信迪利单抗联合吉西他滨治疗Ⅳ期肺鳞患者临床观察

Clinical observation of sindillimab combined with gemcitabine in treatment of stage Ⅳ patients with squamous cell lung carcinoma

目的分析Ⅳ期肺鳞癌患者应用信迪利单抗联合吉西他滨对血管内皮细胞生长因子及免疫分子含量的影响。方法选取2020-09-05-2021-08-10济源市人民医院Ⅳ期肺鳞癌患者83例作为研究对象,根据性别、年龄、病程、吸烟史均衡原则进行分组。对照组41例给予吉西他滨联合顺铂治疗,研究组42例给予吉西他滨联合信迪利单抗治疗。16周后,对比2组患者临床疗效;6周后,以酶联免疫吸附法检测肿瘤标志物水平、血管内皮细胞生长因子水平;6周后,以流式细胞仪检测细胞免疫水平;记录治疗过程中不良反应。研究数据由收集临床相关登记资料、检查与检验、问卷调查取得,组间比较采用单因素协方差分析、重复测量方差分析。结果研究组总有效率71.43%高于对照组48.78%,差异有统计学意义,χ^(2)=4.443,P=0.035;治疗后,研究组患者癌胚抗原(CEA)水平(19.72±2.34)ng/mL低于对照组(29.36±3.69)ng/mL,差异有统计学意义,F=14.875,P<0.001;细胞角蛋白片段19抗原21-1(CYFRA21-1)水平(9.87±1.04)ng/mL低于对照组(14.07±1.62)ng/mL,差异有统计学意义,F=14.793,P<0.001;鳞状细胞癌抗原(SCCA)水平(3.65±0.47)ng/mL低于对照组(5.58±0.68)ng/mL,差异有统计学意义,F=15.854,P<0.001。治疗后,研究组患者血管内皮细胞生长因子(VEGF)水平(125.13±16.84)pg/mL低于对照组(173.67±20.08)pg/mL,差异有统计学意义,F=12.059,P<0.001;转化生长因子-β(TGF-β)水平(67.09±8.18)pg/mL低于对照组(97.18±9.36)pg/mL,差异有统计学意义,F=15.178,P<0.001;神经元特异性烯醇化酶(NSE)水平(14.81±2.03)ng/mL低于对照组(20.62±5.73)pg/mL,差异有统计学意义,F=6.836,P<0.001。治疗后,研究组患者CD3^(+)水平(64.98±6.34)%高于对照组(62.05±6.19)%,差异有统计学意义,F=2.853,P=0.032;CD4^(+)水平(42.18±5.40)%高于对照组(37.59±5.38)%,差异有统计学意义,F=3.905,P<0.001;CD8^(+)水平(23.39±3.76)%高于对照组(21.06±3.69)%,差异有统计学意义,F=2.972,P=0.006。2组患者恶心呕吐、腹泻、骨髓抑制、皮疹、肝肾功能损伤发生率比较,差异无统计学意义,均P>0.05。结论信迪利单抗联合吉西他滨治疗晚期肺鳞癌患者效果确切,能够有效抑制肿瘤细胞扩散,降低肿瘤标志物及血管内皮生长因子水平,调节免疫功能,且不增加不良反应,值得临床推广应用。

Objective To analyze the effects of sindellizumab combined with gemcitabine on the content of vascular endothe-lial cell growth factor and immune molecules in patients with stage Ⅳ squamous cell lung carcinoma.Methods Eighty-three patients with stage Ⅳ squamous cell lung carcinoma in Jiyuan People's Hospital from 2020-09-05 to 2021-08-10 were selected as the study objects,and grouped them according to the balance principle of gender,age,course of disease and smoking history.Forty-one patients in the control group were treated with gemcitabine combined with cisplatin,and 42 patients in the study group were treated with gemcitabine combined with sindellizumab.After 16 weeks,the clinical effi-cacy of the two groups was compared.After 6 weeks,the levels of tumor markers and vascular endothelial growth factor were detected by enzyme-linked immunosorbent assay.After 6 weeks,the cellular immunity level was detected by flow cytometry.Adverse reactions during treatment were recorded.The study data were collected by clinical registration data,examination and test,questionnaire survey.Univariate covariance test and repeated measurement analysis of variance were conducted.Results The total effective rate of the study group was 71.43%higher than that of the control group 48.78%,with statistical significance(χ^(2)=4.443,P=0.035).After treatment,the CEA level in the study group(19.72±2.34)ng/mL was lower than that in the control group(29.36±3.69)ng/mL,and the difference was statistically significant,F=14.875,P<0.001;The level of cytokeratin fragment 19 antigen 21-1(CYFRA21-1)was(9.87±1.04)ng/mL lower than that of control group(14.07±1.62)ng/mL,the difference was statistically significant,F=14.793,P<0.001;Squamous cell carcinoma antigen(SCCA)level(3.65±0.47)ng/mL was lower than that of control group(5.58±0.68)ng/ml,the difference was statistically significant(F=15.854,P<0.001).After treatment,the vascular endothelial growth factor(VEGF)level in the study group(125.13±16.84)pg/mL was lower than that in the control group(173.67±20.08)pg/mL,the difference was statistically significant,F=12.059,P<0.001;The level of transforming growth factor-β(TGF-β)pg/mL(67.09±8.18)was lower than that of control group(97.18±9.36)pg/mL,the difference was statistically significant,F=15.178,P<0.001;The neuron-specific enolase(NSE)level(14.81±2.03)ng/mL was lower than that of the control group(20.62±5.73)pg/mL,and the difference was statistically significant(F=6.836,P<0.001).After treatment,the level of CD3^(+)in the study group(64.98±6.34)%was higher than that in the control group(62.05±6.19)%,the difference was statistically significant,F=2.853,P=0.032;CD4^(+)level(42.18±5.40)%was higher than that of control group(37.59±5.38)%,the difference was statistically significant,F=3.905,P<0.001;CD8^(+)level(23.39±3.76)%was higher than control group(21.06±3.69)%,the difference was statistically significant,F=2.972,P=0.006.There was no significant difference in the incidence of nausea,vomiting,diarrhea,bone marrow suppression,rash and liver and kidney function injury between 2 groups(P>0.05).Conclusions Sindillimab combined with gemcitabine has a definite effect in the treatment of patients with advanced lung squamous cell carcinoma,which can effectively inhibit the spread of tumor cells,reduce the level of tumor markers and vascular endothelial growth factor,regulate immune function without increasing adverse reactions,and is worthy of clinical promotion and application.