目的 研究重组人血管内皮抑素联合奥希替尼和洛铂治疗肺腺癌恶性胸腔积液的临床疗效。方法 选取2018年1月—2025年1月在南京脑科医院胸科院区住院的78例晚期肺腺癌合并恶性胸腔积液的患者作为研究对象，用随机数字表法将78例患者分为对照组和治疗组，每组各有患者39例。对照组患者给予甲磺酸奥希替尼片口服，每日1次，每次1片。对于胸腔积液行胸腔穿刺引流，将胸腔积液排净后，向胸腔内注入注射用洛铂，每次30 mg。治疗组在对照组的治疗基础上向胸腔内同时注入重组人血管内皮抑制素注射液，每次45 mL。每周引流胸腔积液2次。比较两组患者临床疗效和胸腔积液病理阳性率，同时观察两组治疗前后胸腔积液中肿瘤标志物。结果 治疗后，治疗组客观缓解率（ORR）、疾病控制率（DCR）分别为89.74%、97.44%，显著高于对照组的66.67%、84.62%（P＜0.05）。与对照组相比，治疗后一个月及治疗后两个月，治疗组胸腔积液病理阳性率分别是25.64%、12.82%，对照组分别是48.72%、33.33%，两组比较差异显著（P＜0.05）。治疗后1个月，两组患者胸腔积液中癌胚抗原（CEA）和细胞角蛋白19可溶性片段（CYFRA21-1）明显下降（P＜0.05）；与对照组相比，治疗组治疗后胸腔积液中的CEA和CYFRA21-1下降更显著（P＜0.05）。结论 对于EGFR敏感突变晚期肺腺癌合并恶性胸腔积液的患者，在奥希替尼靶向治疗的基础上，胸腔内注入重组人血管内皮抑素和洛铂可提高恶性胸腔积液的客观缓解率和疾病控制率，有效控制胸腔积液，且不增加治疗的不良反应，值得临床推广。

Objective To study the clinical efficacy of recombinant human endostatin combined with osimertinib and lobaplatin in treatment of lung adenocarcinoma related malignant pleural effusion. Methods A total of 78 patients with lung adenocarcinoma related malignant pleural effusion who were hospitalized at the Thoracic Department of Nanjing Brain Hospital from January 2018 to January 2025 were selected as the research subjects. Using the random number table method, these 78 patients were divided into control group and treatment group, with 39 patients in each group. The control group patients were given oral administration of Osimertinib Mesylate Tablets, once daily, 1 tablet each time. For pleural effusion, thoracentesis and drainage were performed, and the pleural effusion was drained completely. Then, injection of Lobaplatin for injection was injected into the pleural cavity, 30 mg each time. The treatment group patients simultaneously injected Recombinant Human Endostatin Injection into pleural cavity, 45 mL each time. Thoracentesis was performed twice weekly. The clinical efficacy and the positive rate of pleural effusion pathology of two groups were compared. At the same time, the tumor markers in the pleural effusion before and after treatment in two groups were observed. Results After treatment, the objective response rate (ORR) and disease control rate (DCR) of treatment group were 89.74% and 97.44%, respectively, which were significantly higher than those of control group (66.67% and 84.62%) (P < 0.05). Compared with control group, the pathological positive rate of pleural effusion in treatment group was 25.64% and 12.82% one month and two months after treatment, respectively, while that of control group was 48.72% and 33.33%. The difference between two groups was significant (P < 0.05). One month after treatment, the levels of carcinoembryonic antigen (CEA) and soluble cytokeratin 19 fragment (CYFRA21-1) in pleural effusion of two groups decreased significantly (P < 0.05). Compared with control group, the decrease of CEA and CYFRA21-1 in pleural effusion of treatment group was more significant (P < 0.05). Conclusion For patients with lung adenocarcinoma related malignant pleural effusion with EGFR sensitive mutations, based on the targeted therapy with osimertinib, injecting recombinant human endostatin and lobaplatin into thoracic cavity can increase the objective response rate and disease control rate of malignant pleural effusion, effectively control the pleural effusion, and does not increase the adverse reactions of treatment, which is worthy of clinical promotion.

R979.1

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