Assessing the Effectiveness of Montelukast Sodium in Managing Pulmonary Infections in Lung Cancer Patients

Objective:To investigate the efficacy of montelukast sodium in the treatment of lung cancer patients with pulmonary infections.Methods:A total of 330 patients diagnosed with lung cancer and pulmonary infection,who were admitted to the First Affiliated Hospital of Xi’an Medical University from 2020 to 2022,were selected as research subjects.They were randomly divided into two groups:a control group receiving conventional treatment and an observation group receiving conventional treatment combined with montelukast sodium.Each group consisted of 165 cases.The time required for clinical symptom improvement,the resolution of lung infection signs,and the levels of serum inflammatory factors before and after treatment were compared between the two groups.Results:The observation group exhibited significantly faster improvement in clinical symptoms compared to the control group(P<0.001).ELISA assays were conducted to detect the expression levels of IL-1β,IL-6,IL-8,and TNF-αin the serum of both groups at 1 week and 2 weeks into the treatment.The results indicated that,as the treatment progressed,the observation group displayed significantly lower levels of the four serum inflammatory factors compared to the control group(P<0.001).Conclusion:Montelukast sodium demonstrates efficacy in the treatment of patients with lung cancer complicated by pulmonary infections.These findings suggest its potential for further verification and clinical application.

Role of inflammatory markers in the evaluation of indeterminate pulmonary nodules:a review

The global mortality rate of lung cancer surpasses that of any other type of cancer,establishing it as the foremost cause of cancer-related deaths worldwide.The objectives of lung nodule assessment are to expedite the diagnosis and treatment of patients with malignant nodules while minimizing unnecessary diagnostic procedures for those with benign nodules.The systemic inflammatory response is closely linked to tumorigenesis.Serum levels of inflammatory markers and their derived parameters markers including neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),monocyte-to-albumin ratio(MAR),platelet-to-lymphocyte ratio(PLR)and systemic immune‐inflammation index(SII),closely associated with lung cancer.The objective of this article is to comprehensively evaluate the differentiation between benign and malignant pulmonary nodules in terms of inflammatory response indicators,aim at provide practical recommendations for the clinical diagnosis,treatment,and management of pulmonary nodules.

Protective effect of methylprednisolone combined with ulinastatin pretreatment on inflammatory lung injury induced by anesthesia for esophageal cancer

Objective:To investigate the protective effect of methylprednisolone combined with ulinastatin pretreatment on inflammatory lung injury induced by single-lung ventilation.Methods: A total of 120 patients with radical resection of cancer surgery admitted to our hospital from January 2016 to December 2017 were randomly divided into control group, methylprednisolone group, ulinastatin group, and methylprednisolone combined with ulinastatin pretreatment group. Before single lung ventilation (T0), 30 min after ventilation (T1), and 60 min (T2) after the end of ventilation, enzyme-linked immunosorbent kit method was used to detect the levels of inflammatory factors TNF-α, IL-8 and IL-10. The mean airway pressure (Pmean) at each monitoring point and the oxygenation indexes (PaO2/FiO2) before and after surgery were detected. And also, the extraction time, drainage volume and sputum volume of the drainage tube after surgery were measured.Results:Compared with the control group, the other three groups can reduce the levels of TNF-α and IL-8 in the blood of patients with esophageal cancer, improve IL-10 and increase the oxygenation index (P<0.05). However, methylprednisolone combined with ulinastatin pretreatment group was significantly better than methylprednisolone group and ulinastatin group in reducing serum inflammatory factor levels and increasing oxygenation index. In addition, the drainage tube extraction time, drainage volume and sputum volume of the patients treated with methylprednisolone combined with ulinastatin were also significantly lower than those of the control group, the methylprednisolone group and the ulinastatin group.Conclusions: Methylprednisolone combined with ulinastatin has a synergistic protective effect on inflammatory lung injury caused by radical resection of esophageal cancer patients, which is worthy of first-line clinical recommendation.

