目的 探討奧希替尼輔助DP方案（多西他賽聯(lián)合順鉑）治療晚期非小細(xì)胞肺癌（non-small cell lung cancer，NSCLC）的臨床療效及其對(duì)患者血清抗菌肽人類陽(yáng)離子抗菌蛋白18（hCAP18）及POK紅細(xì)胞髓性致癌因子（POK）表達(dá)的影響。方法 選取2017年3月—2019年1月邢臺(tái)醫(yī)學(xué)高等?？茖W(xué)校第二附屬醫(yī)院收治的70例晚期NSCLC患者作為研究對(duì)象，按照隨機(jī)分組的方法分為對(duì)照組和觀察組兩組，每組各35例。對(duì)照組患者給予DP方案治療，在第1、8天靜脈滴注多西他賽注射液，60 mg/m²與250 mL的0.9%氯化鈉溶液進(jìn)行充分的混勻，1次/d；第1～4天靜脈滴注注射用順鉑，30 mg/m²，1次/d。所有患者均以3周為1個(gè)化療周期，連續(xù)2個(gè)周期。觀察組在對(duì)照組的基礎(chǔ)上口服甲磺酸奧希替尼片，80 mg/d，連續(xù)治療2個(gè)療程后進(jìn)行臨床療效等指標(biāo)的評(píng)價(jià)。觀察兩組患者的近期療效，比較兩組治療前后的癌胚抗原（CEA）、血管內(nèi)皮生長(zhǎng)因子（VEGF）、細(xì)胞角質(zhì)蛋白19片段（CYFRA21-1）等腫瘤標(biāo)志物的水平，血清中的hCAPI8、Pokemon表達(dá)情況，遠(yuǎn)期的生存情況和不良反應(yīng)的發(fā)生情況。結(jié)果 治療后，觀察組的客觀緩解率（ORR）和疾病控制率（DCR）分別為62.9%和85.7%，對(duì)照組的ORR和DCR分別為28.6%和60.0%，觀察組的ORR和DCR均顯著高于對(duì)照組（P<0.05）。治療后，兩組CEA、VEGF、CYFRA21-1水平較治療前有明顯的下降（P<0.05）；治療后，觀察組的CEA、VEGF、CYFRA21-1水平顯著低于對(duì)照組（P<0.05）。治療后，兩組患者血清hCAP18、Pokemon的水平有明顯的下降（P<0.05）；治療后，觀察組hCAP18、Pokemon水平下降更顯著（P<0.05）。觀察組生存率顯著高于對(duì)照組（P<0.05）。結(jié)論 奧希替尼輔助DP方案可以有效降低晚期非小細(xì)胞肺癌患者CEA、VEGF、CYFRA21-1水平，高效改善患者的近期療效及遠(yuǎn)期生存情況，且治療過(guò)程安全有效，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical efficacy of osimertinib combined with DP regimen in treatment of advanced nonsmall cell lung cancer and its effect on serum hCAP18 and Pokemon. Methods A total of 70 patients with advanced NON-small cell lung cancer (NSCLC) admitted to the Second Affiliated Hospital of Xingtai Medical College from March 2017 to January 2019 were selected as the research objects and randomly divided into two groups, the control group and the observation group, with 35 patients in each group. Patients in the control group were treated with DP regimen, and docetaxel was given on day 1 and 8 by intravenous infusion, 60 mg/m² and 250 mL 0.9% sodium chloride solution were fully mixed, once daily, on day 1 to 4, cisplatin was given intravenously, 30 mg/m², once daily. All patients were treated with 3-week chemotherapy cycle for 2 consecutive cycles. Patients in the observation group was treated with ositinib at 80 mg/d for 2 courses of continuous treatment on the basis of the control group, and the clinical efficacy and other indicators were evaluated. The short-term efficacy of the two groups was observed, and the levels of tumor markers such as carcinoembryonic antigen (CEA), vascular endothelial growth factor (VEGF), cytokeratinin-19 fragment (CYFRA21-1), serum hCAPI8 and Pokemon expression, long-term survival and the occurrence of adverse reactions were compared between two groups before and after treatment. Results After treatment, the ORR and DCR of the observation group were 62.9% and 85.7%, respectively, and the ORR and DCR of the control group were 28.6% and 60.0%, respectively. The ORR and DCR of the observation group were significantly higher than those of the control group (P < 0.05). After treatment, the levels of CEA, VEGF and CYFRA21-1 in two groups were significantly decreased compared with those before treatment (P < 0.05). After treatment, the levels of CEA, VEGF and CYFRA21-1 in the observation group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of serum hCAP18 and Pokemon in two groups were significantly decreased (P < 0.05). After treatment, the levels of hCAP18 and Pokemon in the observation group decreased more significantly (P < 0.05). After treatment, the levels of serum hCAP18 and Pokemon in two groups were significantly decreased (P < 0.05). After treatment, the levels of hCAP18 and Pokemon in the observation group decreased significantly (P < 0.05). The survival rate of observation group was significantly higher than that of control group (P < 0.05). Conclusions Osimertinib combined with DP regimen can effectively reduce the levels of CEA, VEGF and CYFRA21-1 in patients with advanced non-small cell lung cancer, effectively improve the patient's short-term efficacy and long-term survival, and the treatment process is safe and effective value.

R974

河北省邢臺(tái)市科技計(jì)劃項(xiàng)目（2019ZC277）