扶正抑瘤方联合PD-1/PD-L1抑制剂对晚期非小细胞肺癌不同证型治疗效果  

The effect of the tumor on the treatment of the different syndromic cells in the late phase of the small cell lung cancer

作　　者：王达 燕彩霞 王胜杰 WANG Da;YAN Caixia;WANG Shengjie(Jinan Hospital of Integrated Traditional Chinese and Western Medicine,Jinan Shandong 250001,China)

机构地区：[1]济南市中西医结合医院,山东济南250001

出　　处：《四川中医》2024年第7期116-121,共6页Journal of Sichuan of Traditional Chinese Medicine

摘　　要：目的:分析扶正抑瘤方联合程序性死亡受体1(programmed cell death protein,PD-1)和配体1(programmed cell death protein ligand1,PD-L1)抑制剂对晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)不同证型治疗效果。方法:对入选的137例接受扶正抑瘤方联合PD-1/PD-L1抑制剂的NSCLC患者进行分型,并收集患者的临床资料,统计无进展生存期(Progression-free Survival,PFS),并通过功能状态(Karnofsky,KPS)评分和中医证候积分对患者治疗4周后功能状态和证候变化进行评估分析。结果:入选患者中肺脾气虚30例(21.74%),气虚痰湿证46例(33.33%),气血瘀滞证34例(24.64%),气阴两虚证28例(20.29%)。总体中位PFS(media Progressionfree Survival,mPFS)为6.0个月(95%CI:4.5~8.4)。其中气血瘀滞证mPFS最高为7.8个月(95%CI:5.5~10.0),气阴两虚证mPFS最低仅为4.5个月(95%CI:3.0~4.8)。不同证型之间mPFS差异有统计学意义(χ^(2)=15.527,P<0.01)。治疗4周后客观缓解率(Objective Response Rate,ORR)为23.66%,疾病控制率(Disease Control Rate,DCR)为62.6%。四个证型组的患者治疗4周期后KPS评分总改善有效率为63.36%,其中气血瘀滞证患者KPS改善率最高,为76.67%,其次为气虚痰湿72.73%;气阴两虚证患者KPS改善率最低,为35.71%。四证型组差异有统计学意义,气虚痰湿和气血瘀滞明显高于气阴两虚(P<0.01)。四个证型组的患者治疗满4周期后中医积分改善有效率为63.36%。其中肺脾气虚有效率为34.48%;气虚痰湿有效率为36.36%;气血瘀滞有效率为60%;气阴两虚有效率为25%。四个证型有效率对比差异有统计学意义,气血瘀滞证明显高于其他证型(P<0.05)。患者不良反应发生率为83.97%。主要包括疲劳,皮肤瘙痒、红肿、水泡,肺炎,肝、肾、甲状腺、心脏功能异常、消化道不良反应和骨髓抑制。结论:非小细胞肺癌主要可分为肺脾气虚证、气虚痰湿证、气血瘀滞证、气阴两虚证,扶正抑瘤方联合PD-1/PD-L1抑制剂对不�objective:to analyze the therapeutic of FuzhengYiyufang combined with programmed cell death protein(PD-1)and ligand1(PD-L1)inhibitor on different syndrome types of advanced non-small cell lung cancer(NSCLC).Methods:A total of 137NSCLC patients who received FuzhengYiyufang combined with PD-1/PD-L1inhibitors were classified,and clinical data of the patients were collected to make statistics on Progression-free Survival(PFS).Functional status(Karnofsky,KPS)score and TCM syndrome score were used to evaluate and analyze the functional status and syndrome changes of patients after 4weeks of treatment.Results:Among the selected patients,there were 30cases(21.74%)of lung qi deficiency,46cases(33.33%)of qi deficiency and phlegm-dampness,34cases(24.64%)of qi and blood stasis,and 28cases(20.29%)of qi Yin deficiency.Overall median media Progression-free Survival(mPFS)was 6.0months(95%CI:4.5~8.4).The highest mPFS in Qi-blood stasis syndrome was 7.8months(95%CI:5.5~10.0),and the lowest mPFS in Qi-yin deficiency syndrome was only 4.5months(95%CI:3.0~4.8).There was significant difference in mPFS among different syndrome types(x2=15.527,P<0.01).After 4weeks of treatment,the Objective Response Rate(ORR)was 23.66%,and the Disease Control Rate(DCR)was 62.6%.After 4cycles of treatment,the total improvement rate of KPS score in the four syndrome groups was 63.36%.The improvement rate of KPS in patients with Qi-blood stasis syndrome was the highest(76.67%),followed by Qi-deficiency phlegm-dampness 72.73%.The improvement rate of KPS in patients with Qi-Yin deficiency syndrome was the lowest(35.71%).The difference between the four syndrome groups was statistically significant.Qi-deficiency phlegm-dampness and Qi-blood stasis were significantly higher than Qi-yin deficiency(P<0.01).The effective rate of improvement of TCM score was 63.36%in the four syndrome groups after 4cycles of treatment.The effective rate of lung Qi deficiency was 34.48%;The effective rate of Qi deficiency and phlegm dampness was 36.36%.The effective rate of Qi and b

关 键 词：非小细胞肺癌 程序性死亡受体1抑制剂 气阴两虚证 无进展生存期 

分 类 号：R734.2[医药卫生—肿瘤]