目的 觀察阿帕替尼聯(lián)合卡培他濱＋奧沙利鉑（XELOX）化療治療中晚期結(jié)直腸癌患者的近期療效。方法 選取2019年6月—2023年3月北京石景山醫(yī)院和山西省腫瘤醫(yī)院收治的76例中晚期結(jié)直腸癌患者，按1∶1原則將患者隨機分為對照組和試驗組，每組各38例。對照組采用XELOX化療方案，試驗組在XELOX化療基礎(chǔ)上同時口服甲磺酸阿帕替尼片，每次850 mg，每天1次，餐后服用，每3周為1個療程，連續(xù)治療至疾病進展，或無法耐受。對比兩組近期療效，比較兩組治療前后血管生成指標(biāo)、腫瘤標(biāo)志物、炎癥指標(biāo)、免疫功能指標(biāo)等，比較兩組治療期間不良反應(yīng)發(fā)生情況。結(jié)果 試驗組在進行2個周期治療后，近期疾病緩解率60.53%顯著高于對照組的39.47%（P＜0.05）。治療前，兩組血管內(nèi)皮生長因子（VEGF）、血管生成素（Ang）-1、Ang-2及白細(xì)胞介素（IL）-8、腫瘤壞死因子（TNF）-α、中性粒細(xì)胞與淋巴細(xì)胞比值（NLR）、血小板與淋巴細(xì)胞比值（PLR）、癌胚抗原（CEA）、糖類抗原19-9 （CA19-9）、糖類抗原125 （CA125）、CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、自然殺傷細(xì)胞（NK）等各項指標(biāo)比較，差異均不顯著（P＞0.05）。治療2個周期后，兩組Ang-1、Ang-2、VEGF、IL-8水平均較本組治療前顯著降低（P＜0.05），CEA、CA19-9、CA125水平均較本組治療前顯著降低（P＜0.05），TNF-α及NLR、PLR均較本組治療前顯著降低（P＜0.05）。治療2個周期后，試驗組的VEGF、Ang-1、Ang-2及IL-8水平均顯著低于對照組（P＜0.05）； TNF-α、NLR、PLR水平均顯著低于對照組（P＜0.05）；腫瘤標(biāo)志物CEA、CA19-9、CA125水平顯著低于對照組（P＜0.05）。治療2個周期后，對照組CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、NK細(xì)胞較治療前無顯著變化（P ＞0.05），而試驗組各項免疫功能指標(biāo)較治療前有所改善（P＜0.05），且試驗組CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、NK細(xì)胞均高于對照組（P＜0.05）。兩組治療期間的不良反應(yīng)均可控，且3～4級不良反應(yīng)發(fā)生率較低，兩組骨髓抑制、胃腸道反應(yīng)、肝腎功能異常、血液學(xué)毒性發(fā)生率比較，差異無統(tǒng)計學(xué)意義（P＞0.05）。結(jié)論 阿帕替尼聯(lián)合XELOX化療治療中晚期結(jié)直腸癌患者的近期療效較好，且能降低血管生成因子表達(dá)，在一定程度上改善患者免疫功能，值得臨床關(guān)注。

Objective To observe the short-term efficacy of apatinib combined with capecitabine and oxaliplatin (XELOX) chemotherapy in the treatment of patients with advanced colorectal cancer. Method 76 patients with advanced colorectal cancer admitted to Beijing Luhe Hospital affiliated with Capital Medical University from June 2019 to March 2023 were randomly divided into a control group and an experimental group based on a 1∶ 1 ratio, with 38 cases in each group. The control group received XELOX chemotherapy regimen, while the experimental group received concurrent oral administration of Apatinib Mesylate Tablets at a dose of 850 mg per dose, once a day, after meals, for a course of treatment every three weeks until disease progression or intolerance. The recent therapeutic effects of two groups was compared, the angiogenesis indicators, tumor markers, inflammation indicators, immune function indicators were compared, before and after treatment. The incidence of adverse reactions during the treatment period between the two groups was compared. Results After two cycles of treatment, the recent disease remission rate of the experimental group was 60.53%, which was significantly higher than that of the control group (39.47%, P < 0.05). Before treatment, there were no significant differences in vascular endothelial growth factor (VEGF), angiopoietin (Ang) -1, Ang-2, interleukin (IL) -8, tumor necrosis factor (TNF) - α, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125), CD3⁺, CD3⁺CD4⁺, CD4⁺/CD8⁺, natural killer cell (NK) and other indicators between the two groups (P > 0.05). After two cycles of treatment, the levels of Ang-1, Ang-2, VEGF and IL-8 in the two groups were significantly lower than those before treatment (P < 0.05), the levels of CEA, CA19-9 and CA125 were significantly lower than those before treatment (P < 0.05), and TNF- α, NLR and PLR were significantly lower than those before treatment (P < 0.05). After two cycles of treatment, the levels of VEGF, Ang-1, Ang-2 and IL-8 in the experimental group were significantly lower than those in the control group (P < 0.05), the levels of TNF-α, NLR and PLR were significantly lower than those in the control group (P < 0.05), the levels of tumor markers CEA, CA19-9 and CA125 were significantly lower than those in the control group (P < 0.05). After two cycles of treatment, the levels of CD3⁺, CD3⁺ CD4⁺ CD4⁺ / CD8⁺, NK cells in the control group had no significant change compared with those before treatment (P > 0.05), while the immune function indexes in the experimental group were improved compared with those before treatment (P < 0.05), and the levels of CD3⁺ CD3⁺ CD4⁺ , CD4⁺ /CD8⁺ , NK cells in the experimental group were higher than those in the control group (P < 0.05). The adverse reactions in the two groups during treatment were controllable, and the incidence of grade 3—4 adverse reactions was low. There was no significant difference in the incidence of bone marrow suppression, gastrointestinal reactions, liver and kidney dysfunction, hematological toxicity between the two groups (P > 0.05). Conclusion Apatinib combined with XELOX chemotherapy has a good short-term effect in the treatment of advanced colorectal cancer patients, and can reduce the expression of angiogenic factors, improve the immune function of patients to a certain extent, which is worthy of clinical attention.

R979.1