2024 年第 8 期 第 0 卷

吉西他滨或注射用紫杉醇(白蛋白结合型)联合其他药物一线治疗晚期无基因突变非小细胞肺癌的效果及安全性观察

Observation on the efficacy and safety of gemcitabine or paclitaxel for injection(albumin bound) combined with other drugs in the first-line treatment of advanced non-small cell lung cancer without gene mutation

作者：王国平1张燕2曾守琼1

英文作者：Wang Guoping1 Zhang Yan2 Zeng Shouqiong1

单位：1四川省成都市第五人民医院成都中医药大学附属第五人民医院/第二临床医学院肿瘤科四川省成都市肿瘤防治所，成都611130；2西南医科大学附属四川省泸州市人民医院肿瘤科，泸州646000

英文单位：1Department of Oncology Chengdu Fifth People′s Hospital Sichuan Province the Second Clinical Medical College Affiliated Fifth People′s Hospital of Chengdu University of Traditional Chinese Medicine Cancer Prevention and Treatment Institute of Chengdu Chengdu 611130 China; 2Department of Oncology Luzhou People′s Hospital of Sichuan Province Affiliated to Southwest Medical University Luzhou 646000 China

关键词：晚期非小细胞肺癌；吉西他滨；洛铂；注射用紫杉醇(白蛋白结合型)；卡瑞利珠单抗；淋巴细胞亚群；肿瘤标志物

英文关键词：Advancednon-smallcelllungcancer;Gemcitabine;Lobaplatin;Paclitaxelforinjection(albuminbound);Camrelizumab;Lymphocytesubsets;Tumormarker

• 摘要：

• 目的 观察吉西他滨或注射用紫杉醇(白蛋白结合型)联合洛铂及卡瑞利珠单抗一线治疗晚期无基因突变非小细胞肺癌（NSCLC）的效果及安全性。方法 选取四川省成都市第五人民医院2022年1月至2023年6月收治的晚期无基因突变NSCLC患者120例，按照随机数字表法分为对照组和观察组，各60例。对照组予以吉西他滨联合洛铂及卡瑞利珠单抗方案治疗；观察组予以注射用紫杉醇(白蛋白结合型)联合洛铂及卡瑞利珠单抗方案治疗。比较2组治疗前及治疗后14 d血清鳞状细胞癌相关抗原（SCC）、细胞角蛋白19片段抗原（CA21-1）、转化生长因子β1（TGF-β1）水平，血清CD+3、CD+4、CD+8水平及CD+4/CD+8比值，比较2组临床疗效及毒副反应发生情况。结果 治疗后14 d，2组患者血清SCC、CA21-1、TGF-β1和CD+8水平均低于治疗前且观察组均低于对照组，血清CD+3、CD+4水平及CD+4/CD+8比值均高于治疗前且观察组高于对照组，差异均有统计学意义（均P＜0.05）。观察组客观缓解率、疾病控制率均高于对照组［45.0%（27/60）比28.3%（17/60）、73.3%（44/60）比58.3%（35/60）］，差异均有统计学意义（均P<0.05）。观察组患者粒细胞减少、血小板减少发生率低于对照组，肌肉/关节痛发生率高于对照组［25.0%（15/60）比78.3%（47/60）、30.0%（18/60）比66.7%（40/60）、71.7%（43/60）比23.3%（14/60）］，差异均有统计学意义（均P<0.05），2组间恶心呕吐发生率差异无统计学意义（P>0.05）。结论 与吉西他滨联合洛铂及卡瑞利珠单抗相比，注射用紫杉醇(白蛋白结合型)联合洛铂及卡瑞利珠单抗一线治疗晚期无基因突变NSCLC不但效果较为显著，可有效降低肿瘤标志物水平，还具有毒性低、对免疫系统影响小、有助于T淋巴细胞亚群恢复、减轻骨髓抑制等优势。

• Objective To observe the efficacy and safety of gemcitabine or paclitaxel for injection (albumin bound) combined with lobaplatin and camrelizumab as first-line treatment for advanced non-small cell lung cancer (NSCLC) without gene mutation. Methods  Totally 120 patients with advanced NSCLC without gene mutation admitted to Chengdu Fifth People′s Hospital, Sichuan Province from January 2022 to June 2023 were selected. They were divided into control group and observation group using a random number table method, with 60 cases in each group. The control group was treated with gemcitabine combined with lobaplatin and camrelizumab. The observation group was treated with paclitaxel for injection (albumin bound) combined with lobaplatin and camrelizumab. The levels of serum squamous cell carcinoma associated antigen (SCC), cytokeratin 19 fragment antigen (CA21-1), transforming growth factor-β1(TGF-β1), serum CD+3, CD+4, CD+8 and the ratio of CD+4/CD+8 were compared between the two groups before and 14 d after treatment. The clinical efficacy and incidence of toxic side effects were compared between the two groups. Results  After 14 d of treatment, the levels of SCC, CA21-1 and TGF- β1 and CD+8 in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group; the serum levels of CD+3, CD+4, and the ratio of CD+4/CD+8 in both groups were higher than those before treatment, and those in the observation group were higher than those in the control group (all P<0.05). The objective remission rate and disease control rate of the observation group were higher than those of the control group ［45.0%(27/60) vs 28.3%(17/60), 73.3%(44/60) vs 58.3%(35/60)］(both P<0.05). The incidences of granulocytopenia and thrombocytopenia in the observation group were lower than those in the control group, and the incidence of muscle/joint pain was higher than that in the control group ［25.0%(15/60) vs 78.3%(47/60), 30.0%(18/60) vs 66.7%(40/60), 71.7%(43/60) vs 23.3%(14/60)］(all P<0.05), and there was no statistically significant difference in the incidence of nausea and vomiting between the two groups(P>0.05). Conclusions  Compared with gemcitabine combined with lobaplatin and camrelizumab, paclitaxel for injection (albumin bound) combined with lobaplatin and camrelizumab is more effective in the first-line treatment of advanced NSCLC without gene mutations, which can effectively reduce the level of tumor markers. It also has the advantages of low toxicity, little effect on the immune system, helping the recovery of T lymphocyte subsets, and reducing bone marrow suppression.