目的 观察白蛋白紫杉醇联合铂类化疗方案治疗进展期食管癌的临床疗效。方法 选择2020年7月—2021年3月在河北北方学院附属第一医院治疗的62例进展期食管癌患者，按照随机数字表法分为对照组（31例）和治疗组（31例）。对照组采取调强放疗联合含铂类化疗方案，临床靶区总剂量54Gy，1.8Gy/次，肿瘤靶区总剂量63Gy，2.1Gy/次，5次/周，连续治疗6周；同时第1～3天静脉滴注注射用奈达铂，80mg/m²加入生理盐水100mL。治疗组在对照组基础上静脉滴注注射用紫杉醇（白蛋白结合型），第1、8天给药，260mg/m²加入100mL生理盐水。3周为1个周期，两组患者共治疗2个周期。观察两组患者临床疗效，比较治疗前后两组患者临床疗效和生存率，β-连环蛋白（β-catenin）、细胞周期蛋白D1（CCND1）、食管癌相关基因4（ECRG4）、10号染色体缺失的磷酸酶和张力蛋白同源基因（PTEN）、肿瘤相关细胞角蛋白19片段（CYFRA21-1）、癌胚抗原（CEA）、鳞状细胞癌抗原（SCC-Ag）、血红素氧合酶-1（HO-1）、血管内皮生长因子C（VEGF-C）、基质金属蛋白酶-9（MMP-9）、T淋巴细胞亚群CD4^＋、CD8^＋、免疫球蛋白（Ig）M水平，及不良反应。结果 治疗后，治疗组疾病缓解率为83.87%，对照组疾病缓解率为58.06%，治疗组疾病缓解率高于对照组（P＜0.05）。治疗后，两组ECRG4、PTEN水平升高（P＜0.05），β-catenin、CCND1水平明显降低（P＜0.05）；治疗后治疗组患者ECRG4、PTEN水平高于对照组（P＜0.05），β-catenin、CCND1水平显著低于对照组（P＜0.05）。治疗后，两组CEA、CYFRA21-1、SCC-Ag水平明显降低（P＜0.05），且治疗后，治疗组CEA、CYFRA21-1、SCC-Ag水平低于对照组（P＜0.05）。治疗后，两组患者MMP-9、HO-1、VEGF-C水平明显降低（P＜0.05），且治疗组患者MMP-9、HO-1、VEGF-C水平低于对照组（P＜0.05）。治疗后，两组IgM、CD4^＋水平升高，CD8^＋水平降低（P＜0.05）；治疗后，治疗组IgM、CD4^＋水平均高于对照组，CD8^＋水平低于对照组（P＜0.05）。结论 白蛋白紫杉醇联合铂类化疗方案治疗进展期食管癌患者，可提升抑癌基因水平，降低原癌基因、肿瘤标志物、MMP-9、HO-1、VEGF-C水平，减少机体免疫损伤，提升临床疗效，减少不良反应发生率。

Objective To observe clinical effect of albumin paclitaxel combined with platinum chemotherapy regimen in treatment of advanced esophageal cancer. Methods Patients (62 cases) with advanced esophageal cancer in the First Affiliated Hospital of Hebei North University from July 2020 to March 2021 were divided into control (31 cases) and treatment (31 cases) group according to the random number table method. Patients in the control group were administered with intensity modulated radiotherapy combined with platinum-containing chemotherapy, total dose of clinical target was 54 Gy, 1.8 Gy/time, total dose of tumor target was 63 Gy, 2.1 Gy/time, five times every week for 6 weeks. At the same time, patients in the control group were iv administered with Nedaplatin for injection on the 1st to 3rd day, and 80 mg/m² was added with 100 mL of normal saline. Patients in the treatment group were iv administered with Paclitaxel for injection (Albumin Bound) on the basis of the control group on the first day and the eighth day, and 260 mg/m² was added to 100 mL saline. 3 weeks was a course of treatment, and patients in two groups were treated for 2 cycles. After treatment, the clinical evaluation and survival rate were evaluated, the levels of β-catenin, CCND1, ECRG4, PTEN, CEA, CYFRA21-1, SCC-Ag, MMP-9, HO-1, VEGF-C, IgM, CD4⁺, and CD8⁺, adverse reaction in two groups before and after treatment were compared. Results After treatment, the disease remission rate was 83.87% in the treatment group and 58.06% in the control group, and which in the treatment group was significantly higher than that in the control group (P<0.05). After treatment, the levels of ECRG4 and PTEN were increased (P<0.05), while the levels of β-catenin and CCND1 were significantly decreased (P<0.05). After treatment, the levels of ECRG4 and PTEN in treatment group were higher than those in control group (P<0.05), and the levels of β-catenin and CCND1 in treatment group were significantly lower than those in control group (P<0.05). After treatment, CEA, CYFRA21-1 and SCC-Ag levels in both groups were significantly decreased (P<0.05), and CEA, CYFRA21-1 and SCC-Ag levels in the treatment group were lower than those in the control group (P<0.05). After treatment, the levels of MMP-9, HO-1 and VEGF-C in two groups were significantly decreased (P<0.05), and the levels of MMP-9, HO-1 and VEGF-C in the treatment group were lower than those in the control group (P<0.05). After treatment, the levels of IgM and CD4⁺ were increased, while the levels of CD8⁺ were decreased (P<0.05). After treatment, the levels of IgM and CD4⁺ in the treatment group were higher than those in the control group, while the levels of CD8⁺ were lower than those in the control group (P<0.05). Conclusion Albumin paclitaxel combined with platinum chemotherapy regimen in treatment of advanced esophageal cancer can increase the level of tumor suppressor genes, reduce the levels of proto-oncogenes, tumor markers, MMP-9, HO-1, and VEGF-C, reduce the immune damage, improve clinical efficacy, and reduce the incidence of adverse reactions.

R979.1

河北省医学科学研究课题计划项目（20220617）