以化疗和肠内营养为基础联合程序性死亡受体-1抑制剂治疗肝癌患者的临床研究  

Clinical Study of Chemotherapy-Enteral Nutrition Based Therapy Combined with Programmed Death-1 Inhibitor in the Treatment of Patients with Hepatocellular Carcinoma

作　　者：黄宏春[1] 张海波 孟敏[1] 陈芳洁[1] 陈玉军[1] 蒋珊珊 HUANG Hong-chun;ZHANG Hai-bo;MENG Min;CHEN Fang-jie;CHEN Yu-jun;JIANG Shan-shan(Department of Gastroenterology,Anyang People's Hospital,Anyang 455000,China)

机构地区：[1]安阳市人民医院消化内科,安阳455000

出　　处：《中国合理用药探索》2024年第9期20-27,共8页Chinese Journal of Rational Drug Use

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230854)。

摘　　要：目的:探讨以化疗和肠内营养为基础联合程序性死亡受体-1(PD-1)抑制剂治疗肝癌患者的临床疗效。方法:回顾性选取2020年1月~2022年12月期间某院收治的78例肝癌患者作为研究对象,根据病历系统记录的治疗方式分为对照组(n=42)和观察组(n=36)。对照组患者予以经导管动脉栓塞化疗(TACE)和肠内营养治疗,观察组患者在对照组治疗基础上加用PD-1抑制剂帕博利珠单抗注射液。比较两组患者临床疗效、肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)、间接胆红素(IBIL)和直接胆红素(DBIL)]、免疫功能[CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+)]及不良反应发生情况。结果:治疗3周和6周后,观察组患者病情控制率均高于对照组(P<0.05);两组患者血清ALT、AST、+IBIL、DBIL水平和CD8均降低,且观察组低于对照组(P<0.05);CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)均升高,且观察组高于对照组(P<0.05)。重复测量方差分析显示,两组患者血清ALT、AST、IBIL、DBIL水平及外周血CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/+CD8组间效应、时间效应和交互效应比较均有统计学差异(P<0.05)。治疗期间,两组患者不良反应总发生率比较无统计学差异(P>0.05)。结论:以化疗和肠内营养为基础联合PD-1抑制剂治疗肝癌患者临床疗效较佳,可有效改善肝功能和免疫功能,且未增加不良反应的发生风险。Objective:To investigate the therapeutic effect of chemotherapy-enteral nutrition based therapy combined with programmed death-1(PD-1)inhibitor in patients with hepatocellular carcinoma.Methods:A Total of 78 patients with hepatocellular carcinoma admitted to a hospital from January 2020 to December 2022 were retrospectively selected and divided into the control group(n=42)and the observation group(n=36)according to the treatment regimens recorded in the medical record system.Patients in the control group were treated with transcatheter arterial chemoembolization(TACE)and enteral nutrition,while patients in the observation group were treated with PD-1 inhibitor pembrolizumab injection in addition to the treatment of the control group.The clinical efficacy,liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST),indirect bilirubin(IBIL)and direct bilirubin(DBIL)],immune function[CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)]and the incidence of adverse reactions were compared between the two groups.Results:After 3 weeks of treatment and 6 weeks of treatment,the disease control rate in the observation group was higher than that of control group(P<0.05).Serum ALT,AST,IBIL and DBIL levels and CD8^(+)were decreased in both groups,and the observation group were lower than those in the control group(P<0.05).CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)were increased in both groups,and the observation group were higher than those in the control group(P<0.05).Repeated-measures ANOVA showed statistically significant differences in between-group effects,time effects,and interaction effects for serum ALT,AST,IBIL and DBIL levels,and peripheral blood CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)between the two groups(P<0.05).During the treatment period,there was no statistically significant difference was observed in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Chemotherapy-enteral nutrition based therapy in combination with PD-1 demonstrated favorable clinical efficacy and can improve

关 键 词：化疗 肠内营养 程序性死亡受体-1抑制剂 肝癌 肝功能 免疫功能 

分 类 号：R735.7[医药卫生—肿瘤]