Effect of Goal-Directed Fluid Therapy on Lung Function, Cognitive Function and Inflammatory Response in Patients Undergoing Radical Esophageal Cancer Surgery under One-Lung Ventilation

Objective: To explore the effects of goal-directed fluid therapy (GDFT) on lung function, cognitive function and inflammatory response in patients undergoing radical esophageal cancer surgery under one-lung ventilation. Methods: Sixty-seven patients undergoing radical esophageal cancer surgery were divided into GDFT group (GDFT therapy) and control group (conventional liquid therapy). The changes in patients’ pulmonary function, cognitive function and inflammatory response were evaluated. Results: Both alveolar-arterial oxygen partial pressure difference [P(A-a)O2] and respiratory index (RI) increased at one-lung ventilation for 30 minutes (T2) and decreased at one-lung ventilation for 60 minutes (T3), and after surgery (T4) in the two groups, and the GDFT group was lower than the control group (P < 0.05);theoxygenation index (OI) of the two groups decreased at T2, T3, and T4 compared with that at T1 (before one-lung ventilation), and the GDFT group was higher than the control group (P < 0.05). At T4 and T5, the tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), central nervous system specific protein (S100β), and neuron specific enolase (NSE) in the GDFT group were lower compared to the control group (P < 0.05), while interleukin-10 (IL-10) was higher compared to the control group (P < 0.05);the incidence of perioperative neurocognitive disorder (PND) in the GDFT group was lower than that in the control group (P < 0.05). Conclusion: GDFT can help prevent lung injury during radical esophageal cancer surgery under one-lung ventilation, reduce the body’s inflammatory response, and reduce the incidence of perioperative cognitive disorder to a certain extent.

Effects of Yiqi Gu Ben Decoction combined with DC chemotherapy on serum tumor markers, inflammatory factors and immune function in patients with locally advanced non-small cell lung cancer

Objective: To investigate the effects of Yiqi Gu decoction combined with DC chemotherapy on serum tumor markers, inflammatory factors and immune function in patients with locally advanced non-small cell lung cancer. Methods: A total of 95 patients with locally advanced non-small cell lung cancer were selected as the research objects, according to the random data table they were divided into control group (n=48) and observation group (n=47), patients in the control group were given DC chemotherapy, On the basis of this treatment, the patients in the observation group were given Yiqi Gu decoction treatment, Comparison of the levels of serum tumor markers [antigen (CEA) and carbohydrate antigen 19-9 (CA19-9)], inflammatory factor [C reactive protein (CRP) and tumor necrosis factor-α (TNF-α)] and immune function (CD3+, CD4+, CD8+, CD4+/CD8+)Results: Before treatment, there were no significant difference in the levels of CEA, CA19-9, CRP, TNF-α, CD3+, CD4+, CD8+, CD4+/CD8+ between the two groups;After treatment, the CEA, CA19-9, CRP, TNF-α, CD8+ levels of two groups were significantly lower than those in the same group before treatment, and the decreased range in observation group was significantly higher than the control group, moreover the levels after treatment were obviously lower than control group;After treatment, the levels of CD3+, CD4+, CD4+/CD8+ in the observation group were (64.72±5.25)% , (39.51±5.14)% and (1.35±0.27), which were significantly higher than the same group before treatment, and significantly higher than the control group [(58.57±5.09)%, (31.34±5.06)%, (1.14±0.33)], differences were statistically significant. Conclusion: DC chemotherapy combined with Yiqi Guben Decoction in the treatment of locally advanced non-small cell lung cancer, can effectively reduce the serum tumor marker levels, decrease inflammatory stress, improve immune function, has an important clinical value.

Observation on the Effect of Spontaneous Ventilation Single-Port Thoracoscopy and Conventional Thoracoscopy on T Lymphocyte Subsets and Inflammatory Factors in Patients with Non-Small Cell Lung Cancer

