目的 探討注射用紫杉醇(白蛋白結(jié)合型)聯(lián)合卡鉑與靶向藥物曲妥珠單抗治療人表皮生長因子受體-2(HER-2)陽性乳腺癌患者的效果,以及對(duì)患者抑癌基因和免疫功能的影響。方法 選取邢臺(tái)市第三醫(yī)院于 2018年1月-2019年1月收治的 124 例 HER-2 陽性乳腺癌患者,隨機(jī)分為對(duì)照組和試驗(yàn)組,每組 62 例。對(duì)照組患者接受紫杉醇注射液、卡鉑聯(lián)合曲妥珠單抗治療,試驗(yàn)組接受注射用紫杉醇(白蛋白結(jié)合型)、卡鉑聯(lián)合曲妥珠單抗治療,共治療 6 個(gè)周期,隨訪 12~40 個(gè)月。比較兩組患者治療后的臨床療效、生存率、中位生存期、不良反應(yīng)情況,以及 T 淋巴細(xì)胞亞群、抑癌基因變化情況。結(jié)果 試驗(yàn)組完全緩解(CR)率顯著高于對(duì)照組(41.94% vs 19.35%,P<0.05)。治療后,兩組患者的CD³⁺、CD⁴⁺表達(dá)水平明顯增加,而 CD⁸⁺表達(dá)水平無明顯變化,其中試驗(yàn)組治療后的 CD³⁺、CD⁴⁺表達(dá)水平高于對(duì)照組(P<0.05)。治療后兩組患者病灶內(nèi)抑癌基因 Bax、ARID1A、FasL、Caspase-3、PTEN mRNA 表達(dá)量均明顯高于同組治療前(P<0.05);治療后試驗(yàn)組患者病灶內(nèi) Bax、ARID1A、FasL、Caspase-3、PTEN mRNA 表達(dá)量均明顯高于對(duì)照組(P<0.05)。試驗(yàn)組生存率顯著高于對(duì)照組(45.16% vs 27.42%,P<0.05),中位生存期長于對(duì)照組(33.25 個(gè)月 vs 22.85 個(gè)月,P<0.05)。兩組各不良反應(yīng)分級(jí)發(fā)生情況無統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論 注射用紫杉醇(白蛋白結(jié)合型)聯(lián)合卡鉑與靶向藥物曲妥珠單抗治療 HER-2 陽性乳腺癌的療效顯著,可改善患者免疫功能,上調(diào)抑癌基因表達(dá),提高生存率,利于預(yù)后。

Objective To explore the effect of Paclitaxel for Injection (albumin binding type) combined with carboplatin and trastuzumab on treatment of human epidermal growth factor receptor-2 (HER-2) positive breast cancer patients and its effect on tumor suppressor genes and immune function. Methods A total of 124 patients with HER-2 positive breast cancer admitted to Xingtai Third Hospital from January 2018 to January 2019 were randomly divided into control group and experimental group, 62 cases in each group. Patients in control group were treated with Paclitaxel for Injection + carboplatin combined with trastuzumab, and patients in experimental group were treated with Paclitaxel for Injection (albumin binding type) and carboplatin combined with trastuzumab. Both groups were treated for 6 cycles and followed up for 12 to 40 months. The clinical efficacy, survival rate, median survival, adverse reactions, T lymphocyte subsets and tumor suppressor genes were compared between two groups. Results The complete remission (CR) rate of experimental group was higher than that of control group (41.94% vs 19.35%, P<0.05). After treatment, the expression levels of CD³⁺ and CD⁴⁺ in two groups were significantly increased, while the expression level of CD⁸⁺ had no significant change. The expression levels of CD³⁺ and CD⁴⁺ in experimental group after treatment were higher than those in control group (P<0.05). After treatment, the expression of tumor suppressor genes Bax, ARID1A, FasL, Caspase-3 and PTEN mRNA in the lesions of the two groups were significantly higher than that before treatment (P<0.05). The mRNA expressions of Bax, ARID1A, FasL, Caspase-3 and PTEN in lesions of experimental group were significantly higher than those of control group (P<0.05). The survival rate of the experimental group was higher than that of the control group (45.16% vs 27.42%, P<0.05), and the median survival time was longer than that of the control group (33.25 months vs 22.85 months, P<0.05). There were no statistical significance in the occurrence of each adverse reaction grade between two groups (P > 0.05). Conclusion Paclitaxel for Injection (albumin binding type) combined with carboplatin and targeted drugs-trastuzumab has a significant curative effect in treatment of HER-2 positive breast cancer, which can improve the immune function of patients and up-regulate tumor suppressor genes, thereby improving survival rate and benefiting prognosis.

R979.1

邢臺(tái)市重點(diǎn)研發(fā)計(jì)劃項(xiàng)目(2020ZC383)