目的 探讨脾多肽注射液联合阿帕替尼治疗晚期胃癌的临床疗效。方法 选取阜阳市第二人民医院2017年1月-2019年1月收治的晚期胃癌患者80例为研究对象，利用随机数字表法将患者分成对照组和观察组，每组各40例。对照组口服甲磺酸阿帕替尼片，500 mg/次，1次/d，治疗过程中若出现不良反应，则根据受试者耐受情况减量或暂停服用。观察组在对照组基础上静脉滴注脾多肽注射液，每次将10 mL脾多肽注射液加入500 mL 5%葡萄糖液中充分稀释后给药，1次/d，连用1周后停药3周。两组均以4周为1个疗程，连续治疗2个疗程。观察两组近期疗效及毒副作用发生情况，比较治疗前后两组的血清肿瘤标记物水平、卡氏功能状态量表（KPS）和修订版Piper疲乏量表（RPFS）评分。结果 经治疗，观察组客观有效率（ORR）和疾病控制率（DCR）分别为20.00%、70.00%；均高于对照组的12.50%、50.00%，但差异均无统计学意义。两组治疗后血清癌胚抗原（CEA）、糖类抗原（CA）125（CA125）和CA19-9水平均较本组治疗前显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；且治疗后，观察组血清肿瘤标志物水平较对照组同期均显著更低，两组比较差异具有统计学意义（P<0.05）。对照组治疗后外周血血小板（PLT）较本组治疗前显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）。两组治疗后KPS评分均较本组治疗前有显著提高，RPFS评分则均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）；治疗后，观察组KPS、RPFS评分的改善效果均显著优于对照组，两组比较差异具有统计学意义（P<0.05）。用药期间，观察组乏力发生率为30.00%，显著低于对照组的55.00%，差异有统计学意义（P<0.05）。结论 脾多肽注射液联合阿帕替尼治疗化疗失败的晚期胃癌能有效提高近期疗效，并有助于减少单用阿帕替尼所产生的乏力等毒副作用，降低血清肿瘤标志物CEA、CA125和CA19-9水平，有效维持晚期胃癌患者外周血PLT稳定，值得临床推广研究。

Objective To investigate the therapeutic effect of Lienal Polypeptide Injection combined with apatinib in treatment of advanced gastric cancer. Methods Patients (80 cases) with advanced gastric cancer in the Second People's Hospital of Fuyang from January 2017 to January 2019 were divided into control group (40 cases) and observation group (40 cases) by random number table method. Patients in the control group were po administered with Apatinib Mesylate Tablets, 500 mg/time, once daily. In case of adverse reactions during the treatment, the dosage shall be reduced or suspended according to the tolerance of the subject. Patients in the observation group were iv administered with Lienal Polypeptide Injection on the basis of control group, 10 mL was added to 500 mL 5% glucose solution, once daily, stoppded medication for 3 weeks after 1 week of continuous use. The two groups were treated with 4 weeks as a course of treatment, two courses of continuous treatment. The short-term efficacy and side effects in two groups were compared, and the levels of serum tumor markers, peripheral blood PLT, KPS and RPFS before and after treatment were compared. Results After treatment, the ORR and DCR in the observation group were 20.00% and 70.00%, respectively, which were higher than 12.50% and 50.00% in the control group, but the difference was not statistically significant. After treatment, serum CEA, CA125, CA19-9 levels in two groups were significantly decreased, and the differences before and after treatment in the same group were statistically significant (P<0.05). After treatment, the serum levels of tumor markers in the observation group were significantly lower than those in the control group, and the difference between the two groups was statistically significant (P<0.05). After treatment, the peripheral blood PLT in the control group was significantly decreased, and the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, the KPS score in two groups was significantly increased, while the RPFS score was significantly decreased, the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, the improvement effect of KPS and RPFS scores in the observation group was significantly better than that in the control group, and the difference between the two groups was statistically significant (P<0.05). During the treatment period, the incidence of asthenia in the observation was 30.00%, which was significantly lower than 55.00% in the control group, with a statistically significant difference (P<0.05). Conclusion Lienal Polypeptide Injection combined with apatinib in treatment of advanced gastric cancer with chemotherapy failure can effectively improve the short-term efficacy, and help to reduce the toxicity and side effects caused by apatinib alone, reduce the levels of serum tumor markers CEA, CA125, and CA19-9, and effectively maintain the stability of peripheral blood PLT in patients with advanced gastric cancer, which is worthy of clinical promotion and research.

R979.1

安徽省卫生健康委员会科研课题（2018R01220）