Objective:To explore the effects of two types of surgical approaches,spontaneous ventilation single-port thoracoscopy and conventional thoracoscopy,on T lymphocyte subsets and inflammatory factors in patients with non-small cell lung cancer.Methods:Fifty-eight patients with non-small cell lung cancer who underwent surgery in the Affiliated Hospital of Hebei University from January 2020 to December 2021 were selected as the study subjects.All of them underwent standard lobectomy and lymph node dissection.Among them,32 patients who underwent spontaneous ventilation single-port thoracoscopy were included in the study group,while 26 patients who underwent conventional thoracoscopy were included in the control group.The perioperative related indices,lung function,immune factor levels,and inflammatory factor levels were compared between the two groups.Results:In the study group,the perioperative incision length,intraoperative blood loss,operation time,and number of lymph node dissections were 4.28±2.01,77.89±12.02,87.21±16.11,and 20.69±4.45,respectively.In the control group,the perioperative incision length,intraoperative blood loss,operation time,and number of lymph node dissections were 6.32±2.45,84.98±16.98,95.88±14.89,and 21.45±4.36,respectively.There was no statistical difference between the study group and the control group in the number of lymph node dissections and intraoperative blood loss;the lung function in the study group was significantly better than that in the control group;the levels of T cell subsets CD4+,CD8+,CD4+/CD8+,CD16+CD56+of the study group were 46.36±5.87,30.98±4.12,1.19±0.23,and 17.41±6.25,respectively,while those in the control group were 35.78±4.12,34.14±3.87,1.04±0.24,and 12.45±5.56,respectively;the levels of immunoglobulin IgG,IgM,and IgA of the study group were 10.45±2.14,1.21±0.24,and 1.26±0.25,respectively,while those of the control group were 8.78±1.78,1.06±0.12,and 1.06±0.26,respectively,with statistical differences;the levels of CRP,IL-6,IL-8,and TNF-αof the control group were 21.87±4.26,98.01±9.58,111.03±9.96,and 123.05±9.77,respectively,while those of the study group were 19.47±3.89,89.12±8.96,104.32±9.12,and 112.98±9.16,respectively,in which the comparison was statistically significant.Conclusion:In the surgical treatment of non-small cell lung cancer,spontaneous ventilation single-port thoracoscopic surgery has several advantages,which include less trauma and bleeding.It reduces the impact of surgical trauma on the immune function of the body,improves the postoperative lung function and inflammatory stress of the body,as well as accelerates the recovery of patients.It is an alternative to open lung lobectomy for the treatment of lung cancer.

Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer and Surgery Treatment

Objectives To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung cancer and surgery therapy.Methods We retrospectively enrolled 637 male patients who underwent curative-intent lung cancer resection between January 2014 and December 2016.Patients were classified as the current smokers,the never smokers,and the ex-smokers based on their smoking history,and the ex-smokers were allocated into five subgroups according to their smoking cessation times(CeT):CeT W6 weeks,6weeks<CeT W lyear,lyear<CeT<5years,5years<CeT<lOyears,CeT>10years.The preoperative peripheral blood white blood cells(WBCs),albumin,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),intraoperative blood loss,30-day mortality,in-hospital days,hospitalization costs,intensive care un辻(ICU),admission days and placement time of closed thoracic drainage tube were compared among difTerent groups.Results There were significant differences in WBC(F=S.275,P<0.001)and albumin(F=2,470,P<0.05)among patients of current smokers,ex-smokers with different smoking cessation time,and never-smokers.The blood WBC count in current smokers(7.7 X 109/L)was significantly higher than that in ex・smokers(7.0 X 109/L)and never-smokers(5.9 X 109/L)(t=-2.145,P<0.05;t=-6.073,P<0.01,respectively).The level of peripheral blood albumin in current smokers(41.1 g/L)was lower than that in ex・smokers(42.1 g/L)and neve—smokers(43.2 g/L)(t=2.323,P<0.05;t=3.995,P<0.01,respectively).The level of peripheral blood NLR in current smokers(3.7)was higher than that in ex-smokers(3.1)and never smokers(2.8)(t—-1.836,P<0.05;t=-2.889,P<0.01,respectively).There was no significant difference in WBC,albumin and NLR among five subgroups of different smoking cessation time.No significant difference was observed in intraoperative blood loss,30-day mortality,hospitalization costs,hospital stay,ICU stay and placement time of closed thoracic drainage tube among groups either.Conclusion Smoking increases the preoperative inflammatory indexes in peripheral blood of lung cancer patients.Smoking cessation has beneficial effect on reducing levels of these inflammatory indexes,which may be not impacted by the time length of smoking cessation.Therefore,lung cancer patients should be encouraged to quit smoking at any time.

Effect of dexmedetomidine pretreatment on postoperative immune function and inflammatory stress response in patients with non-small cell lung cancer surgery

Objective:To study the effect of dexmedetomidine pretreatment on postoperative immune function and inflammatory stress response in patients with non-small cell lung cancer surgery. Methods: Patients with non-small cell lung cancer who underwent radical operation for lung cancer in Xi'an Aerospace General Hospital between August 2014 and September 2017 were selected and randomly divided into the Dex group who received dexmedetomidine pretreatment combined with general anesthesia and the control group who received routine general anesthesia. The same day after surgery and 3 d after surgery, the peripheral blood was collected respectively to determine the contents of immune cells and the serum was collected respectively to determine the contents of inflammatory stress response indexes.Results:The same day after surgery and 3 d after surgery, CD3+CD4+T cell, CD3+CD8+T cell and CD16+CD56+NK cell contents in peripheral blood of Dex group were significantly higher than those of control group whereas CD11b+CD15+CD33+CD14-G-MDSC, CD11b+CD15-CD33+CD14+M-MDSC and CD4+CD25+CD127lowTreg contents in peripheral blood as well as TNF-α, SAA, CRP, IL-8, IL-10, Cor, Ins, NE, E and AT-II contents in serum were significantly lower than those of control group.Conclusion: Dexmedetomidine pretreatment can improve the immune function and inhibit the inflammatory stress response in patients with non-small cell lung cancer surgery.

