2025 年第 10 期 第 20 卷

二甲双胍联合卡瑞利珠单抗及经导管动脉化疗栓塞术治疗合并2型糖尿病晚期肝细胞癌患者的临床效果分析

Analysis of the clinical effect of metformin combined with camrelizumab and transcatheter arterial chemoembolization in the treatment of patients with advanced hepatocellular carcinoma complicated with type 2 diabetes mellitus

作者：李岩1王春雨1魏攀2陈亚琼3蔡晓庆4

英文作者：Li Yan1 Wang Chunyu1 Wei Pan2 Chen Yaqiong3 Cai Xiaoqing4

单位：1中国人民解放军联勤保障部队第九四〇医院内分泌科，兰州730050；2中国人民解放军联勤保障部队第九四〇医院肿瘤科，兰州730050；3中国人民解放军联勤保障部队第九四〇医院眼科，兰州730050；4中国人民解放军联勤保障部队第九四〇医院心血管内科，兰州730050

英文单位：1Department of Endocrinology the 940th Hospital of the Joint Service Support Force of the Chinese People′s Liberation Army Lanzhou 730050 China; 2Department of Oncology the 940th Hospital of the Joint Service Support Force of the Chinese People′s Liberation Army Lanzhou 730050 China; 3Department of Ophthalmology the 940th Hospital of the Joint Service Support Force of the Chinese People′s Liberation Army Lanzhou 730050 China; 4Department of Cardiovascular Medicine the 940th Hospital of the Joint Service Support Force of the Chinese People′s Liberation Army Lanzhou 730050 China

关键词：肝细胞癌；2型糖尿病；程序性细胞死亡受体1抑制剂；二甲双胍；联合治疗

英文关键词：Hepatocellularcarcinoma;Type2diabetesmellitus;Programmedcelldeathreceptor-1inhibitor;Metformin;Combinationtherapy

• 摘要：

• 目的 探讨二甲双胍联合卡瑞利珠单抗及经导管动脉化疗栓塞术（TACE）治疗合并2型糖尿病（T2DM）晚期肝细胞癌患者的临床效果。方法 收集2018年1月至2022年12月在中国人民解放军联勤保障部队第九四〇医院接受治疗的82例合并T2DM的晚期肝细胞癌患者的临床资料进行回顾性分析。根据治疗方式不同将患者分为二甲双胍组（42例）和对照组（40例）。对照组接受卡瑞利珠单抗及TACE联合非二甲双胍降糖药物治疗；二甲双胍组接受卡瑞利珠单抗及TACE联合二甲双胍治疗。比较2组在免疫功能、生化指标、肿瘤标志物、疗效及安全性方面的差异。结果 治疗后二甲双胍组CD+3、CD+4 T淋巴细胞、CD+4/CD+8比值、自然杀伤细胞比例、γ干扰素、肿瘤坏死因子α、白细胞介素2水平均高于对照组，CD+8 T淋巴细胞比例、白细胞介素6和程序性细胞死亡受体1表达水平、天冬氨酸转氨酶、总胆红素、碱性磷酸酶、天冬氨酸转氨酶与血小板比值指数、甲胎蛋白水平及循环肿瘤DNA阳性率均低于对照组（均P<0.05）。二甲双胍组客观缓解率和疾病控制率均显著高于对照组［61.9%（26/42）比30.0%（12/40）、90.5%（38/42）比67.5%（27/40）］（均P<0.05）。2组不良反应发生率差异均无统计学意义（均P>0.05）。结论 二甲双胍联合卡瑞利珠单抗及TACE治疗能显著改善合并T2DM的肝细胞癌患者的免疫功能、肝功能和代谢状态，降低肿瘤活性，且安全性良好。

• Objective To investigate the clinical effect of metformin combined with camrelizumab and transcatheter arterial chemoembolization (TACE) in the treatment of patients with advanced hepatocellular carcinoma complicated with type 2 diabetes mellitus (T2DM). Methods The clinical data of 82 patients with advanced hepatocellular carcinoma and T2DM who were treated in the 940th Hospital of the Joint Service Support Force of the Chinese People′s Liberation Army from January 2018 to December 2022 were retrospectively analyzed. According to different treatment methods , the patients were divided into metformin group (42 cases) and control group (40 cases). The control group was treated with camrelizumab and TACE combined with non-metformin hypoglycemic drugs. The metformin group was treated with camrelizumab and TACE combined with metformin. The differences in immune function, biochemical indexes, tumor markers, efficacy and safety between the two groups were compared. Results After treatment, the levels of CD+3, CD+4 T lymphocytes, CD+4/CD+8 ratio, natural killer cell ratio, Interferon-γ, tumor necrosis factor-α, and interleukin-2 in the metformin group were all higher than those in the control group; the proportion of CD+8 T lymphocytes, expression levels of interleukin-6 and programmed cell death receptor-1, aspartate aminotransferase, total bilirubin, alkaline phosphatase, aspartate aminotransferase to platelet ratio index, alpha fetoprotein levels, and positive rate of circulating tumor DNA were all lower than those in the control group (all P<0.05). The objective  response rate and disease control rate were significantly higher in the metformin group than those in the control group ［61.9%(26/42) vs 30.0%(12/40), 90.5%(38/42) vs 67.5%(27/40)］(both P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (all P>0.05). Conclusion Metformin combined with camrelizumab and TACE can significantly improve the immune function, liver function and metabolic status of hepatocellular carcinoma patients with T2DM, reduce tumor activity, and has good safety.