卡瑞利珠单抗联合AP方案治疗晚期非鳞癌非小细胞肺癌的临床研究  

Efficacy of camrelizumab combined with AP regimen for advanced non-squamous non-small cell lung cancer

作　　者：曹亚男 赵成秀[2] 张雪 刘登登 王敬苗 刘蓉[2] 张萌 Cao Yanan;Zhao Chengxiu;Zhang Xue;Liu Dengdeng;Wang Jingmiao;Liu Rong;Zhang Meng(Department of Outpatient,Handan First Hospital,Handan 056002,China;Operating Room,Handan First Hospital,Handan 056002,China;Department of Traditional Chinese Medicine,Handan First Hospital,Handan 056002,China;Department of Oncology,Handan First Hospital,Handan 056002,China)

机构地区：[1]邯郸市第一医院门诊部,邯郸056002 [2]邯郸市第一医院手术室,邯郸056002 [3]邯郸市第一医院中医科,邯郸056002 [4]邯郸市第一医院肿瘤科,邯郸056002

出　　处：《国际呼吸杂志》2022年第23期1788-1795,共8页International Journal of Respiration

摘　　要：目的探讨卡瑞利珠单抗联合培美曲塞联合顺铂(AP方案)治疗晚期非鳞癌非小细胞肺癌(NSCLC)的临床疗效,以及其对患者外周血T细胞免疫功能和血清肿瘤标志物、血管生成调节因子水平的影响。方法本研究为病例对照研究。采用非随机抽样的方法选择邯郸市第一医院2021年1月至2022年1月收治的119例晚期非鳞癌NSCLC患者作为研究对象,按治疗方案的不同分成观察组60例与对照组59例。对照组给予AP方案化疗,观察组在此基础上联合卡瑞利珠单抗治疗。连续治疗4个周期后观察2组疗效及不良反应情况。比较2组治疗前后外周血T淋巴细胞亚群水平、辅助性T细胞17(Th17)与调节性T细胞(Treg)免疫平衡状态和血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原199(CA199)、细胞角蛋白19片段抗原21-1(CYFRA21-1)]以及血管生成调节因子[内皮抑素、血管内皮生长因子(VEGF)、转化生长因子β1(TGF-β1)]水平。结果观察组客观缓解率、疾病控制率分别为53.33%(32/60)、78.33%(47/60),与对照组[33.90%(20/59)、61.02%(36/59)]相比均升高,差异有统计学意义(χ^(2)值分别为4.57、4.23,P<0.05)。对照组治疗后外周血CD3+、CD4+水平和CD4+/CD8+均较治疗前降低(P值均<0.05),观察组治疗后以上指标则均较治疗前升高(P值均<0.05)。治疗后,观察组外周血CD3+、CD4+水平和CD4+/CD8+均高于对照组(P值均<0.05)。治疗后,观察组外周血Treg比例低于对照组,外周血Th17比例、Th17/Treg高于对照组,差异均有统计学意义(P值均<0.05)。2组治疗后血清CEA、CA199和CYFRA21-1水平均较治疗前降低,差异均有统计学意义(P值均<0.05);治疗后,观察组以上各项水平均低于对照组,差异均有统计学意义(P值均<0.05)。2组治疗后血清内皮抑素水平均较治疗前升高,血清VEGF、TGF-β1水平均较治疗前降低,差异均有统计学意义(P值均<0.05);治疗后,观察组以上各项水平与对照组比较差异均有统�Objective To explore the clinical efficacy of camrelizumab combined with AP regimen(pemetrexed+cisplatin)for advanced non-squamous non-small cell lung cancer(NSCLC)and how it impacts on immune function of peripheral blood t lymphocyte,serum tumor markers,angiogenesis regulators.Methods This study is a case-control study.Using a simple non-random sampling model,patients(n=119)with advanced non-squamous NSCLC who treated in Handan First Hospital from January 2021 to January 2022 were enrolled.According to the different treatment plans,these patients were randomly assigned to receive either AP regimen(n=59,control group)or camrelizumab+AP regimen(n=60,observation group)for 4 cycles,aiming to compare T-lymphocyte sub-populations,immune balance of T helper cell 17(Th17)and regulatory T cells(Treg),serum tumor markers(carcinoembryonic antigen[CEA],carbohydrate antigen 199[CA199],cytokeratin 19 fragment antigen 21-1[CYFRA21-1]),angiogenesis regulators(endostatin[ES],vascular endothelial growth factor[VEGF],transforming growth factor beta 1[TGF-β1]).The curative effect and adverse incidence were assessed.Results The objective remission rate(ORR)and disease control rate(DCR)in the observation group were superior to those in the control group(53.33%[32/60]vs 33.90%[20/59],78.33%[47/60]vs 61.02%[36/59],[χ^(2)=4.57,4.23,P<0.05],respectively).After treatment,CD3+,CD4+and CD4+/CD8+in the control group were decreased(all P<0.05),while the observation group was increased(all P<0.05),the observation group was superior to the control group for CD3+,CD4+and CD4+/CD8+(all P<0.05);decreased Treg,and increased Th17,Th17/Treg ratio were detected in the observation group as compared with the control group,with statistically significant differences(all P<0.05);CEA,CA199 and CYFRA21-1 in groups were notably decreased(all P<0.05),the reduction in the observation group was more prevalent(all P<0.05);significantly increased ES and decreased VEGF and TGF-β1 were detected in groups(all P<0.05),the difference was statistically significant in

关 键 词：癌 非小细胞肺 生物标记 肿瘤 血管生成调节剂 卡瑞利珠单抗 AP方案 T细胞免疫功能 

分 类 号：R734.2[医药卫生—肿瘤]