TPF诱导化疗卡瑞利珠单抗治疗与二者联合治疗鼻咽癌的疗效比较及对患者神经膜蛋白2及表皮生长因子的影响  

Comparison of the efficacy of TPF induction chemotherapy regimen,PD1 mAb therapy and combination therapy and its effects on neuromembrane protein 2 and epidermal growth factor in patients

作　　者：张太伟 丁传海 吴迪 Zhang Taiwei;Ding Chuanhai;Wu Di(Department of Otolaryngology,Zhoushan Branch,Shanghai Ruijin Hospital,Zhoushan,Zhejiang 316000,China;Department of Oncology,Zhoushan Branch,Shanghai Ruijin Hospital,Zhoushan,Zhejiang 316000,China)

机构地区：[1]上海瑞金医院舟山分院耳鼻喉科,浙江舟山316000 [2]上海瑞金医院舟山分院肿瘤科,浙江舟山316000

出　　处：《中国药物与临床》2023年第5期290-296,共7页Chinese Remedies & Clinics

摘　　要：目的探究TPF诱导化疗方案(多西他赛+顺铂+5-氟尿嘧啶)、卡瑞利珠单抗(PD1)治疗二者联合治疗鼻咽癌的疗效比较及对患者神经膜蛋白2、表皮生长因子的影响。方法选取2020年2月至2023年2月,于上海瑞金医院舟山分院院进行鼻咽癌化疗治疗的患者163例,按治疗方式分组将其分为PD1单抗(PD1组)52例、TPF诱导化疗方案(TPF组)54例、联合组57例。PD1组给予PD1单抗治疗;TPF组给予TPF诱导化疗方案治疗;联合组给予TPF诱导化疗方案联合PD1单抗治疗。检测酶联免疫吸附试验检测癌胚抗原(CEA)、鳞状细胞癌抗原(SCCAg)、糖类抗原125(CA125)、巨噬细胞炎性蛋白-3α(MIP-3α)、层黏连蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、表皮生长因子(EGF)水平;流式细胞仪检测CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平;RT-PCR法测定神经膜蛋白2(NRSN2)相对表达量。对比3组治疗效果,记录其不良毒副反应。结果治疗后,与PD1组、TPF组对比,联合组CEA、SCCAg、CA125、MIP-3α、LN、HA、PCⅢ、CD8^(+)、NRSN2、EGF水平均降低(P<0.05);CD4^(+)、CD4^(+)/CD8^(+)水平升高(P<0.05);与PD1组、TPF组相比[23%(12/52)和24%(13/54)],联合组总治疗有效率最高[49%(28/57),P<0.05];联合组疾病控制率最高[86%(49/57),61%(33/54),60%(31/52),P<0.05];与PD1组、TPF组相比,联合组恶心呕吐、白细胞降低、口腔黏膜炎及血小板减少情况均升高(P>0.05),白细胞降低最高(P<0.05)。结论采用TPF诱导化疗方案、PD1单抗以及二者联合,对鼻咽癌患者进行治疗,能降低肿瘤标志物和血清纤维化指标水平,提高免疫功能、下调NRSN2相对表达量,改善EGF水平,临床效果显著。Objective To explore the efficacy of TPF induction chemotherapy regimen,PD1 mAb therapy and combination therapy of nasopharyngeal carcinoma and its effects on neuropil protein 2 and epidermal growth factor.Methods One hundred and sixty-three patients receiving NPC chemotherapy in Zhoushan Branch,Shanghai Ruijin Hospital,from February 2020 to February 2023 were selected and divided into 52 cases of PD1 mAb(PD1 group),54 cases of TPF induction chemotherapy regimen(TPF group)and 57 cases in the combination group according to the treatment modality.PD1 group was treated with PD1 mAb;TPF group received TPF induction chemotherapy regimen;and the combined group received TPF induction chemotherapy regimen combined with PD1 mAb.Enzyme-linked im-munosorbent assay for carcinoembryonic antigen(CEA),squamous cell carcino-ma antigen(SCCAg),sugar antigen 125(CA125),macrophage inflammatory protein-3α(MIP-3α),laminin(laminin,LN),hyaluronic acid(Hyaluronic acid,HA),typeⅢprocollagen(PC),epidermal growth factor(EGF)horizontal.CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)levels were measured by flow cytometry.The relative expression level of neu-romembrane protein 2(NRSN2)for were measured by RT-PCR determination.The effects of treatment in the three groups were compared,and the adverse effects were recorded.Results After treatment,compared with the PD1 and TPF groups,the levels of CEA,SCCAg,CA125,MIP-3α,LN,HA,PCⅢ,CD8^(+),NRSN2,and EGF were reduced in the combined group(P<0.05);the levels of CD4^(+)and CD4^(+)/CD8^(+)were increased(P<0.05);compared with the PD1 and TPF groups[23%(12/52)vs 24%(13/54)],the effective rate and the disease control rate were the highest[49%(28/57),P<0.05].Nausea and vomiting,leukocyte reduction,oral mucositis and thrombocytopenia were elevated in the combination group compared with the PD1 and TPF groups[86%(49/57),61%(33/54),60%(31/52),P<0.05].The highest reduction in leukocytes was observed in the combination group(P>0.05).Conclusion TPF induction chemotherapy regimen combined with PD1 mAb can reduce the le

关 键 词：鼻咽癌 TPF诱导化疗方案 PD1单抗 神经膜蛋白2 表皮生长因子 

分 类 号：R739.63[医药卫生—肿瘤]