胶质瘤切除术后同步放化疗联合卡瑞丽珠单抗静脉滴注临床效果观察  

Clinical effects of simultaneous radiotherapy combined with karelizumab intravenous infusion after glioma resection

作　　者：高宇 闫文明[1] 王宏伟[1] 秦晓玲[1] 张汝焘 郭奇伟 刘福义 董禹伯 张巍瀚 GAO Yu;YAN Wenming;WANG Hongwei;QIN Xiaoing;ZHANG Rutao;GUO Qiwei;LIU Fuyi;DONG Yubo;ZHANG Weihan(Radiotherapy Department,The Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院放疗科,内蒙古呼和浩特010050 [2]托克托县医院放疗科,内蒙古呼和浩特010299

出　　处：《山东医药》2025年第1期24-28,共5页Shandong Medical Journal

基　　金：北京医学奖励基金会资助项目(YXJL-2020-0785-0561);内蒙古呼和浩特市医疗卫生科技计划项目(呼卫健医疗-2023076);内蒙古医科大学附属医院青年探索项目(2022NYFYTS023)。

摘　　要：目的探讨胶质瘤切除术后同步放化疗联合卡瑞丽珠单抗静脉滴注的临床效果。方法选择胶质瘤患者70例,按随机数字表法分为观察组和对照组各35例。所有患者进行胶质瘤切除术,对照组术后2~6周予放疗同步替莫唑胺化疗,观察组术后2~6周予PD-1抑制剂卡瑞丽珠单抗联合放疗同步替莫唑胺化疗。治疗结束,评估近期疗效,计算疾病控制率(DCR)和肿瘤客观缓解率(ORR)。治疗前及治疗结束后,采集外周静脉血,采用生化分析仪检测血清表皮生长因子(EGF)、血管内皮生长因子(VEGF);采用流式细胞仪检测外周血CD3^(+)、CD4^(+)T淋巴细胞亚群,计算CD4^(+)/CD8^(+)。记录两组治疗期间不良反应情况,包括恶心呕吐、腹痛腹泻、高血压、尿蛋白阳性以及白细胞(WBC)、血小板(PTL)、中性粒细胞(ANC)计数下降。化疗结束,采用卡氏功能状态(KPS)评分评估患者生活质量;进行为期2年的跟踪随访,记录总生存期(OS)和无进展生存期(PFS)。结果观察组与对照组DCR分别为65.71%、40.00%,ORR分别为11.43%、2.86%;观察组DCR高于对照组(P<0.05),两组ORR比较差异无统计学意义。两组血清EGF、VEGF水平均降低,外周血CD3^(+)、CD4^(+)T淋巴细胞亚群以及CD4^(+)/CD8^(+)均升高,以观察组治疗后变化更为显著(P均<0.05)。两组治疗期间恶心呕吐、腹痛腹泻、高血压、尿蛋白阳性发生率以及WBC、PTL、ANC计数下降总发生率比较差异均无统计学意义(P均>0.05)。观察组KPS评分、OS、PFS均高于对照组(P均<0.05)。随访2年,观察组与对照组总生存率分别为65.71%、40.00%,观察组总生存率高于对照组(P<0.05)。结论胶质瘤切除术后同步放化疗联合卡瑞丽珠单抗在胶质瘤治疗中表现出协同抑制作用,能够提高治疗效果和生存质量,同时增强机体免疫功能、抑制肿瘤进展。Objective To investigate the clinical effects of simultaneous radiotherapy combined with karelizumab intravenous infusion after glioma resection.Methods Seventy patients with glioma were selected and randomly divided into the observation group and control group,with 35 cases in each group.All glioma patients underwent surgical resection,and patients in the control group received radiotherapy and temozolomide chemotherapy 2-6 weeks after surgery.Patients in the observation group received PD-1 inhibitor karelizumab combined with radiotherapy and concurrent temozolomide chemotherapy 2-6 weeks after surgery.At the end of treatment,we evaluated the recent efficacy,calculated disease control rate(DCR)and objective response rate(ORR).Before and after treatment,peripheral venous blood was collected and serum epidermal growth factor(EGF)and vascular endothelial growth factor(VEGF)were detected using the biochemical analyzer.We used flow cytometry to detect peripheral blood CD3^(+)and CD4^(+)T lymphocyte subsets,and calculated CD4^(+)/CD8^(+).We recorded the adverse reactions during the two treatment periods,including nausea and vomiting,abdominal pain and diarrhea,hypertension,positive urine protein,and decreased white blood cell(WBC),platelet(PTL),and neutrophil(ANC)counts.After chemotherapy,the Karnofsky functional status(KPS)score was used to evaluate the patients´quality of life.A follow-up period of 2 years was conducted,and we recorded the overall survival(OS)and progression-free survival(PFS).Results The DCRs of the observation group and the control group were 65.71%and 40.00%,respectively.The ORRs were 11.43%and 2.86%,respectively.The DCR of the observation group was higher than that of the control group(P<0.05),and there was no statistically significant difference in ORR between the two groups.Serum EGF and VEGF levels significantly decreased in both groups,while peripheral blood CD3^(+),CD4^(+)T lymphocyte subsets and CD4^(+)/CD8^(+)significantly increased,and the changes were more significant in the observatio

关 键 词：胶质瘤 同步放化疗 免疫治疗 卡瑞丽珠单抗 总生存期 无进展生存期 

分 类 号：R739.41[医药卫生—肿瘤]