多西他赛或培美曲塞联合铂类对EGFR-TKI耐药的非小细胞肺癌晚期患者外周血PD-1表达水平及淋巴细胞亚群影响分析

The effect of docetaxel or pemetrexed combined with platinum on PD-1 expression and lymphocyte subsets in peripheral blood of patients with advanced non-small cell lung cancer resistant to EGFR-TKI

目的探究多西他赛或培美曲塞联合铂类对表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)耐药的非小细胞肺癌晚期患者外周血程序性死亡受体1(PD-1)表达水平及淋巴细胞亚群的影响。方法回顾性选取2021年3月~2023年4月在如皋市人民医院接受治疗的110例非小细胞肺癌晚期患者。根据不同的治疗方式将患者分为多西他赛组和培美曲塞组,每组各55例。多西他赛组使用多西他赛联合顺铂治疗,培美曲塞组使用培美曲塞联合顺铂治疗,以21 d为1个周期,两组均治疗4个周期。治疗后观察评估两组治疗疗效;比较两组不良反应情况及生活质量情况;观察比较两组CA125、CYFRA21-1、Gal-3水平和PD-1阳性率;比较两组淋巴细胞亚群CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)和NK水平。结果多西他赛组疾病控制率(DCR)率92.73%,培美曲塞组DCR率89.09%,两组疾病控制率差异无统计学意义(P>0.05);治疗后培美曲塞组不良反应率显著低于多西他赛组,生活质量改善率显著高于多西他赛组,差异有统计学意义(P<0.05)。两组患者血清Gal-3、CYFRA21-1、CA125水平和PD-1阳性率治疗前后差值差异无统计学意义(P>0.05);治疗后患者CD3^(+)、CD4^(+)及NK明显提高,差异有统计学意义(P<0.05),而CD8^(+)差异无统计学意义(P>0.05)。结论多西他赛或培美曲塞联合铂类对EGFR-TKI耐药的非小细胞肺癌晚期患者外周血PD-1表达水平及淋巴细胞亚群影响区别无明显差异,但培美曲塞联合顺铂治疗的不良反应发生率比较低,治疗方案更理想,有临床应用价值。

Objective To investigate the effects of docetaxel or pemetrexed combined with platinum on PD-1 expression and lymphocyte subsets in peripheral blood of patients with advanced non-small cell lung cancer resistant to EGFR-TKI.Methods A retrospective study was conducted on 110 patients with advanced lung cancer who were treated in the Department of Pharmacy of Rugao People′s Hospital from March 2021 to April 2023.According to different treatment method,the patients were divided into docetaxel group and pemetrexed group,with 55 patients in each group.The docetaxel group was treated with docetaxel combined with cisplatin,and the pemetrexed group was treated with pemetrexed combined with cisplatin,with 21 days as a cycle.Both groups were treated for 4 cycles.After treatment,the curative effect of the two groups was observed and evaluated.The adverse reactions and quality of life of the two groups were compared.The levels of CA125,CYFRA21-1,Gal-3 and the positive rate of PD-1 were observed and compared between the two groups.The levels of lymphocyte subsets CD3^(+),CD4^(+),CD8^(+)and NK were compared between the two groups.Results The DCR rate was 92.73%in the docetaxel group and 89.09%in the pemetrexed group.There was no significant difference in disease control rate between the two groups(P>0.05).After treatment,the adverse reaction rate of pemetrexed group was significantly lower than that of docetaxel group(P<0.05).After treatment,the improvement rate of quality of life in pemetrexed group was significantly higher than that in docetaxel group(P<0.05).There was no significant difference in serum Gal-3,CYFRA21-1,CA125 levels and PD-1 positive rate between the two groups before and after treatment(P>0.05).After treatment,CD3^(+),CD4^(+)and NK were significantly increased(P<0.05).Conclusion There is no significant difference in the effect of docetaxel or pemetrexed combined with platinum on PD-1 expression level and lymphocyte subsets in peripheral blood of patients with advanced non-small cell lung cancer resistant to EGFR-TKI.However,the incidence of adverse reactions in pemetrexed combined with cisplatin treatment is relatively low,and the treatment plan is ideal.It has the value of promotion and popularization in clinical practice.