目的 評價信迪利單抗聯(lián)合環(huán)磷酰胺＋表柔比星＋依托泊苷＋長春新堿＋潑尼松、利妥昔單抗無放射治療（DA-EPOCH-R）方案治療彌漫大B細(xì)胞淋巴瘤（DLBCL）的效果及安全性。方法 回顧性選取2019年3月—2022年2月洛陽市第三人民醫(yī)院收治的經(jīng)一線治療方案治療后疾病復(fù)發(fā)或進(jìn)展的DLBCL患者103例，根據(jù)治療方案分為試驗組54例、對照組49例。對照組給予DA-EPOCH-R方案治療，試驗組在對照組基礎(chǔ)上加用信迪利單抗治療。比較兩組治療前后免疫相關(guān)指標(biāo)、血管內(nèi)皮生長因子（VEGF）、血清胸苷激酶1（TK1）、白細(xì)胞介素-2（IL-2）水平，統(tǒng)計療效和不良反應(yīng)。結(jié)果 試驗組客觀緩解率（ORR）達(dá)72.22%，高于對照組的53.06%，差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，試驗組Treg細(xì)胞占比及VEGF、TK1水平低于本組治療前（P<0.05），Th17細(xì)胞占比、IL-2水平高于本組治療前（P<0.05）；對照組NK細(xì)胞占比及VEGF、TK1水平低于本組治療前（P<0.05），Treg細(xì)胞占比及IL-2水平高于本組治療前（P<0.05）；兩組CD3⁺T、CD3⁺CD4⁺T、CD3⁺CD8⁺T與治療前比較無統(tǒng)計學(xué)意義（P>0.05）。試驗組治療后IL-2水平、NK細(xì)胞占比、Th17細(xì)胞占比較對照組更高（P<0.05），Treg細(xì)胞占比及VEGF、TK1水平較對照組更低（P<0.05）。試驗組和對照組敗血癥、皮疹、肺部感染、黏膜炎、腹瀉、惡心嘔吐、脫發(fā)、腎功能損傷、肝功能損傷、血小板減少、白細(xì)胞減少、貧血、發(fā)熱、甲狀腺功能減退等不良反應(yīng)方面比較，差異無統(tǒng)計學(xué)意義（P>0.05）。結(jié)論 信迪利單抗聯(lián)合DA-EPOCH-R方案治療DLBCL可改善患者免疫功能，降低VEGF、TK1的表達(dá)，加強(qiáng)療效，安全性良好。

Objective To observe the efficacy and safety of sintilimab combined with dose-adjusted etoposide, doxorubicin and cyclophosphamide with vincristine, prednisone and rituximab without radiotherapy (DA-EPOCH-R) regimen in treatment of diffuse large B-cell lymphoma (DLBCL). Methods A total of 103 patients with DLBCL who relapsed or progressed after first-line treatment in Luoyang Third People's Hospital from March 2019-February 2022 were selected retrospectively. According to the treatment plan, they were divided into 54 cases in the experimental group and 49 cases in the control group. Patients in the control group were treated with DA-EPOCH-R regimen, and patients in the experimental group were treated with sintilimab on the basis of the control group. The immune related indexes, vascular endothelial growth factor (VEGF), serum thymidine kinase 1 (TK1) and interleukin-2 (IL-2) levels were compared between the two groups, statistical efficacy and adverse reactions were recorded. Results The objective remission rate (ORR) in the experimental group was 72.22%, which was higher than 53.06% in the control group (P<0.05). The percentage of Treg cells, levels of VEGF and TK1 in the experimental group were lower than those before treatment. The percentage of Th17 cells and IL-2 level were higher than those before treatment (P<0.05), and the percentage of NK cells, levels of VEGF and TK1 in the control group were lower than those before treatment (P<0.05), and the percentage of Treg cells and IL-2 level were higher than those before treatment (P<0.05), and CD3⁺T, CD3⁺CD4⁺T and CD3⁺CD8⁺T in the two groups had no statistical significance compared with those before treatment (P>0.05). After treatment, IL-2 level, the percentage of NK cells and Th17 cells in the experimental group were higher than those in the control group (P<0.05), and the percentage of Treg cells, levels of VEGF and TK1 were lower than those in the control group (P<0.05). There was no significant difference between the experimental group and the control group in terms of sepsis, rash, pulmonary infection, mucositis, diarrhea, nausea and vomiting, hair loss, renal function injury, liver function injury, thrombocytopenia, leucopenia, anemia, fever, hypothyroidism and other adverse reactions (P>0.05). Conclusion Sintilimab combined with DA-EPOCH-R regimen in treatment of DLBCL can improve immune function, reduce the expression of VEGF and TK1, strengthen the curative effect and have considerable safety.

R979.1