清miR-34a显著上升,let-7i水平显著下降(均P<0.05),且观察组血清miR-34a高于对照组,let-7i水平显著低于对照组(均P<0.05)。在Ⅰ~Ⅱ级不良反应中,以恶心呕吐、白细胞下降居多;对照组和观察组Ⅲ~Ⅳ度白细胞下降发生率分别为5.56%(2/36)和5.56%(2/36);Ⅲ~Ⅳ度血小板下降发生率分别为5.56%(2/36)和2.78%(1/36);对照组有1例患者出现Ⅲ~Ⅳ级肝功能异常,观察组有1例患者出现Ⅲ~Ⅳ级恶心呕吐。所有出现不良反应的患者在给予对症治疗后均得到有效缓解,未出现与治疗有关的死亡病例。观察组无进展生存期(PFS)为24.90个月(95%CI:0.469~1.955),对照组PFS为21.85个月(95%CI:0.512~2.131),观察组的PFS较对照组显著延长(Log-Rank=1.357,P=0.007)。结论伊立替康结合XELOX方案治疗晚期胃癌,能有效提升血清miR-34a水平,降低let-7i含量,有效改善患者的免疫功能,且安全性较好。Objective To investigate the effect of irinotecan combined with XELOX regimen on serum CD cells,miR-34a and let-7i in patients with advanced gastric cancer.Methods A total of 72 patients with advanced gastric cancer treated in the Affiliated Hospital of Hubei University of Arts And Science from January 2015 to January 2020 were prospectively selected,and they were divided into control group and observation group with 36 cases in each group by random number table method.The control group was treated with XELOX regimen,while the observation group was treated with irinotecan on the basis of the control group.The efficacy,serum immune level,serum miR-34a and let-7i contents,incidence of toxic and side effects and life cycle of the two groups were compared.Results The objective response rate(ORR)of the observation group was 33.33%,which were significantly higher than that of the control group(13.89%,χ^(2)=3.770,P>0.05).There was no significant difference in serum immune level,miR-34a and let-7i between the two groups before treatment(all P>0.05).After treatment,the levels of CD3^(+),CD4^(+)and CD8^(+)in the two groups were significantly increased(all P<0.05),and the improvement of CD3^(+),CD4^(+)and CD8^(+)in observation group was significantly better than that in control group(all P<0.05).After treatment,the serum miR-34a level increased significantly and serum let-7i level decreased significantly in the two groups(all P<0.05),and the serum miR-34a level in the observation group was higher than that in the control group,and the serum let-7i level was significantly lower than that in the control group(all P<0.05).Among the grade Ⅰ-Ⅱ adverse reactions,nausea and vomiting and leukocyte decline were the most common;The incidence of grade Ⅲ-Ⅳ leukopenia in the control group and the observation group were 5.56%(2/36)and 5.56%(2/36),respectively;The incidence of grade Ⅲ-Ⅳ thrombocytopenia was 5.56%(2/36)and 2.78%(1/36),respectively;One patient in the control group had grade Ⅲ-Ⅳ abnormal liver function,and o

关 键 词：胃肿瘤 伊立替康 抗肿瘤联合化疗方案 MIR-34A let-7i 

分 类 号：R735.2[医药卫生—肿瘤]