白蛋白结合型紫杉醇联合卡铂治疗晚期卵巢癌的疗效及血清HE4、CA125、淋巴细胞亚群检测的临床意义

Efficacy of albumin-bound paclitaxel combined with carboplatin in the treatment of advanced ovarian cancer and the clinical significance of serum HE4,CA125 and lymphocyte subsets detection

目的探讨白蛋白结合型紫杉醇联合卡铂治疗晚期卵巢癌的临床疗效及安全性,分析人附睾蛋白4(HE4)、糖类抗原(CA)125、淋巴细胞亚群检测的临床意义。方法回顾性分析2018年12月至2022年12月该院收治的晚期卵巢癌患者临床资料,对照组(29例)采用紫杉醇脂质体联合卡铂治疗,观察组(29例)采用白蛋白结合型紫杉醇联合卡铂治疗,两组均治疗6个疗程。比较两组客观缓解率(ORR)、疾病控制率(DCR)、不良反应及治疗前后血清HE4、CA125、T淋巴细胞亚群的变化。结果观察组ORR为79.31%,高于对照组的51.72%(χ^(2)=4.884,P=0.027)。观察组DCR为93.10%,高于对照组的79.31%(χ^(2)=4.062,P=0.044)。对照组各项不良反应发生率均高于观察组(P<0.05)。重复测量方差分析结果显示,两组HE4及CA125水平存在组间效应、时间效应和交互效应(P<0.001)。单因素重复测量方差分析结果显示,与治疗前比较,两组患者治疗2、4、6个周期后HE4、CA125水平均下降(P<0.008),多变量方差分析结果显示,观察组治疗2、4、6个周期后HE4、CA125水平均低于对照组(P<0.001)。两组治疗前CD3+、CD4^(+)、CD8^(+)T淋巴细胞比例及CD4^(+)T淋巴细胞/CD8^(+)T淋巴细胞比值比较,差异无统计学意义(P>0.05),治疗后两组CD3+、CD4^(+)淋巴细胞比例及CD4^(+)淋巴细胞/CD8^(+)淋巴细胞比值升高(P<0.05),观察组高于对照组(P<0.05),治疗后两组CD8^(+)T淋巴细胞比例下降,观察组低于对照组(P<0.05)。结论白蛋白结合型紫杉醇联合卡铂治疗晚期卵巢癌患者临床疗效更佳,安全性更好,且可明显降低血清HE4、CA125水平,促进淋巴细胞发挥免疫调节作用,改善机体免疫状态。

Objective To investigate the clinical efficacy and safety of albumin-bound paclitaxel combined with carboplatin in the treatment of advanced ovarian cancer,and to analyze the clinical significance of human epididyms protein 4(HE4),carbohydrate antigen(CA)125 and lymphocyte subsets detection.Methods A retrospective analysis was conducted on patients with advanced ovarian cancer admitted to the hospital from December 2018 to December 2022.The control group(29 cases)was treated with liposomal paclitaxel combined with carboplatin,while the observation group(29 cases)was treated with albumin-bound paclitaxel combined with carboplatin.Both groups were treated for 6 cycles of treatment.The objective response rate(ORR),disease control rate(DCR),adverse reactions were compared between the two groups,as well as changes in serum HE4,CA125 and T lymphocyte subsets before and after treatment.Results The ORR in the observation group was 79.31%,which was significantly higher than the 51.72%in the control group(χ^(2)=4.884,P=0.027).The DCR in the observation group was 93.10%,which was higher than the 79.31%in the control group(χ^(2)=4.062,P=0.044).The incidence rates of adverse reactions in the control group were higher than those in the observation group(P<0.05).Repeated-measures ANOVA showed that there were between-group effects,time effects and interaction effects for HE4 and CA125 levels in both groups(P<0.001).The results of univariate repeated-measures ANOVA showed that HE4 and CA125 levels decreased in both groups after 2,4 and 6 cycles of treatment compared with those before treatment(P<0.008),and the results of multivariate ANOVA showed that HE4 and CA125 levels were lower in the observation group than in the control group after 2,4 and 6 cycles of treatment(P<0.001).There was no statistically significant differences in the proportions of CD3+,CD4^(+),and CD8^(+)T lymphocytes,as well as the CD4^(+)/CD8^(+)T lymphocyte ratio between the two groups before treatment(P>0.05).After treatment,the proportions of CD3+,CD4^(+)T lymphocytes,as well as the CD4^(+)/CD8^(+)T lymphocyte ratio increased in both group(P<0.05),those in the observation group were higher than those in the control group(P<0.05).Additionally,the proportion of CD8^(+)T lymphocytes decreased in both group(P<0.05),those in the observation group were lower than the control group(P<0.05).Conclusion Albumin-bound paclitaxel combined with carboplatin has better clinical efficacy and safety in the treatment of patients with advanced ovarian cancer,and significantly reduces serum HE4 and CA125 levels,promotes lymphocytes to play an immunomodulatory role,and improves the immune status of the body.