目的 觀察白蛋白紫杉醇聯(lián)合鉑類化療方案治療進展期食管癌的臨床療效。方法 選擇2020年7月—2021年3月在河北北方學(xué)院附屬第一醫(yī)院治療的62例進展期食管癌患者，按照隨機數(shù)字表法分為對照組（31例）和治療組（31例）。對照組采取調(diào)強放療聯(lián)合含鉑類化療方案，臨床靶區(qū)總劑量54Gy，1.8Gy/次，腫瘤靶區(qū)總劑量63Gy，2.1Gy/次，5次/周，連續(xù)治療6周；同時第1～3天靜脈滴注注射用奈達鉑，80mg/m²加入生理鹽水100mL。治療組在對照組基礎(chǔ)上靜脈滴注注射用紫杉醇（白蛋白結(jié)合型），第1、8天給藥，260mg/m²加入100mL生理鹽水。3周為1個周期，兩組患者共治療2個周期。觀察兩組患者臨床療效，比較治療前后兩組患者臨床療效和生存率，β-連環(huán)蛋白（β-catenin）、細胞周期蛋白D1（CCND1）、食管癌相關(guān)基因4（ECRG4）、10號染色體缺失的磷酸酶和張力蛋白同源基因（PTEN）、腫瘤相關(guān)細胞角蛋白19片段（CYFRA21-1）、癌胚抗原（CEA）、鱗狀細胞癌抗原（SCC-Ag）、血紅素氧合酶-1（HO-1）、血管內(nèi)皮生長因子C（VEGF-C）、基質(zhì)金屬蛋白酶-9（MMP-9）、T淋巴細胞亞群CD4^＋、CD8^＋、免疫球蛋白（Ig）M水平，及不良反應(yīng)。結(jié)果 治療后，治療組疾病緩解率為83.87%，對照組疾病緩解率為58.06%，治療組疾病緩解率高于對照組（P＜0.05）。治療后，兩組ECRG4、PTEN水平升高（P＜0.05），β-catenin、CCND1水平明顯降低（P＜0.05）；治療后治療組患者ECRG4、PTEN水平高于對照組（P＜0.05），β-catenin、CCND1水平顯著低于對照組（P＜0.05）。治療后，兩組CEA、CYFRA21-1、SCC-Ag水平明顯降低（P＜0.05），且治療后，治療組CEA、CYFRA21-1、SCC-Ag水平低于對照組（P＜0.05）。治療后，兩組患者MMP-9、HO-1、VEGF-C水平明顯降低（P＜0.05），且治療組患者MMP-9、HO-1、VEGF-C水平低于對照組（P＜0.05）。治療后，兩組IgM、CD4^＋水平升高，CD8^＋水平降低（P＜0.05）；治療后，治療組IgM、CD4^＋水平均高于對照組，CD8^＋水平低于對照組（P＜0.05）。結(jié)論 白蛋白紫杉醇聯(lián)合鉑類化療方案治療進展期食管癌患者，可提升抑癌基因水平，降低原癌基因、腫瘤標(biāo)志物、MMP-9、HO-1、VEGF-C水平，減少機體免疫損傷，提升臨床療效，減少不良反應(yīng)發(fā)生率。

Objective To observe clinical effect of albumin paclitaxel combined with platinum chemotherapy regimen in treatment of advanced esophageal cancer. Methods Patients (62 cases) with advanced esophageal cancer in the First Affiliated Hospital of Hebei North University from July 2020 to March 2021 were divided into control (31 cases) and treatment (31 cases) group according to the random number table method. Patients in the control group were administered with intensity modulated radiotherapy combined with platinum-containing chemotherapy, total dose of clinical target was 54 Gy, 1.8 Gy/time, total dose of tumor target was 63 Gy, 2.1 Gy/time, five times every week for 6 weeks. At the same time, patients in the control group were iv administered with Nedaplatin for injection on the 1st to 3rd day, and 80 mg/m² was added with 100 mL of normal saline. Patients in the treatment group were iv administered with Paclitaxel for injection (Albumin Bound) on the basis of the control group on the first day and the eighth day, and 260 mg/m² was added to 100 mL saline. 3 weeks was a course of treatment, and patients in two groups were treated for 2 cycles. After treatment, the clinical evaluation and survival rate were evaluated, the levels of β-catenin, CCND1, ECRG4, PTEN, CEA, CYFRA21-1, SCC-Ag, MMP-9, HO-1, VEGF-C, IgM, CD4⁺, and CD8⁺, adverse reaction in two groups before and after treatment were compared. Results After treatment, the disease remission rate was 83.87% in the treatment group and 58.06% in the control group, and which in the treatment group was significantly higher than that in the control group (P<0.05). After treatment, the levels of ECRG4 and PTEN were increased (P<0.05), while the levels of β-catenin and CCND1 were significantly decreased (P<0.05). After treatment, the levels of ECRG4 and PTEN in treatment group were higher than those in control group (P<0.05), and the levels of β-catenin and CCND1 in treatment group were significantly lower than those in control group (P<0.05). After treatment, CEA, CYFRA21-1 and SCC-Ag levels in both groups were significantly decreased (P<0.05), and CEA, CYFRA21-1 and SCC-Ag levels in the treatment group were lower than those in the control group (P<0.05). After treatment, the levels of MMP-9, HO-1 and VEGF-C in two groups were significantly decreased (P<0.05), and the levels of MMP-9, HO-1 and VEGF-C in the treatment group were lower than those in the control group (P<0.05). After treatment, the levels of IgM and CD4⁺ were increased, while the levels of CD8⁺ were decreased (P<0.05). After treatment, the levels of IgM and CD4⁺ in the treatment group were higher than those in the control group, while the levels of CD8⁺ were lower than those in the control group (P<0.05). Conclusion Albumin paclitaxel combined with platinum chemotherapy regimen in treatment of advanced esophageal cancer can increase the level of tumor suppressor genes, reduce the levels of proto-oncogenes, tumor markers, MMP-9, HO-1, and VEGF-C, reduce the immune damage, improve clinical efficacy, and reduce the incidence of adverse reactions.

R979.1

河北省醫(yī)學(xué)科學(xué)研究課題計劃項目（20220617）