Activation of Toll-like receptors signaling in non-small cell lung cancer cell line induced by tumor-associated macrophages

Background： Inflammation is often linked with the progress and poor outcome of lung cancer. The understanding of the relationship between tumor-associated macrophages （TAMs） and lung cancer cells involves in the underlying mechanism of inflammatory cytokine production. Toll-like receptors （TLRs） are engaged in promoting the production of pro-inflammatory cytokines and play an important role in tumor immunology. Methods： To investigate the mechanisms by which TAMs influence the production of pro-inflammatory cytoldnes in lung cancer cells, we established an in vitro coculture system using TAMs and human non- small cell lung cancer （NSCLC） cell line SPC-A1. Levels of interleukin （IL）-113, IL-6 and IL-8 in SPC-A1 were evaluated by RT-PCR and cytometric bead array assay after being cocultured with TAMs. Expression changes of TLRs and TLRs signaling pathway proteins in SPC-Al were further confirmed by RT-PCR and western blot. The level changes of IL-1β, IL-6 and IL-8 in SPC-Al were also detected after the stimulation of TLRs agonists. Results： We found that the phenotype markers of TAMs were highly expressed after stimulating human monocyte cell line THP-1 by phorbol-12-myristate-β-acetate （PMA）. Higher mRNA and supernate secretion levels of IL-1β, IL-6 and IL-8 were detected in SPC-A1 after being eocultured with TAMs. We also found that TLR1, TLR6 and TLR7 were up-regulated in SPC-A1 in the coculture system with TAMs. Meanwhile, TLRs signaling pathway proteins were also significantly activated. Moreover, pre-treatment with agonist ligands for TLR1, TLR6 and TLR7 could dramatically promote inductions of IL-1β, IL-6 and IL-8. Conclusions： These findings demonstrated that TAMs may enhance IL-1β, IL-6 and IL-8 expressions via TLRs signaling pathway. We conclude that TAMs contribute to maintain the inflammation microenvironment and ultimately promote the development and progression of lung cancer.

呼吸训练联合呼吸道管理在肺癌根治术患者中的应用

目的分析呼吸训练联合呼吸道管理对肺癌根治术后患者炎症指标以及临床恢复效果的影响。方法回顾性分析在连云港市中医院2019年1月至2022年12月期间接受肺癌根治术治疗的80例肺癌患者临床资料,其中接受常规呼吸训练护理的40例患者作为对照组,同期接受呼吸训练联合呼吸道管理护理的40例患者作为观察组。对照组男26例、女14例,年龄59~76(67.53±2.41)岁;观察组男27例、女13例,年龄57~76(66.97±2.41)岁。对比两组患者肺功能恢复水平、炎症指标水平以及相关并发症发生情况。统计学方法采用χ^(2)检验、t检验。结果护理后,观察组患者用力肺活量(FVC)、呼气流量峰值(PEF)、第一秒用力呼气量(FEV1)水平均高于对照组[(3.41±0.63)L比(3.02±0.51)L、(4.23±0.64)L/min比(3.81±0.72)L/min、(1.71±0.43)L比(1.43±0.59)L],差异均有统计学意义(t=3.04、2.76、2.43,均P<0.05);护理后,观察组患者白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)均低于对照组[(21.98±5.48)μg/L比(25.53±5.68)μg/L、(23.08±6.05)μg/L比(27.54±5.56)μg/L、(23.97±6.45)pg/L比(28.53±6.25)pg/L],差异均有统计学意义(t=2.85、3.43、3.21,均P<0.05);观察组患者肺癌根治术后并发症发生率低于对照组[5.00%(2/40)比20.00%(8/40)],差异有统计学意义(χ^(2)=4.11,P<0.05)。结论对肺癌根治术患者应用常规呼吸训练联合呼吸道管理,可有效提高患者肺功能恢复水平,降低炎症指标表达水平以及相关并发症的发生。

