目的 探討納武利尤單抗治療肺癌的療效及對患者預(yù)后的影響，并探討療效與IFN-γ基因突變的相關(guān)性。方法 選取邢臺醫(yī)學(xué)高等專科學(xué)校第二附屬醫(yī)院2020年1月—2021年6月收治的肺癌患者共150例作為研究對象，根據(jù)治療方案不同，將150例患者分為對照組和試驗組，每組各75例；納入同期邢臺醫(yī)學(xué)高等?？茖W(xué)校第二附屬醫(yī)院行健康體檢的人群100例，設(shè)為健康對照組。對照組采用多西他賽進(jìn)行化療，試驗組應(yīng)用納武利尤單抗進(jìn)行治療。比較治療6周后兩組療效，觀察用藥治療期間不良反應(yīng)發(fā)生情況，隨訪記錄患者生存情況，分析肺癌患者與健康對照人群IFN-γ基因+874A/T單核苷酸多態(tài)性，并分析IFN-γ+874A/T基因多態(tài)性與納武利尤單抗療效的關(guān)系。結(jié)果 試驗組治療總有效率為28.0%，高于對照組的14.6%，兩組比較差異顯著（P＜0.05）；試驗組不良反應(yīng)中脫發(fā)、貧血、肌肉酸痛、中性粒細(xì)胞減少情況均顯著少于對照組（P＜0.05）；試驗組疲倦、胃腸道反應(yīng)發(fā)生情況與對照組比較差異無統(tǒng)計學(xué)意義（P＜0.05）；隨訪15個月后，試驗組患者中位生存時間為2.500個月（95%CI：2.120～10.425）；對照組患者中位生存時間為4.264個月（95%CI：2.021～11.230）。Log-rank檢驗顯示，兩組患者生存情況無顯著差異（χ²＝3.84，P=0.912）；肺癌患者IFN-γ+874TT基因型頻率和T等位基因頻率分別為25.33%、48.6%，顯著高于健康對照人群的6.0%、22.0%（P＜0.05）；試驗組75例患者中15例有效（20.0%），有效患者中TT基因型與T等位基因占比與無效患者基因型比較，差異顯著（P＜0.05）。結(jié)論 納武利尤單抗能夠提升肺癌治療效果，并且具有較高的安全性；IFN-γ+874A/T基因多態(tài)性與納武利尤單抗治療肺癌療效可能有關(guān)。

Objective To investigate the efficacy of nivolumab in the treatment of lung cancer and its influence on the prognosis of patients, and to explore the relationship between efficacy and IFN-γ gene mutations.Methods A total of 150 patients with lung cancer admitted to the Second Affiliated Hospital of Xingtai Medical College from January 2020 to June 2021 were selected as the study subjects. According to different treatment schemes, 150 patients were divided into control group and test group, with 75 patients in each group. A total of 100 people who were included in the Second Affiliated Hospital of Xingtai Medical College for physical examination in the same period were set as healthy control group. Patients in the control group were treated with docetaxel, and patients in the experimental group were treated with nivolumab. The efficacy of the two groups after six weeks of treatment was compared, and the adverse reactions during drug treatment were observed. The survival time of patients were record in following up period, and the IFN-γ gene +874 A/T single nucleotide polymorphism of lung cancer patients and healthy control population were analyzed and the relationship between IFN-γ+874A/T gene polymorphism and the efficacy of nivolumab was analysed.Results The total effective rate of the test group was 28.0%, higher than that of the control group (14.6%), with a significant difference between the two groups (P <0.05). In the adverse reactions, alopecia, anemia, muscle soreness and neutropenia in the experimental group were significantly less than those in the control group (P <0.05). There was no significant difference in fatigue and gastrointestinal reaction between the experimental group and the control group (P > 0.05). After 15 months of follow-up, the median survival time of patients in the experimental group was 2.500 months (95% CI: 2.120-10.425), and the median survival time of patients in the control group was 4.264 months (95% CI: 2.021-11.230). Log-rank test showed no significant difference in survival between the two groups (χ² = 3.84, P = 0.912). The genotype frequency and T allele frequency of IFN-γ+ 874 TT of lung cancer patients were 25.33% and 48.6%, respectively, which were significantly higher than those of healthy controls (6.0% and 22.0%, P <0.05). Fifteen of the 75 patients in the experimental group were effective (20.0%). The proportion of TT genotype and T allele in effective patients was significantly different from that in ineffective patients (P <0.05).Conclusion Nivolumab can improve the therapeutic effect of lung cancer, and has high safety. IFN-γ+874A/T gene polymorphism may be related to the efficacy of nivolumab in the treatment of lung cancer.

R979.1

邢臺市科技局重點研發(fā)計劃項目(2021ZC178)