适形调强放射治疗同步TP化疗对局部晚期非小细胞肺癌患者免疫功能、全身炎症反应指标和血清肿瘤标志物的影响

摘要 目的：观察适形调强放射治疗（IMRT）同步TP化疗方案（顺铂联合紫杉醇）对局部晚期非小细胞肺癌（NSCLC）患者免疫功能、全身炎症反应指标和血清肿瘤标志物的影响。方法：选取2017年8月-2019年8月期间清远市人民医院收治的局部晚期NSCLC患者86例。采用抛硬币法随机将患者分为对照组和实验组，各43例，对照组给予TP化疗，实验组在对照组基础上联合IMRT，对比两组临床疗效、免疫功能、全身炎症反应指标和血清肿瘤标志物，观察两组不良反应发生率、1年生存率和中位生存时间。结果：实验组的客观缓解率、疾病控制率分别为44.19%、83.72%，均高于对照组的23.26%、53.49%（P<0.05）。治疗2个周期后，两组CD3⁺、CD4⁺/CD8⁺、CD4⁺降低，但实验组较对照组高（P<0.05）；两组CD8⁺升高，但实验组低于对照组（P<0.05）。治疗2个周期后，两组糖类抗原125(CA125)、癌胚抗原(CEA)、中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)降低，且实验组低于对照组（P<0.05）。实验组的中位生存时间长于对照组。Kaplan-Meier生存曲线分析发现，实验组的1年生存率高于对照组（P<0.05）。两组不良反应发生率对比无统计学差异（P>0.05）。结论：IMRT同步TP化疗应用于局部晚期NSCLC患者，可减轻免疫抑制，缓解炎症反应，阻止肿瘤进展，近期疗效较好。

The effect of Intensity Modulated Radiation Therapy Synchronous TP Chemotherapy on Immune Function, Systemic Inflammatory Response Index and Serum Tumor Markers in Patients with Locally Advanced non Small Cell Lung Cancer

ABSTRACT Objective: To observe the effect of intensity modulated radiation therapy (IMRT) synchronous TP chemotherapy (cisplatin combined with paclitaxel) on immune function, systemic inflammatory response index and serum tumor markers in patients with locally advanced non small cell lung cancer (NSCLC). Methods: 86 patients with locally advanced NSCLC in Qingyuan People''s Hospital were selected from August 2017 to August 2019. According to the coin tossing, they were divided into control group and experimental group, 43 cases in each group. The control group was treated with TP chemotherapy. The experimental group was treated with combined with IMRT on the basis of the control group. The clinical efficacy, immune function, systemic inflammatory response index and serum tumor markers were compared between the two groups. The incidence of adverse reactions, 1-year survival rate and median survival time in the two groups were observed. Results: The objective remission rate and disease control rate of the experimental group were 44.19% and 83.72% respectively, which were higher than 23.26% and 53.49% of the control group(P<0.05). 2 cycles after treatment, CD3⁺, CD4⁺/CD8⁺, CD4⁺ were decreased in the two groups, but the experimental group was higher than the control group(P<0.05); CD8⁺ was increased in the two groups, but the experimental group was lower than the control group (P<0.05). 2 cycles after treatment, the glycogen 125 (CA125), carcinoembryonic antigen (CEA), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) were decreased in the two groups, and the experimental group was lower than the control group(P<0.05). The median survival time of the experimental group was longer than that of the control group. Kaplan Meier survival curve analysis showed that the 1-year survival rate of the experimental group was higher than that of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion: IMRT synchronous TP Chemotherapy in patients with locally advanced NSCLC can reduce the immunosuppression, reduce the inflammatory response and prevent tumor progression, with good short-term efficacy.