目的 探討納武利尤單抗聯(lián)合DP方案超選擇性支氣管動(dòng)脈栓塞灌注治療晚期非小細(xì)胞肺癌（NSCLC）患者的臨床療效。方法 選取2018年12月—2020年12月在成都醫(yī)學(xué)院第一附屬醫(yī)院呼吸與危重癥醫(yī)學(xué)科收治的晚期NSCLC患者187例，將患者按照治療方法分為對照組（92例）和觀察組（95例）。對照組使用超選擇支氣管動(dòng)脈栓塞灌注化療治療，輸注2 000 mL 0.9%氯化鈉溶液或糖鹽水水化，0.9%氯化鈉溶液100 mL分別稀釋多西他賽注射液及順鉑注射液，37.5 mg/m²，先緩慢注入稀釋后多西他賽，間隔30 min再注入稀釋后順鉑。灌注化療間隔3周，共4個(gè)療程。觀察組患者在對照組的基礎(chǔ)上靜脈輸注納武利尤單抗注射液，3 mg/kg，每2周用藥1次，直至患者不耐受或病情進(jìn)展。觀察兩組患者臨床療效，比較治療前后Karnofsky功能狀態(tài)評分（KPS）、腫瘤標(biāo)志物和T淋巴細(xì)胞亞群變化以及化療期間不良反應(yīng)情況。結(jié)果 治療后，觀察組的總有效率為65.26%，顯著高于對照組的40.22%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者KPS評分較化療前均增加（P<0.05），且觀察組KPS評分增加程度明顯較對照組大（P<0.05）。治療后，兩組患者血清癌抗原125（CA125）、癌胚抗原（CEA）、CYFRA21-1水平較化療前降低（P<0.05）；且觀察組腫瘤標(biāo)志物水平顯著低于對照組（P<0.05）。治療后，對照組患者CD3⁺、CD4⁺和CD4⁺/CD8⁺均顯著降低（P<0.05），而觀察組患者顯著升高（P<0.05）；觀察組免疫功能指標(biāo)顯著優(yōu)于對照組（P<0.05）。兩組患者化療期間不良反應(yīng)發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義。結(jié)論 納武利尤單抗聯(lián)合DP方案超選擇性支氣管動(dòng)脈栓塞灌注治療對晚期NSCLC患者近期療效良好，且可以改善患者生存資料和免疫功能，降低腫瘤標(biāo)志物水平，不良反應(yīng)輕，患者耐受性較好。

Objective To investigate the clinical efficacy of nivolumab combined with DP scheme in treatment of advanced nonsmall cell lung cancer by superselective bronchial arterial embolization. Methods A total of 187 patients with advanced NSCLC who were admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Chengdu Medical College from December 2018 to December 2020 were selected and divided into control group (92 cases) and observation group (95 cases) according to treatment methods. Patients in the control group was treated with superselective bronchial arterial embolization and perfusion chemotherapy, with 2 000 mL normal saline or sugar saline hydration, and 100 mL 0.9% sodium chloride solution to dilute Docetaxel injection and Cisplatin injection, respectively, at 37.5 mg/m². Docetaxel was slowly injected first and then diluted, and then diluted cisplatin was injected at an interval of 30 min. There were 4 courses of infusion chemotherapy at an interval of 3 weeks. Observation group received intravenous infusion of Nivolumab injection, 3 mg/kg, once every 2 weeks, on the basis of control group, until patients' intolerance or disease progression. Clinical efficacy was observed between two groups. Changes in Karnofsky functional status score (KPS), tumor markers, T lymphocyte subsets, and adverse reactions during chemotherapy were compared before and after treatment. Results After treatment, the total effective rate of the observation group was 65.26%, significantly higher than that of the control group (40.22%), and the difference between two groups was statistically significant (P < 0.05). After treatment, KPS scores in two groups were increased compared with those before chemotherapy (P < 0.05), and the increase degree of KPS scores in observation group was significantly greater than that in control group (P < 0.05). After treatment, the levels of serum CA125, CEA and CYFRA21-1 in two groups were lower than those before chemotherapy (P < 0.05). The level of tumor markers in the observation group was significantly lower than that in the control group (P < 0.05). After treatment, CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in control group were significantly decreased (P < 0.05), while in observation group, they were significantly increased (P < 0.05). The immune function indexes of observation group were significantly better than those of control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups during chemotherapy. Conclusion Nivolumab combined with DP scheme in treatment of advanced non-small cell lung cancer by superselective bronchial arterial embolization has good short-term efficacy, and can improve the survival data and immune function of patients, reduce the level of tumor markers, and have mild adverse reactions and good tolerance in patients.

R979.1

國家自然科學(xué)基金青年科學(xué)基金項(xiàng)目（81600388）