多模态MRI在肺炎性结节与肺癌中的应用价值

目的探讨多模态MRI在肺炎性结节与肺癌中的应用价值。方法收集我院经病理或临床随访证实的肺炎性结节与肺癌患者各25例,所有病例均行胸部CT平扫及多模态MRI扫描,MRI序列包括轴位T_(1)WI、轴位T_(2)WI、轴位T_(2)WI压脂、多b值DWI扫描,多b值DWI序列b值设定为600、800、1000、1200、1500、2000s/mm^(2),并测量病灶不同b值的ADC值。采用卡方检验比较肺癌的CT及MRI征象。采用两独立样本的t检验或Mann-Whitney U检验分别比较两组不同b值的ADC值。运用MedCalc 11.4软件绘制ROC曲线,计算曲线下面积,采用Delong检验对不同b值的ADC值的ROC曲线诊断效能进行比较。结果肺炎性结节组与肺癌组在显示支气管狭窄或截断上有统计学差异(P<0.05),其余征象均无统计学差异(P>0.05)。肺炎性结节组在T_(1)WI上以等信号和低信号为主,T_(2)WI上以高信号为主;而肺癌组在T_(1)WI上以等信号和混杂信号为主,T_(2)WI上以高信号和混杂信号为主。肺炎性结节组与肺癌组不同b值的ADC值之间均有统计学差异(P<0.05),且肺癌组不同b值情况下,ADC值均低于肺炎性结节组;随着b值的升高,肺癌组ADC值下降显著。通过绘制不同b值ADC值的ROC曲线,得出b值1000的诊断价值最高,AUC为0.934(0.826-0.985),敏感度为96%,特异度为92%,诊断阈值为1.25×10^(-3)mm^(2)/s。结论多模态MRI在肺炎性结节与肺癌的鉴别诊断中有重要价值,能够为肺部疾病的诊断及治疗方式的选择提供更多信息。

银翘三黄膏联合中药塌渍对肺癌靶向药物所致药疹的干预作用

目的观察银翘三黄膏联合中药塌渍对肺癌靶向药物所致药疹的干预作用。方法选择2019年10月至2021年10月于该院治疗的92例肺癌靶向药物所致药疹患者作为研究对象,按随机数字表法将患者分为研究组和对照组,每组46例。对照组给予丁酸氢化可的松乳膏治疗,研究组在对照组基础上给予银翘三黄膏联合中药塌渍治疗。比较两组治疗前后Th17细胞、Treg细胞、CD4+T淋巴细胞、CD3+T淋巴细胞比例及肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)、白细胞介素-1β(IL-1β)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶-2(MMP-2)、CC趋化因子受体1(CCR1)、趋化因子C-C-基元配体3(CCL3)、C反应蛋白(CRP)、CXC趋化因子配体10(CXCL10)、趋化因子受体3(CXCR3)水平。治疗前后对患者药疹进行分级,并采用皮肤病生活质量指数量表(DLQI)评价两组患者生活质量;比较两组临床疗效。结果治疗前,两组Th17细胞、Treg细胞、CD4+T淋巴细胞、CD3+T淋巴细胞比例比较,差异均无统计学意义(P>0.05);治疗1个月后,两组CD3+T淋巴细胞、Th17细胞、CD4+T淋巴细胞比例均较治疗前降低(P<0.05),且研究组低于对照组(P<0.05);治疗1个月后两组Treg细胞比例均较治疗前升高(P<0.05),且研究组高于对照组(P<0.05)。治疗前,两组TNF-α、IFN-γ、IL-1β、CRP水平比较,差异均无统计学意义(P>0.05);治疗1个月后,研究组IL-1β、TNF-α、IFN-γ、CRP水平均低于对照组(P<0.05)。治疗前,两组CCL3、CCR1、CXCL10、CXCR3水平比较,差异均无统计学意义(P>0.05);治疗1个月后,两组CCR1水平均较治疗前升高(P<0.05),且研究组高于对照组(P<0.05);治疗1个月后,两组CXCL10、CCL3、CXCR3水平均较治疗前降低(P<0.05),且研究组低于对照组(P<0.05)。治疗前,两组MMP-2、MMP-9水平比较,差异均无统计学意义(P>0.05);治疗1个月后,研究组MMP-2、MMP-9水平低于对照组(P<0.05)。治疗1个月后,研究组药疹分级明显改善(Z=3.315,P<0.001),研究组药疹分级优于对照组(Z=2.343,P=0.010)。治疗1个月后,研究组DLQI评分低于对照组(P<0.05)。研究组的总有效率(97.83%)高于对照组(84.78%),但差异无统计学意义(P>0.05)。结论银翘三黄膏联合中药塌渍治疗肺癌靶向药物所致药疹,可调节患者免疫状态,减轻炎症,降低MMP-2、MMP-9水平,改善药疹分级,提高患者生活质量。

