替莫唑胺联合γ-分次立体定向放疗对肺癌脑转移患者血清骨桥蛋白、细胞角蛋白19片段、鳞状细胞癌抗原水平的影响  

Effects of Temozolomide combined withγ-fractionated stereotactic radiotherapy on serum levels of OPN,CYFRA21-1 and SCC in lung cancer patients with brain metastases

作　　者：薛昭 陈治 张琴 XUE Zhao;CHEN Zhi;ZHANG Qin(Oncology Department,The First People’s Hospital of Xianyang,Xianyang 712000,China;Clinical Laboratory,Xi’an Trade Union Hospital,Xi’an 710100,China)

机构地区：[1]陕西中医药大学附属咸阳市第一人民医院肿瘤科,陕西咸阳712000 [2]西安工会医院检验科,陕西西安710100

出　　处：《陕西医学杂志》2025年第4期492-496,506,共6页Shaanxi Medical Journal

基　　金：陕西省自然科学基金资助项目(2021-JC-QN-0897);陕西省咸阳市重点研发计划项目(2020K02-105)。

摘　　要：目的:探讨肺癌脑转移患者采用γ-分次立体定向放疗联合替莫唑胺进行治疗的疗效。方法:采用临床随机试验,选取102例肺癌脑转移患者开展临床研究,采用统计学软件生成随机数字表将患者分为联合治疗组和对照组各51例,联合治疗组采用替莫唑胺联合γ-分次立体定向放疗方法治疗,对照组采用γ-分次立体定向放疗,比较两组治疗前后血清骨桥蛋白(OPN)、细胞角蛋白19片段(CYFRA21-1)、鳞状细胞癌抗原(SCC)的变化及近期疗效、免疫指标变化,并计算两组患者的生存时间。结果:治疗前,联合治疗组与对照组患者的OPN、CYFRA21-1、SCC及CD3^(+)、CD4^(+)、CD8^(+)水平进行对比分析,两组之间比较无统计学差异(P>0.05);联合治疗组与对照组患者在治疗后的OPN、CYFRA21-1、SCC水平与本组治疗前对比显著降低(均P<0.05),且联合治疗组较对照组降低更为明显(P<0.05);同时,两组患者CD3^(+)、CD4^(+)水平显著降低(均P<0.05),CD8^(+)水平显著升高(P<0.05),联合治疗组治疗后的CD3^(+)、CD4^(+)高于对照组(均P<0.05);治疗过程中,联合治疗组患者的恶心、呕吐、白细胞减少、血小板减少发生的严重程度高于对照组(均P<0.05),两组患者腹泻、放射性皮炎、口腔黏膜炎、肝肾功能损伤发生程度比较,差异无统计学意义(均P>0.05);联合治疗组的总体疗效优于对照组(P<0.05);对两组患者连续随访24个月,联合治疗组的中位生存时间15.0个月、对照组的中位生存时间13.0个月,联合治疗组的中位生存时间长于对照组(χ^(2)=7.252,P<0.05)。结论:γ-分次立体定向放疗联合替莫唑胺方案治疗肺癌脑转移的效果优于单独的γ-分次立体定向放疗,并且更有利于延长生存时间,但应注意毒副反应的应对处理。Objective:o investigate the clinical effect of temozolomide combined withγ-fractionated stereotactic radiotherapy on lung cancer patients with brain metastases.Methods:A clinical randomized trial was conducted to investigate 102 patients with brain metastases from lung cancer.Using statistical software to generate a random number table,the patients were divided into a combined treatment group and a control group,with 51 patients in each.The combined treatment group received temozolomide combined with gamma-fractionated stereotactic radiotherapy,while the control group received gamma-fractionated stereotactic radiotherapy alone.Changes in serum osteopontin(OPN),cytokeratin 19 fragment(CYFRA21-1),squamous cell carcinoma antigen(SCC)before and after treatment,as well as short-term efficacy and immune indicators,were compared between the two groups.Additionally,the survival time of patients in both groups was calculated.Results:Before treatment,a comparative analysis of OPN,CYFRA21-1,SCC,and CD3^(+),CD4^(+),CD8^(+)levels was conducted between the combined treatment group and the control group,revealing no significant differences between the two groups(P>0.05).After treatment,the levels of OPN,CYFRA21-1,and SCC in both groups were significantly reduced compared to their pre-treatment levels(all P<0.05),with a more pronounced decrease observed in the combined treatment group compared to the control group(P<0.05).Additionally,the levels of CD3^(+)and CD4^(+)significantly decreased in both groups(all P<0.05),while the level of CD8^(+)significantly increased(P<0.05).Notably,the post-treatment levels of CD3^(+)and CD4^(+)in the combined treatment group were higher than those in the control group(all P<0.05).During treatment,the severity of nausea,vomiting,leukopenia,and thrombocytopenia was higher in the combined treatment group compared to the control group(all P<0.05).However,there was no statistically significant difference in the severity of diarrhea,radiodermatitis,oral mucositis,and liver and kidney function damage

关 键 词：替莫唑胺 γ-分次立体定向放疗 肺癌 脑转移 生存 

分 类 号：R739.41[医药卫生—肿瘤]