目的 探讨奥希替尼辅助DP方案（多西他赛联合顺铂）治疗晚期非小细胞肺癌（non-small cell lung cancer，NSCLC）的临床疗效及其对患者血清抗菌肽人类阳离子抗菌蛋白18（hCAP18）及POK红细胞髓性致癌因子（POK）表达的影响。方法 选取2017年3月—2019年1月邢台医学高等专科学校第二附属医院收治的70例晚期NSCLC患者作为研究对象，按照随机分组的方法分为对照组和观察组两组，每组各35例。对照组患者给予DP方案治疗，在第1、8天静脉滴注多西他赛注射液，60 mg/m²与250 mL的0.9%氯化钠溶液进行充分的混匀，1次/d；第1～4天静脉滴注注射用顺铂，30 mg/m²，1次/d。所有患者均以3周为1个化疗周期，连续2个周期。观察组在对照组的基础上口服甲磺酸奥希替尼片，80 mg/d，连续治疗2个疗程后进行临床疗效等指标的评价。观察两组患者的近期疗效，比较两组治疗前后的癌胚抗原（CEA）、血管内皮生长因子（VEGF）、细胞角质蛋白19片段（CYFRA21-1）等肿瘤标志物的水平，血清中的hCAPI8、Pokemon表达情况，远期的生存情况和不良反应的发生情况。结果 治疗后，观察组的客观缓解率（ORR）和疾病控制率（DCR）分别为62.9%和85.7%，对照组的ORR和DCR分别为28.6%和60.0%，观察组的ORR和DCR均显著高于对照组（P<0.05）。治疗后，两组CEA、VEGF、CYFRA21-1水平较治疗前有明显的下降（P<0.05）；治疗后，观察组的CEA、VEGF、CYFRA21-1水平显著低于对照组（P<0.05）。治疗后，两组患者血清hCAP18、Pokemon的水平有明显的下降（P<0.05）；治疗后，观察组hCAP18、Pokemon水平下降更显著（P<0.05）。观察组生存率显著高于对照组（P<0.05）。结论 奥希替尼辅助DP方案可以有效降低晚期非小细胞肺癌患者CEA、VEGF、CYFRA21-1水平，高效改善患者的近期疗效及远期生存情况，且治疗过程安全有效，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of osimertinib combined with DP regimen in treatment of advanced nonsmall cell lung cancer and its effect on serum hCAP18 and Pokemon. Methods A total of 70 patients with advanced NON-small cell lung cancer (NSCLC) admitted to the Second Affiliated Hospital of Xingtai Medical College from March 2017 to January 2019 were selected as the research objects and randomly divided into two groups, the control group and the observation group, with 35 patients in each group. Patients in the control group were treated with DP regimen, and docetaxel was given on day 1 and 8 by intravenous infusion, 60 mg/m² and 250 mL 0.9% sodium chloride solution were fully mixed, once daily, on day 1 to 4, cisplatin was given intravenously, 30 mg/m², once daily. All patients were treated with 3-week chemotherapy cycle for 2 consecutive cycles. Patients in the observation group was treated with ositinib at 80 mg/d for 2 courses of continuous treatment on the basis of the control group, and the clinical efficacy and other indicators were evaluated. The short-term efficacy of the two groups was observed, and the levels of tumor markers such as carcinoembryonic antigen (CEA), vascular endothelial growth factor (VEGF), cytokeratinin-19 fragment (CYFRA21-1), serum hCAPI8 and Pokemon expression, long-term survival and the occurrence of adverse reactions were compared between two groups before and after treatment. Results After treatment, the ORR and DCR of the observation group were 62.9% and 85.7%, respectively, and the ORR and DCR of the control group were 28.6% and 60.0%, respectively. The ORR and DCR of the observation group were significantly higher than those of the control group (P < 0.05). After treatment, the levels of CEA, VEGF and CYFRA21-1 in two groups were significantly decreased compared with those before treatment (P < 0.05). After treatment, the levels of CEA, VEGF and CYFRA21-1 in the observation group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of serum hCAP18 and Pokemon in two groups were significantly decreased (P < 0.05). After treatment, the levels of hCAP18 and Pokemon in the observation group decreased more significantly (P < 0.05). After treatment, the levels of serum hCAP18 and Pokemon in two groups were significantly decreased (P < 0.05). After treatment, the levels of hCAP18 and Pokemon in the observation group decreased significantly (P < 0.05). The survival rate of observation group was significantly higher than that of control group (P < 0.05). Conclusions Osimertinib combined with DP regimen can effectively reduce the levels of CEA, VEGF and CYFRA21-1 in patients with advanced non-small cell lung cancer, effectively improve the patient's short-term efficacy and long-term survival, and the treatment process is safe and effective value.

R974

河北省邢台市科技计划项目（2019ZC277）