人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用研究

目的分析人工气胸在全腔镜食管癌根治术肺保护性通气策略中的应用效果。方法选取2021年1月-2023年3月在该院行人工气胸全腔镜食管癌根治术治疗的88例患者作为研究对象,按随机数表法分为两组,每组各44例,对照组采用常规通气模式,实验组采用肺保护性通气策略模式,比较不同通气模式的临床效果。结果实验组与对照组在气管插管后10 min(T_(1))、单肺通气1 h(T_(2))、手术完毕时(T_(3))和术后24 h(T_(4))的pH和二氧化碳分压(PCO_(2))比较,差异均无统计学意义(P>0.05),两组患者T_(1)、T_(2)、T_(3)和T_(4)时点的氧合指数比较,差异均有统计学意义(P<0.05);实验组与对照组T_(1)、T_(2)和T_(3)时点的静态肺顺应性(Cs)、平台压(Pplat)和气道峰压(Ppeak)比较,差异均有统计学意义(P<0.05);实验组与对照组T1时点的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)和白细胞介素-6(IL-6)水平比较,差异均无统计意义(P>0.05),两组患者T_(2)、T_(3)和T_(4)时点上述指标比较,差异均有统计学意义(P<0.05);对照组肺部并发症发生率为25.00%,高于实验组的9.09%,差异有统计学意义(P<0.05)。结论潮气量(VT)6 mL/kg+100.00%吸入氧浓度+呼气末正压5 cmH_(2)O+肺复张的肺保护性通气策略,用于人工气胸全腔镜食管癌根治术中,能够明显降低术中气道压力,减轻炎症反应,提高通气安全性。

胸腔镜下亚肺叶切除治疗ⅠA期非小细胞肺癌的临床研究

目的探究ⅠA期非小细胞肺癌患者应用胸腔镜下亚肺叶切除术治疗的效果。方法方便选取2022年7月—2023年12月宜兴市人民医院收治的92例ⅠA期非小细胞肺癌患者为研究对象。按Excel表格分组法均分为研究组和参照组,各46例。参照组给予胸腔镜下肺叶切除术治疗。研究组给予胸腔镜下亚肺叶切除术治疗。对比两组的手术指标、炎性因子水平及术后并发症发生情况。结果研究组手术指标均优于参照组,差异有统计学意义(P均<0.05);术前两组各炎性因子水平对比,差异无统计学意义(P均>0.05);术后,研究组炎性因子水平均低于参照组,差异有统计学意义(P均<0.05);研究组术后并发症发生率(4.35%)低于参照组(17.39%),差异有统计学意义(χ^(2)=4.039,P<0.05)。结论对比胸腔镜下肺叶切除术,胸腔镜下亚肺叶切除术治疗ⅠA期非小细胞肺癌患者的应用价值更高。患者手术指标及炎性因子水平改善,术后并发症减少,具有临床借鉴价值。

肺瘤消积方联合吉非替尼治疗痰瘀互结型晚期非小细胞肺癌的临床疗效

目的探讨肺瘤消积方联合吉非替尼治疗痰瘀互结型晚期非小细胞肺癌(NSCLC)的临床疗效及对血清肿瘤标志物和炎性因子水平的影响。方法选取2019年2月—2021年2月于我院就诊的痰瘀互结型晚期NSCLC患者100例,根据随机数字表法分为对照组和治疗组(n=50)。对照组患者口服吉非替尼片,治疗组患者在对照组的基础上加用肺瘤消积方,以21 d为1个治疗周期,两组患者均治疗4周期。对比分析两组血清肿瘤标志物和炎性因子水平、生活质量评分、无进展生存期(PFS)、中医症状分级、临床疗效、不良反应。结果治疗后,两组细胞角质蛋白19片段抗原21-1(CYFRA21-1)、糖类抗原19-9(CA19-9)、癌胚抗原(CEA)、白细胞介素-1(IL-1)、IL-6、肿瘤坏死因子-α(TNF-α)水平以及癌症患者生命质量测定量表(QLQ-C30)评分均低于治疗前,且治疗组低于对照组(P<0.05);治疗组PFS显著长于对照组(P<0.05);两组中医症状分级均显著改善,且治疗组优于对照组(P<0.05);治疗组客观缓解率(ORR)、疾病控制率(DCR)(68.00%、84.00%)均显著高于对照组(42.00%、62.00%)(P<0.05);治疗组皮肤反应、腹泻总发生率(22.00%、50.00%)均显著低于对照组(42.00%、74.00%)(P<0.05)。结论肺瘤消积方联合吉非替尼治疗痰瘀互结型晚期NSCLC患者疗效显著,可有效降低患者血清CYFRA21-1、CA19-9、CEA、IL-1、IL-6、TNF-α水平,改善患者病情,且安全性较高。

