冷冻消融联合卡瑞利珠单抗治疗肝细胞癌的效果及安全性分析  

Efficacy and safety of cryoablation combined with Camrelizumab monoclonal antibody in treatment of hepatocellular carcinoma

作　　者：张长旺 武宁晗 王聪[1] 郑峥[1] 高思铭 邹长鹏[1] 张素静 李娜[1] ZHANG Changwang;WU Ninghan;WANG Cong;ZHENG Zheng;GAO Siming;ZOU Changpeng;ZHANG Sujing;LI Na(Department of Oncology,The First Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第一医院肿瘤科,石家庄050000

出　　处：《临床肝胆病杂志》2024年第6期1169-1174,共6页Journal of Clinical Hepatology

基　　金：河北省卫生健康委医学科学研究课题(20210335)。

摘　　要：目的探讨分析冷冻消融联合抑制剂卡瑞利珠单抗治疗肝细胞癌(HCC)的有效性和安全性。方法选取2020年6月—2023年6月河北医科大学第一医院收治的HCC患者103例为研究对象,将患者随机分为联合治疗组(53例)和对照组(50例)。对照组患者接受经皮氩氦刀冷冻消融术治疗,联合治疗组患者接受经皮氩氦刀冷冻消融术联合卡瑞利珠单抗治疗。比较两组患者近期疗效、治疗前后T淋巴细胞亚群变化、肝功能及AFP变化、随访无进展生存期及总体生存期。符合正态分布的计量资料两组间比较采用成组t检验;计数资料两组间比较采用χ^(2)检验。Kaplan-Meier法绘制生存曲线,Logrank检验比较两组生存时间差异。结果联合治疗组患者总缓解率、疾病控制率均明显高于对照组(χ^(2)值分别为4.156、4.348,P值分别为0.042、0.037)。联合治疗组患者治疗后CD3^(+)、CD4^(+)T淋巴细胞百分比及CD4^(+)/CD8^(+)值较治疗前均明显升高(P<0.05),CD8^(+)T淋巴细胞百分比较治疗前明显降低(P<0.05),而对照组患者治疗前、后T淋巴细胞亚群均无明显变化(P值均>0.05),且治疗后联合治疗组CD3^(+)、CD4^(+)T淋巴细胞百分比及CD4^(+)/CD8^(+)值均明显高于对照组(P值均<0.05),CD8^(+)细胞百分比明显低于对照组(P<0.05)。两组患者治疗后ALT、AST、AFP水平较治疗前均明显降低(P值均<0.05),Alb水平较治疗前明显升高(P<0.05),且联合治疗组患者治疗后ALT、AST、AFP水平明显低于对照组(P值均<0.05),Alb水平明显高于对照组(P<0.05)。两组患者Ⅲ~Ⅳ级(中重度)不良反应发生率比较差异无统计学意义(P>0.05)。联合治疗组患者无进展生存中位时间(21.32个月vs 15.31个月)、总体生存中位时间(28.36个月vs 20.75个月)均明显优于对照组(χ^(2)值分别为4.689、5.030,P值分别为0.030、0.025)。结论氩氦刀冷冻消融联合卡瑞利珠单抗可有效提升近期疗效,改善机体免疫功能,延长�Objective To investigate the efficacy and safety of cryoablation combined with Camrelizumab monoclonal antibody in the treatment of hepatocellular carcinoma(HCC).Methods A total of 103 HCC patients who were admitted to our hospital from June 2020 to June 2023 were enrolled and randomly divided into combined treatment group with 53 patients and control group with 50 patients.The patients in the control group received percutaneous argon-helium cryoablation,and those in the combined treatment group received percutaneous argon-helium cryoablation combined with Camrelizumab monoclonal antibody.The two groups were compared in terms of short-term response,changes in T lymphocyte subsets after treatment,changes in liver function and alpha-fetoprotein(AFP)after treatment,and progression-free survival and overall survival during follow-up.The t-test was used for comparison of normally distributed continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.The Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for comparison of survival time between the two groups.Results The combined treatment group had significantly higher overall response rate and disease control rate than the control group(χ^(2)=4.156 and 4.348,P=0.042 and 0.037).After treatment,the combined treatment group had significant increases in the percentages of CD3^(+)and CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)ratio(P<0.05)and a significant reduction in the percentage of CD8^(+)T lymphocytes(P<0.05),while the control group had no significant changes in T lymphocyte subsets after treatment(P>0.05),and compared with the control group after treatment,the combined treatment group had significantly higher percentages of CD3^(+)and CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)ratio(all P<0.05)and a significantly lower percentage of CD8^(+)T lymphocytes(P<0.05).After treatment,both groups had significant reductions in the levels of alanine aminotransferase(ALT),aspartate aminotransfer

关 键 词：癌 肝细胞 冷冻外科手术 免疫检查点抑制剂 

分 类 号：R735.7[医药卫生—肿瘤]