吉西他滨联合周疗法紫杉醇脂质体治疗晚期胃癌的疗效  

Curative effect of gemcitabine combined with weeks therapy of paclitaxel liposome on advanced gastric cancer

作　　者：姚磊 李春兰[1] 裴乐乐 YAO Lei;LI Chunlan;PEI Lele(Department of Pharmacy,Jiangsu Second Hospital of Traditional Chinese Medicine,Nanjing 210017,China)

机构地区：[1]江苏省第二中医院药剂科,南京210017

出　　处：《西北药学杂志》2023年第5期119-124,共6页Northwest Pharmaceutical Journal

基　　金：江苏省2020年中医药科技发展计划项目(编号:YB2020108)。

摘　　要：目的探究吉西他滨联合周疗法紫杉醇脂质体治疗晚期胃癌的疗效。方法选取收治的晚期胃癌患者92例,用随机数字表法分为观察组(n=46)和对照组(n=46),对照组患者采用吉西他滨(1000 mg·m^(-2),d1,d8)联合顺铂(75 mg·m^(-2),d1)(GP方案)治疗,观察组患者在对照组治疗的基础上给予紫杉醇脂质体(175 mg·m^(-2),d1)治疗。2组均以21 d为1个疗程,共治疗2个疗程。比较2组患者治疗后的近期疗效及治疗前后的血清肿瘤标志物水平、免疫学指标;比较2组患者治疗后不良反应的发生情况及随访6个月的生存情况。结果观察组与对照组治疗后的总有效率分别为73.91%、63.04%,疾病控制率分别为93.48%、84.78%,2组总有效率与疾病控制率比较差异无统计学意义(P>0.05)。治疗后,2组患者血清E-钙黏连蛋白(E-cadhe-rin,E-cad)、癌胚抗原(carcino-embryonic antigen,CEA)、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCA)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)及细胞角蛋白19片段抗原21-1(cytokeratin 19 fragment antigen 21-1,CYERA21-1)的水平较治疗前均明显下降(P<0.05),但2组上述指标比较差异无统计学意义(P>0.05)。治疗后,观察组CD3+、CD4+、CD4+/CD8+值及自然杀伤细胞(natural killer cell,NK)较对照组高,CD8+、调节性T细胞(regulatory T cells,Treg)、辅助性T细胞17(helper T cell 17,Th17)、Th17/Treg值较对照组低(P<0.05)。用药后观察组恶心呕吐、腹泻、血小板减少、肝肾功能损伤及外周神经毒性等的发生率均明显低于对照组(P<0.05)。观察组随访6个月的生存率明显高于对照组,中位生存期及无进展生存期均明显长于对照组(P<0.05)。结论吉西他滨联合周疗法紫杉醇脂质体治疗晚期胃癌的疗效显著,可明显改善患者血清肿瘤标志物的水平及免疫力,降低不良反应发生的风险,延长生存时间,具有一定的临床推广价值。Objective To explore the curative effect of gemcitabine combined with weeks therapy of paclitaxel liposome on advanced gastric cancer.Methods A total of 92 patients with advanced gastric cancer admitted to the hospital were enrolled.According to random number table method,they were divided into observation group(n=46)and control group(n=46).The patients in control group were given gemcitabine(1000 mg·m^(-2),d1,d8)combined with cisplatin(75 mg·m^(-2),d1)as GP regimen,while those in observation group were additionally given paclitaxel liposome(175 mg·m^(-2),d1).All were treated for 2 courses of treatment,21 days per course.The short-term curative effect after treatment,levels of serum tumor markers and immunological indexes before treatment and after treatment,and the occurrence of adverse reactions after medication were compared between the 2 groups.The survival situations after 6 months of follow-up were observed.Results The total response rates of treatment in observation group and control group were 73.91%and 63.04%,respectively.The disease control rates in the 2 groups were 93.48%and 84.78%,respectively.There was no significant difference between the 2 groups in total response rate or disease control rate(P>0.05).After treatment,the levels of serum E-cadherin(E-cad),carcino-embryonic antigen(CEA),squamous cell carcinoma antigen(SCCA),carbohydrate antigen 19-9(CA19-9)and cytokeratin 19 fragment antigen 21-1(CYERA21-1)in both groups were significantly decreased(P<0.05),but there was no significant difference between the 2 groups(P>0.05).After treatment,the CD3+,CD4+,CD4+/CD8+and natural killer cells(NK)in observation group were higher than those in control group,while the CD8+,regulatory T cells(Treg),helper T cells 17(Th17)and Th17/Treg were lower than those in control group(P<0.05).After medication,the incidence of nausea and vomiting,diarrhea,thrombocytopenia,liver-kidney function damage and peripheral neurotoxicity in observation group was significantly lower than that in control group(P<0.05).After 6 mon

关 键 词：晚期胃癌 吉西他滨 紫杉醇脂质体 血清肿瘤标志物 免疫功能 

分 类 号：R979.1[医药卫生—药品]