从中医病机探析肺癌肿瘤微环境

肺癌是当今世界发病率和死亡率一直居高不下的恶性肿瘤,严重威胁着人民的生命健康。现代医学对肺癌的治疗基本经历了3场变革——传统的放化疗、精准靶向治疗、免疫治疗。其中免疫治疗主要通过适应性免疫系统来监视并杀伤肿瘤细胞,当下热门的嵌合抗原受体T细胞免疫疗法正是通过增强T细胞靶向杀伤肿瘤细胞的能力,达到抗癌的目的。而免疫细胞是肿瘤微环境(TME)的一部分,可见,干预TME已然成为攻克癌症的着眼点。根据中医取类比象思维推测肺癌TME,并将其病机归纳为:免疫逃逸类似营卫失和、肺卫不固;缺氧微环境类似肺脾肾气虚;酸性微环境类似痰湿阻肺;炎性微环境类似痰瘀癌毒积聚。提示以肺癌TME与中医病机契合点为指导,为中医药治疗肺癌提供遣方用药的参考依据。

老年早期非小细胞肺癌采用经皮微波凝固疗法后预后不良的影响因素分析

目的分析采用经皮微波凝固疗法(PMCT)预后不良的影响因素。方法选取2019年1月至2022年1月在江苏省徐州市第一人民医院治疗的老年早期非小细胞肺癌(NSCLC)患者85例,脱落7例,最终纳入78例患者行PMCT治疗,随访6个月,按照疗效分为预后良好组和预后不良组。收集并比较两组临床资料,包括性别、年龄、术前肺功能[肺活量(VC)、用力肺活量(FVC)、第一秒用力呼气量(FEV1)、最大通气量(MVV)]、系统免疫炎症营养指数(SII)、肿瘤原发位置、病理分型、病理分期、病灶直径、分化程度、术后化疗的情况,通过多因素logistic回归分析明确PMCT治疗老年早期NSCLC预后不良的危险因素。结果预后良好组69例,预后不良组9例。预后不良组年龄>70岁、SII>500、病理分期Ⅱ期、病灶直径>4 cm、分化程度低、术后未化疗的比重高于预后良好组,FEV1水平低于预后良好组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄>70岁(OR=2.145,95%CI=1.143~4.025)、FEV1<81.67 L(OR=2.592,95%CI=1.263~5.319)、SII>500(OR=2.168,95%CI=1.250~3.760)、病理分期Ⅱ期(OR=3.421,95%CI=1.064~10.999)、病灶直径>4 cm(OR=2.538,95%CI=1.056~6.100)、分化程度低(OR=2.563,95%CI=1.243~5.285)、术后未化疗(OR=3.156,95%CI=1.319~7.551)是PMCT治疗后预后不良的危险因素(P<0.05)。结论年龄、FEV1、SII、病理分期、病灶直径、分化程度、术后是否接受化疗是PMCT治疗后预后不良的影响因素,可用于患者治疗后预后情况的预测。

