目的 探究维生素 C联合同步放化疗（CCRT）对 III期非小细胞肺癌（NSCLC）患者近期疗效、生存质量及免疫球蛋白（IgA、IgM、IgG）和炎症因子水平的影响。方法 将2019年3月—2021年3月贵州省黔西南布依族苗族自治州人民医院收治的 60例 III期 NSCLC患者随机分为对照组（n＝30）与试验组（n＝30）。对照组患者采用 CCRT治疗。放疗方案：6MV-X 直线加速器扫描，每次 1.8～2.0 Gy，每周 5 次，总剂量 60～66 Gy。化疗方案：顺铂（50 mg·m^-2）第 1 天（d1）、d8、d29、d36静脉滴注，依托泊苷（50 mg·m^-2）d1～d5、d29～d33静脉滴注。36 d为 1个疗程，共治疗 1个疗程。试验组患者采用维生素 C联合 CCRT治疗，CRRT方案同对照组，CCRT治疗方案开始后即给予静脉输注维生素 C，每天 10 g，每周2次（间隔3 d）至放化疗结束，放化疗全程口服维生素C，每天4 g，连续治疗36 d。观察两组患者治疗后近期疗效、生存质量（KPS 评分）以及血清肿瘤坏死因子-α（TNF-α）、IgA、C 反应蛋白（CRP）、IgM、白细胞介素 6（IL-6）、IgG 水平。结果 试验组客观缓解率为 53.33%，略高于对照组的 46.67%，但差异无显著性（P＞0.05）。试验组化疗后生存质量稳定改善率 83.33% 显著高于对照组 56.67%（P＜0.05）。试验组总不良反应发生率 33.33%，显著低于对照组的 60.00%（P＜0.05）。治疗前，两组的 IgA、IgG、IgM 和 IL-6、CRP、TNF-α 水平比较，差异无统计学意义（P＞0.05）；治疗后，两组IgA、IgG、IgM水平均较本组治疗前显著升高（P＜0.05），IL-6、CRP、TNF-α水平较本组治疗前降低（P＜0.05）；与对照组治疗后比较，试验组 IgA、IgG、IgM 水平显著升高（P＜0.05），IL-6、CRP、TNF-α水平降低（P＜0.05）。结论 维生素C联合CCRT治疗III期NSCLC可显著降低不良反应发生率，改善生存质量及机体免疫功能。

Objective To investigate the influences of vitamin C combined with concurrent chemoradiotherapy (CCRT) on the shortterm response rate, quality of life and immunoglobulin (IgA, IgM, IgG) andinflammatory factor levels in patients with stage III nonsmall cell lung cancer (NSCLC). Methods Sixty patients with stage III NSCLC who were treated in People's Hospital of Qianxinan Buyei and Miao Autonomous Prefecture from March 2019 to March 2021 were randomly grouped into control group (n=30) and experimental group (n=30). Control group was treated with CCRT. Radiotherapy regimen: 6MV-X linear accelerator scanning, 1.8—2.0 Gy each time, five times a week, total dose 60—66 Gy. Chemotherapy regimen: Cisplatin (50 mg·m^-2) (d1), d8, d29, d36 intravenous infusion, etoposide (50 mg·m^-2) d1—d5, d29—d33 intravenous infusion. A total of 36 days of treatment, 36 days as a course of treatment. The experimental group was treated with vitamin C combined with CCRT, and the CCRT scheme was the same as that of the control group. After the beginning of the CCRT treatment, the patients were given intravenous infusion of vitamin C, 10 g a day, twice a week (3 d interval), until the end of radiotherapy and chemotherapy. During the whole course of radiotherapy and chemotherapy, oral vitamin C, 4 g a day, was continuously treated for 36 d. The short-term effective rate, quality of life (KPS score), and the levels of serum tumor necrosis factor-α (TNF-α), IgA, C-reactive protein (CRP), IgM, interleukin-6 (IL-6) and IgG in two groups after treatment were observed. Results The short-term effective rate of experimental group was 53.33%, slightly higher than that of control group 46.67%, but the difference was not significant (P＞0.05). The stable improvement rate of quality of life after chemotherapy in experimental group was 83.33%, which was obviously higher than 56.67% in control group (P＜0.05). The incidence of total adverse reactions in the experimental group was 33.33%, which was obviously lower than that in control group (60.00%) (P＜0.05). Before treatment, there were no significant differences in the levels of IgA, IgG, IgM, IL-6, CRP and TNF-α between the two groups (P＞0.05). After treatment, the levels of IgA, IgG and IgM in two groups were significantly increased compared with before treatment (P＜0.05), while the levels of IL-6, CRP and TNF- α were decreased compared with before treatment (P＜0.05). Compared with the control group after treatment, the levels of IgA, IgG and IgM in experimental groups were significantly increased (P＜0.05), while the levels of IL-6, CRP and TNF- α were decreased (P＜0.05). Conclusion Vitamin C combined with CCRT in the treatment of stage III NSCLC can significantly reduce adverse reactions, and improve the quality of life and immune function.

R979.1

黔西南州科技计划项目（2018-2-36）