华蟾素联合阿帕替尼治疗晚期胃癌二线化疗失败患者疗效观察及对免疫失衡、血清肿瘤标志物及相关血清学指标的影响
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R735.2

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Observation of Therapeutic Effect of Cinobufagin Combined with Apatinib for Advanced Gastric Cancer with Second-Line Chemotherapy Failure and Its Effect on Immune Imbalance,Serum Tumor Markers,and Related Serological Indicators
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    摘要:

    目的:观察华蟾素联合阿帕替尼治疗晚期胃癌二线化疗失败患者的近期疗效及对外周血辅助性T 细胞(Th) 17/调节性T细胞(Treg) 免疫失衡、血清肿瘤标志物及相关血清学指标的影响。方法:选择82例 二线化疗失败的晚期胃癌患者作为研究对象,以随机数字表法分为观察组和对照组各41例。对照组予阿帕替 尼治疗,观察组在对照组基础上联合华蟾素治疗,4周为1个疗程,连续治疗3个疗程。比较2组近期疗效及毒 副反应情况,以及治疗前后血清肿瘤标志物[糖类抗原(CA) 72-4、CA19-9、CA242、癌胚抗原(CEA)] 水平、相关血清学指标[血管内皮生长因子A (VEGF-A)、表皮生长因子受体(EGFR)、基质金属蛋白 酶-9(MMP-9)] 及外周血Th17、Treg水平。结果:观察组客观缓解率为36.59%,对照组为24.39%,2组比 较,差异无统计学意义(P>0.05);观察组疾病控制率为73.17%,对照组为51.22%,2组比较,差异有统计学 意义(P<0.05)。治疗后,2组血清CA72-4、CA19-9、CA242、CEA水平均较治疗前降低(P<0.05),且观察 组上述4项水平均低于对照组(P<0.05)。治疗后,2组外周血Th17、Treg表达水平和Th17/Treg比值均较治疗 前降低(P<0.05),且观察组上述3 项水平均低于对照组(P<0.05)。治疗后,2 组血清VEGF-A、EGFR、 MMP-9水平均较治疗前降低(P<0.05),且观察组上述3项水平均低于对照组(P<0.05)。观察组胃肠道反 应、高血压、白细胞减少、血小板减少、蛋白尿、乏力、手足综合征的发生率均低于对照组,且2组白细胞 减少、血小板减少、乏力发生率比较,差异有统计学意义(P<0.05)。结论:华蟾素联合阿帕替尼治疗二线化 疗失败的晚期胃癌能有效下调患者血清肿瘤标志物和VEGF-A、EGFR、MMP-9水平,纠正外周血Th17/Treg免 疫失衡,提高近期疗效,并能在一定程度上减少阿帕替尼引起的毒副反应。

    Abstract:

    Abstract:Objective:To observe the short-term curative effect of Cinobufagin combined with Apatinib in the treatment of advanced gastric cancer with second-line chemotherapy failure, and its effect on immune imbalance of T helper (Th) 17/regulatory T cell (Treg) in peripheral blood, serum tumor markers, and related serological indicators. Methods: A total of 82 advanced gastric cancer patients who failed second-line chemotherapy were selected as the study subjects and randomly divided into the observation group and the control group, with 41 cases in each group, using a random number table method. The control group was treated with Apatinib, and the observation group was additionally treated with Cinobufagin on the basis of the control group. The treatment lasted for three courses, with four weeks being one course. The short-term curative effect and toxic side effect were compared between the two groups. The levels of serum tumor markers [carbohydrate antigen (CA) 72-4, CA19-9, CA242, and carcinoembryonic antigen (CEA)], related strological indicators [vascular endothelial growth factor A (VEGF-A), epidermal growth factor receptor (EGFR), and matrix metalloproteinase-9 (MMP-9)], and levels of Th17 and Treg in peripheral blood were compared before and after treatment. Results: The objective response rate was 36.59% in the observation group, and 24.39% in the control group, there being no significant difference between the two groups (P>0.05). The disease control rate in the observation group was 73.17%, and 51.22% in the control group, the difference being significant (P< 0.05). After treatment,the levels of serum CA72-4,CA19-9,CA242,and CEA in the two groups were decreased when compared with those before treatment (P<0.05), and the levels of the above four indicators in the observation group were lower than those in the control group (P<0.05). After treatment, the expression levels of Th17 and Treg in peripheral blood and the Th17/Treg ratio in both groups were reduced when compared with those before treatment (P<0.05), and the above three indicators in the observation group were lower than those in the control group (P<0.05). After treatment, the levels of VEGF-A,EGFR,and MMP-9 in serum in both groups were decreased when compared with those before treatment (P<0.05),and the levels of the above three indicators in the observation group were lower than those in the control group (P<0.05). The incidence of gastrointestinal reactions,hypertension,leukopenia, thrombocytopenia, proteinuria, fatigue, and hand-foot syndrome in the observation group was lower than that in the control group,and the incidence of leukopenia,thrombocytopenia,and fatigue between the two groups showed significant difference (P<0.05). Conclusion: The combination of Cinobufagin and Apatinib can effectively down-regulate the serum tumor markers and VEGF-A,EGFR,MMP-9 levels in patients with advanced gastric cancer with second-line chemotherapy failure, correct immune imbalance of Th17/Treg in peripheral blood, improve short-term curative effects, and to some extent reduce the toxic side effects caused by Apatinib.

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贾莹莹,马明瑛,郭艳珍.华蟾素联合阿帕替尼治疗晚期胃癌二线化疗失败患者疗效观察及对免疫失衡、血清肿瘤标志物及相关血清学指标的影响[J].新中医,2024,56(16):141-146

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  • 在线发布日期: 2024-08-28
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