肺癌组织中ERO1L、TNFRSF4的表达与患者免疫功能、炎症反应因子及预后的关系

目的探究肺癌组织中内质网氧化物蛋白(ERO1L)、肿瘤坏死因子受体4(TNFRSF4)的表达与肺癌患者免疫功能、炎症反应因子及其预后的关系。方法选取2018年7月~2020年7月于本院进行手术治疗的108例肺癌患者,收集术中留取的癌组织和癌旁组织标本。采用qRT-PCR检测ERO1L和TNFRSF4的mRNA相对表达量;使用免疫组织化学法检测ERO1L和TNFRSF4蛋白表达情况,分析二者表达水平与患者临床病理特征的关系,采用Kaplan-Meier法分析ERO1L、TNFRSF4蛋白表达水平与患者预后的关系。肺癌患者预后生存率的影响因素采用Cox多因素分析。结果肺癌患者癌组织中ERO1L mRNA表达水平显著高于癌旁组织,TNFRSF4 mRNA表达水平显著低于癌旁组织(P<0.05);肺癌组织中ERO1L蛋白高表达率显著高于癌旁组织,TNFRSF4蛋白高表达率显著低于癌旁组织(P<0.05)。ERO1L蛋白高表达组患者CD3^(+)、CD4^(+)显著低于低表达组(P<0.05),IL-1β、IL-6、TNF-α显著高于低表达组(P<0.05);TNFRSF4蛋白高表达组患者CD3^(+)、CD4^(+)显著高于低表达组,IL-1β、IL-6、TNF-α显著低于低表达组(P<0.05)。ERO1L高表达组患者3年累积生存率显著低于低表达组(Log rankχ^(2)=6.100,P=0.014),TNFRSF4高表达组患者3年累积生存率显著高于低表达组(Log rankχ^(2)=11.296,P=0.001)。肺癌组织的低分化、淋巴结转移、TNM分期为Ⅲ-Ⅳ期、ERO1L高表达、TNFRSF4低表达是影响患者生存率的危险因素。结论肺癌组织中ERO1L、TNFRSF4表达与患者免疫功能、炎症因子以及预后具有一定关系。

不同大小肺炎性假瘤的CT形态学分析及淋巴结变化规律

目的 探讨不同大小肺炎性假瘤(pulmonary inflammatory pseudotumor, PIP)的计算机断层扫描(computed tomography, CT)形态学特征及其淋巴结的变化规律。方法 选取经组织病理学证实为肺炎性假瘤的患者56例,按病灶大小分为两组:A组(最大径≤3.0 cm34例),B组(最大径>3.0 cm22例),分析比较两组CT影像学特点及淋巴结表现差异。采用组内相关系数(ICC)及Kappa检验评价2位医师测量数据的一致性,并用Bland-Altman法进一步可视化一致性测量结果。结果 两组在支气管血管束增粗、桃尖征、血管集束征、邻近胸膜增厚及淋巴结肿大方面差异均有统计学意义(P<0.05),B组出现以上征象的比例更大。进一步比较两组淋巴结,发现同侧肺门淋巴结更容易在B组中显示,且大小显著高于A组,差异有统计学意义(P<0.05)。2位医师测量PIP相关数据的一致性均良好或优秀(ICC与Kappa值范围为0.61~0.85),Bland-Altman法分析显示,2位医师评价淋巴结径线的一致性和稳定性较好。结论 不同大小的PIP在CT检查表现存在一定的差异性,本文有助于影像科及临床医师更深刻地认识此病、减少误诊。

免疫治疗联合抗血管生成治疗在晚期非小细胞肺癌患者中的应用效果

目的探讨免疫治疗联合抗血管生成治疗在晚期非小细胞肺癌(NSCLC)患者中的应用效果。方法依据治疗方法的不同将82例晚期NSCLC患者分为观察组(n=49)和对照组(n=33),两组均给予化疗,在此基础上,对照组患者接受抗血管生成药物贝伐珠单抗治疗,观察组患者接受卡瑞利珠单抗联合贝伐珠单抗治疗。比较两组患者的临床疗效、T淋巴细胞亚群(CD3+、CD4+、CD4+/CD8+)、炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、生活质量[卡氏功能状态(KPS)评分]及不良反应发生情况。结果观察组患者的客观缓解率为34.69%,高于对照组患者的12.12%(P﹤0.05),疾病控制率为87.76%,高于对照组患者的66.67%(P﹤0.05)。治疗后,两组患者CD3+、CD4+水平和CD4+/CD8+均高于本组治疗前,观察组患者CD3+、CD4+水平和CD4+/CD8+均高于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者TNF-α、IL-6水平均低于本组治疗前,KPS评分均高于本组治疗前,观察组患者TNF-α、IL-6水平均低于对照组,KPS评分高于对照组,差异均有统计学意义(P﹤0.05)。两组患者不良反应发生率比较,差异均无统计学意义(P﹥0.05)。结论免疫治疗联合抗血管生成治疗对晚期NSCLC的治疗效果较好,可改善机体免疫功能,减轻炎症反应,提高生活质量,安全性相对较高。