仑伐替尼联合阿替利珠单抗序贯TACE治疗乙型肝炎合并晚期肝癌患者的效果评价  

Efficacy evaluation of lenvatinib combined with atezolizumab sequential TACE in the treatment of patients with hepatitis B complicated with advanced liver cancer

作　　者：刘春华[1] 刘玲 陶昌明 贺玉凯[1] Liu Chunhua;Liu Ling;Tao Changming;He Yukai(Department of Infection,Liaocheng People's Hospital,Liaocheng 252000,China;Department of Oncology,Liaocheng Hospital of Traditional Chinese Medicine,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院感染科,聊城252000 [2]聊城市中医医院肿瘤科,聊城252000

出　　处：《国际医药卫生导报》2023年第11期1573-1578,共6页International Medicine and Health Guidance News

基　　金：聊城市重点研发计划政策引导类项目(2022YDSF64)。

摘　　要：目的探究仑伐替尼联合阿替利珠单抗序贯经导管动脉化疗栓塞术(TACE)在乙型肝炎合并晚期肝癌患者治疗中的应用价值。方法本研究为随机对照试验。选取2019年1月10日至2022年9月10日聊城市人民医院收治的96例乙型肝炎合并晚期肝癌患者为研究对象,按随机数字表法分为观察组和对照组,各48例。对照组男25例,女23例,年龄(54.52±7.13)岁,给予常规TACE治疗;观察组男28例,女20例,年龄(53.74±6.55)岁,给予仑伐替尼联合阿替利珠单抗序贯TACE治疗。比较两组疾病缓解率、疾病控制率,治疗前后肝功能指标[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)]、细胞免疫功能指标[淋巴细胞(CD3+、CD4+、CD8+)、CD4+/CD8+]、浸润转移指标[血管内皮生长因子(VEGF)、磷脂酰肌醇蛋白聚糖-3(GPC-3)],不良事件发生情况。统计学方法采用t检验、χ^(2)检验、Ridit检验。结果观察组疾病缓解率、疾病控制率均高于对照组[72.92%(35/48)比52.08%(25/48)、85.42%(41/48)比62.50%(30/48)](χ^(2)=4.444,P=0.035;χ^(2)=6.544,P=0.010)。治疗后,观察组CD3+、CD4+、CD4+/CD8+分别为(64.28±5.35)%、(33.52±2.81)%、(1.28±0.23),均高于对照组的(58.92±5.13)%、(28.75±2.63)%、(1.03±0.19);AST、ALT、TBIL、VEGF、GPC-3、CD8+分别为(38.73±8.41)U/L、(47.62±10.39)U/L、(17.95±2.35)μmol/L、(312.58±33.45)ng/L、(10.75±1.98)μg/L、(26.19±2.04)%,均低于对照组的(55.62±7.85)U/L、(67.88±11.55)U/L、(22.46±2.71)μmol/L、(338.74±35.76)ng/L、(12.46±2.05)μg/L、(27.91±2.13)%;差异均有统计学意义(t=15.010、8.587、5.806、10.172、9.035、8.711、3.701、4.156、4.040,均P<0.001)。观察组不良事件总发生率与对照组比较差异无统计学意义[31.25%(15/48)比25.00%(12/48)](P>0.05)。结论仑伐替尼联合阿替利珠单抗序贯TACE治疗乙型肝炎合并晚期肝癌患者具有较好的疗效,可有效减轻免疫功能抑制,改善肝功能,缓解病情。Objective To investigate the value of lenvatinib combined with atezolizumab sequential transhepatic arterial chemoembolization(TACE)in the treatment of patients with hepatitis B complicated with advanced liver cancer.Methods This study was a randomized controlled trial.A total of 96 patients with hepatitis B complicated with advanced liver cancer admitted to Liaocheng People's Hospital from January 10,2019 to September 10,2022 were selected for the study,and were divided into an observation group and a control group according to the random number table method.In the control group,there were 25 males and 23 females,aged(54.52±7.13)years;in the observation group,there were 28 males and 20 females,aged(53.74±6.55)years.The control group was given conventional TACE treatment,and the observation group was given lenvatinib combined with atezolizumab sequential TACE treatment.The disease remission rate,disease control rate,liver function indexes[aspartate aminotransferase(AST),alanine aminotransferase(ALT),and total bilirubin(TBIL)],cellular immune function indexes[lymphocytes(CD3+,CD4+,and CD8+)and CD4+/CD8+],and infiltrative metastasis indexes[vascular endothelial growth factor(VEGF)and glypican-3(GPC-3)]before and after treatment,and occurrence of adverse events were compared between the two groups.t test,χ^(2) test,and Ridit test were used for statistical analysis.Results The disease remission rate and disease control rate of the observation group were higher than those of the control group[72.92%(35/48)vs.52.08%(25/48),85.42%(41/48)vs.62.50%(30/48)](χ^(2)=4.444,P=0.035;χ^(2)=6.544,P=0.010).After treatment,the CD3+,CD4+,CD4+/CD8+in the observation group were(64.28±5.35)%,(33.52±2.81)%,and(1.28±0.23),which were higher than those in the control group[(58.92±5.13)%,(28.75±2.63)%,and(1.03±0.19)];the AST,ALT,TBIL,VEGF,GPC-3,and CD8+were(38.73±8.41)U/L,(47.62±10.39)U/L,(17.95±2.35)μmol/L,(312.58±33.45)ng/L,(10.75±1.98)μg/L,and(26.19±2.04)%,which were lower than those in the control group[(55.62±7.85)U/

关 键 词：肝癌 乙型肝炎 仑伐替尼 阿替利珠单抗 经肝动脉化疗栓塞术 免疫功能 

分 类 号：R512.62[医药卫生—内科学] R735.7[医药卫生—临床医学]