目的 分析卡瑞利珠單抗聯(lián)合白蛋白紫杉醇和卡鉑治療晚期食管癌的臨床效果。方法 選擇2020年1月—2021年10月安徽醫(yī)科大學(xué)第一附屬醫(yī)院醫(yī)院東城院區(qū)收治的晚期食管鱗狀細(xì)胞癌患者96例，按隨機(jī)抽簽法分為對(duì)照組（48例）和治療組（48例）。對(duì)照組患者靜脈滴注注射用紫杉醇（白蛋白結(jié)合型）和卡鉑注射液治療，第1、8天滴注注射用紫杉醇（白蛋白結(jié)合型），125 mg/m²；第1天靜脈滴注卡鉑注射液，200～400 mg/m²。治療組在對(duì)照組基礎(chǔ)上靜脈滴注注射用卡瑞利珠單抗，第1天，200 mg/次，每3周1次。21 d為1個(gè)周期，兩組治療2個(gè)周期。觀察兩組患者臨床療效，比較治療前后兩組患者生存期、免疫功能指標(biāo)、腫瘤標(biāo)志物、血清炎癥因子水平及程序性死亡-配體1（PD-L1）和腫瘤錯(cuò)配修復(fù)缺陷（dMMR）水平。結(jié)果 治療后，治療組24個(gè)月無進(jìn)展生存（PFS）率、總生存率（OS）、客觀緩解率（ORR）、疾病控制率（DCR）、疾病進(jìn)展時(shí)間（TTP）均明顯高于對(duì)照組（P＜0.05）。治療后，兩組T淋巴細(xì)胞（T_總）、Th、Th/Ts、自然殺傷細(xì)胞（NK）、樹狀突細(xì)胞（DC）、DC/單核巨噬細(xì)胞（PBMC）水平明顯升高，而抑制性T細(xì)胞（Ts）、糖類抗原19-9（CA19-9）、癌胚抗原（CEA）、角蛋白19片段抗原21-1（CYFRA21-1）、鱗狀細(xì)胞癌抗原（SCC-Ag）、TNF-α和IL-8水平明顯降低（P＜0.05），且治療組這些指標(biāo)水平明顯好于對(duì)照組（P＜0.05）。治療后，治療組PD-L1水平降低，而PD-L1＋/dMMR水平升高（P＜0.05），且患者預(yù)后良好組PD-L1水平降低、PD-L1＋/dMMR占比升高（P＜0.05）。結(jié)論 卡瑞利珠單抗聯(lián)合白蛋白紫杉醇和卡鉑治療晚期食管癌可改善晚期食管鱗狀細(xì)胞癌患者的腫瘤標(biāo)志物水平，抑制炎性反應(yīng)，提升免疫功能，提高患者的生存率。

Objective To analyze the effect of camrelizumab combined with albumin paclitaxel and carboplatin in treatment of advanced esophageal cancer. Methods Patients (96 cases) with advanced esophageal cancer in the First Affiliated Hospital of Anhui Medical University from January 2020 to October 2021 were divided into control group (48 cases) and treatment group (48 cases) by random drawing. Patients in the control group were iv administered with Paclitaxel for injection (Albumin Bound) and Carboplatin Injection. Paclitaxel for injection (Albumin Bound) was given intravenously on the 1st and 8th day, and Carboplatin Injection was injected intravenously at 125 mg/m²; on the 1st day, 200 — 400 mg/m². The treatment group were iv administered with Camrelizumab for injection on the basis of the control group, 200 mg/times on the first day, once every 3 weeks. A cycle had 21 days, and patients in two groups were treated for 2 cycles. After treatment, the clinical evaluations were evaluated, the progression-free survival, immune function indexes, tumor markers, serum inflammatory factor levels, and the levels of PD-L1 and dMMR in two groups before and after treatment were compared. Results After treatment, the 24-month PFS rate, OS, ORR, DCR, and TTP in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the levels of T total, Th, Th/Ts, NK, DC and DC/PBMC were significantly increased, while the levels of inhibitory Ts, CA19-9, CEA, CYFRA21-1, SCC-Ag, TNF-α and IL-8 were significantly decreased in the treatment group in two groups (P < 0.05), and the level of these indexes in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the level of PD-L1 was decreased and the level of PD-L1+/dMMR was increased in the treatment group, and the level of PD-L1 was decreased and the proportion of PD-L1+/dMMR was increased in the group with good prognosis (P < 0.05). Conclusion Camrelizumab combined with albumin paclitaxel and carboplatin in treatment of advanced esophageal cancer can improve the level of tumor markers, inhibit inflammatory response, enhance immune function and improve the survival rate of patients with advanced esophageal squamous cell carcinoma.

R979.1

合肥市衛(wèi)健委基金項(xiàng)目（Hwk2022zc043）