目的 探讨榄香烯联合洛铂治疗晚期肺癌合并恶性胸腔积液(MPE)的临床疗效。方法 选取2019-07至2022-07河北省人民医院呼吸内科和胸外科收治的60例晚期肺癌合并MPE患者,随机分为对照组和治疗组,每组30例。对照组给予洛铂常规治疗,治疗组在此基础上加用榄香烯,两组治疗时间均为4周。比较两组治疗后的临床疗效,不良反应及Karnofsky功能状态评分(KPS评分)改善情况,比较两组治疗前后T淋巴细胞亚群(CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺)、血清肿瘤标志物[癌胚抗原(CEA)、鳞状上皮细胞癌抗原(SCC)、细胞角蛋白19片段(CYFRA21-1)]水平。结果 治疗后,治疗组的症状缓解率明显高于对照组(83.3% vs. 56.7%),不良反应的发生率明显低于对照组(30.0% vs. 63.3%),差异均有统计学意义(P<0.05)。两组治疗后均较治疗前明显改善,但治疗组KPS评分、CD3⁺、CD4⁺水平及CD4⁺/CD8⁺显著高于对照组(73.33±10.61 vs. 68.33±8.34;66.50±3.46 vs. 64.07±2.99;55.10±17.69 vs. 36.18±7.45;3.03±0.08 vs. 2.65±0.46),差异有统计学意义(P<0.05);治疗组CD8⁺水平、血清CEA、SCC、CYFRA21-1显著低于对照组,差异有统计学意义(P<0.05)。结论 榄香烯联合洛铂治疗晚期肺癌合并MPE临床疗效显著,不良反应少,可能与提高细胞免疫水平和降低肿瘤标志物含量有一定关系。

Objective To investigate the clinical efficacy of elemene combined with lobaplatin in the treatment of advanced lung cancer patients with malignant pleural effusion (MPE).Methods The subjects of study were 60 cases of advanced lung cancer patients with MPE who were admitted to the Department of Respiratory Medicine or Thoracic Surgery, Hebei General Hospital from July 2019 to July 2022. The enrolled patients were randomly divided into the control group and the treatment group, with 30 cases in each group. Patients in the control group were given lobaplatin, and those in the treatment group were treated with elemene on this basis. Both groups were treated for 4 weeks. Further comparison was performed on the clinical efficacy, adverse reaction, Karnofsky Performance Scale (KPS) scores in the two groups. Meanwhile, T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺), serum tumor markers [carcinoembryonic antigen(CEA) and squamous cell carcinoma antigen(SCC) and Cytokeratin 19 Fragment (CYFRA21-1)] levels were detected and compared before and after treatment.Results After 4 weeks of treatment, the symptom remission rate of the treatment group was significantly improved compared with the control group (83.3% vs. 56.7%), and the incidence of adverse reactions was reduced than that of the control group (30.0% vs. 63.3%; P<0.05). after treatment, both groups were significantly improved compared with before treatment, but the scores of KPS, and the levels of CD3⁺ and CD4⁺, and the ratio of CD4⁺/CD8⁺ in the treatment group increased than those in the control group (73.33±10.61 vs. 68.33±8.34;66.50±3.46 vs. 64.07±2.99;55.10±17.69 vs. 36.18±7.45;3.03±0.08 vs. 2.65±0.46; P<0.05), and CD8⁺ level in the treatment group was significantly lower (P<0.05). In addition, after treatment, the level of CD8⁺, and the levels of serum CEA, SCC and CYFRA21-1 in the treatment group were significantly lower than those in the control group (P<0.05).Conclusions Elemene combined with lobaplatin has significant clinical effect in the treatment of advanced lung cancer patients with MPE, which can reduce the adverse reactions of lobaplatin, and may be related with the improvement of the cellular immune level and decrease of the content of tumor biomarkers of patients.