单药培美曲塞、紫杉醇脂质体及最佳支持治疗对PS 2分晚期肺腺癌患者免疫功能和炎性因子的影响

目的 观察单药培美曲塞(PEM)、紫杉醇脂质体及最佳支持治疗对功能状态评分(PS)为2的晚期肺腺癌患者免疫功能和炎性因子的影响.方法 2014年1月至2016年10月确诊的PS 2分晚期肺腺癌患者101例,随机分为3组:培美曲塞组(PEM组,n=34),紫杉醇脂质体组(LEP组,n=33)和最佳支持治疗组(BSC组,n=34).21d为1个周期,共治疗2个周期.观察3组PS评分恶化率及外周血T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+、CD4+CD2+5、CD1+65+6 T)、炎性因子γ干扰素(IFN-γ)、肿瘤坏死因子-α(TNF-α)、自然杀伤细胞(NK)、自然杀伤细胞活化受体2D(NKG2D)]、肿瘤标志物癌胚抗原(CEA)、糖类抗原(CA125)]变化.结果 PEM组和LEP组的PS评分恶化率(26.47%、27.27%)均低于BSC组(67.65%),差异有统计学意义(P<0.05).与治疗前比较,PEM组和LEP组治疗后CD3+、CD4+、CD4+/CD8+、CD1+65+6 T细胞比例、IFN-γ、NK、NKG2D较治疗前显著升高,CD8+、CD4+CD2+5 T细胞比例、TNF-α、CEA、CA125较治疗前显著降低,差异有统计学意义(P<0.05);BSC组治疗前后上述指标比较差异无统计学意义(P>0.05).结论 单药培美曲塞、紫杉醇脂质体治疗PS2分晚期肺腺癌较最佳支持治疗可明显提高患者免疫功能,抑制炎性反应,从而延缓病情进展.

Effects of pemetrexed,paclitaxelliposome and best supportive therapy on immune function and inflammatory cytokines of advanced pulmonary adenocarcinoma patients with performance status of 2

Objective To observe the effects of pemetrexed,paclitaxelliposome and best supportive therapy on immune function and inflammatory cytokines of advanced pulmonary adenocarcinoma patients with performance status of 2.Methods A total of 101 patients with advanced pulmonary adenocarcinoma who were admitted and treated in our hospital from January 2014 to October 2016 were randomly divided into three groups:pemetrexed group (PEM group,n =34),paclitaxelliposome (LEP group,n=33) and best supportive therapy group (BSC group,n =34),with a treatment course of 21 days for 2 courses of treatment.The aggravation rate of PS scoring and the changes of CD3+,CD4+,CD8+,CD4+ /CD8+,CD4+CD2+5,CD1+65+6 T,IFN-γ,TNF-α,NK,NKG2D,CEA and CA125 were observed and compared among the three groups.Results The aggravation rate of PS scoring in PEM group and LEP group was 26.47%,27.27%,respectively,which was significantly lower than that (67.65%) in BSC group (P<0.05).As compared with those before treatment,the levels of CD3+,CD4+,CD4+ /CD8+,CD1+65+6 T,IFN-γ,NK and NKG2D in PEG group and LEP group were significantly increased after treatment,but the levels of CD8+,CD4+CD2+5 T,TNF-α,CEA and CA125 were significantly decreased in the two groups (P<0.05).However there were no significant differences in these indexes mentioned above in BSC group before treatment and after treatment (P>0.05).Conclusion The single pemetrexed or single paclitaxelliposome is superior to best supportive therapy in enhancing immune function of advanced pulmonary adenocarcinoma patients with performance status of 2,which can inhibit inflammatory reaction so as to postpone the progression of disease.