目的 探讨注射用紫杉醇(白蛋白结合型)联合卡铂与靶向药物曲妥珠单抗治疗人表皮生长因子受体-2(HER-2)阳性乳腺癌患者的效果,以及对患者抑癌基因和免疫功能的影响。方法 选取邢台市第三医院于 2018年1月-2019年1月收治的 124 例 HER-2 阳性乳腺癌患者,随机分为对照组和试验组,每组 62 例。对照组患者接受紫杉醇注射液、卡铂联合曲妥珠单抗治疗,试验组接受注射用紫杉醇(白蛋白结合型)、卡铂联合曲妥珠单抗治疗,共治疗 6 个周期,随访 12~40 个月。比较两组患者治疗后的临床疗效、生存率、中位生存期、不良反应情况,以及 T 淋巴细胞亚群、抑癌基因变化情况。结果 试验组完全缓解(CR)率显著高于对照组(41.94% vs 19.35%,P<0.05)。治疗后,两组患者的CD³⁺、CD⁴⁺表达水平明显增加,而 CD⁸⁺表达水平无明显变化,其中试验组治疗后的 CD³⁺、CD⁴⁺表达水平高于对照组(P<0.05)。治疗后两组患者病灶内抑癌基因 Bax、ARID1A、FasL、Caspase-3、PTEN mRNA 表达量均明显高于同组治疗前(P<0.05);治疗后试验组患者病灶内 Bax、ARID1A、FasL、Caspase-3、PTEN mRNA 表达量均明显高于对照组(P<0.05)。试验组生存率显著高于对照组(45.16% vs 27.42%,P<0.05),中位生存期长于对照组(33.25 个月 vs 22.85 个月,P<0.05)。两组各不良反应分级发生情况无统计学意义(P>0.05)。结论 注射用紫杉醇(白蛋白结合型)联合卡铂与靶向药物曲妥珠单抗治疗 HER-2 阳性乳腺癌的疗效显著,可改善患者免疫功能,上调抑癌基因表达,提高生存率,利于预后。

Objective To explore the effect of Paclitaxel for Injection (albumin binding type) combined with carboplatin and trastuzumab on treatment of human epidermal growth factor receptor-2 (HER-2) positive breast cancer patients and its effect on tumor suppressor genes and immune function. Methods A total of 124 patients with HER-2 positive breast cancer admitted to Xingtai Third Hospital from January 2018 to January 2019 were randomly divided into control group and experimental group, 62 cases in each group. Patients in control group were treated with Paclitaxel for Injection + carboplatin combined with trastuzumab, and patients in experimental group were treated with Paclitaxel for Injection (albumin binding type) and carboplatin combined with trastuzumab. Both groups were treated for 6 cycles and followed up for 12 to 40 months. The clinical efficacy, survival rate, median survival, adverse reactions, T lymphocyte subsets and tumor suppressor genes were compared between two groups. Results The complete remission (CR) rate of experimental group was higher than that of control group (41.94% vs 19.35%, P<0.05). After treatment, the expression levels of CD³⁺ and CD⁴⁺ in two groups were significantly increased, while the expression level of CD⁸⁺ had no significant change. The expression levels of CD³⁺ and CD⁴⁺ in experimental group after treatment were higher than those in control group (P<0.05). After treatment, the expression of tumor suppressor genes Bax, ARID1A, FasL, Caspase-3 and PTEN mRNA in the lesions of the two groups were significantly higher than that before treatment (P<0.05). The mRNA expressions of Bax, ARID1A, FasL, Caspase-3 and PTEN in lesions of experimental group were significantly higher than those of control group (P<0.05). The survival rate of the experimental group was higher than that of the control group (45.16% vs 27.42%, P<0.05), and the median survival time was longer than that of the control group (33.25 months vs 22.85 months, P<0.05). There were no statistical significance in the occurrence of each adverse reaction grade between two groups (P > 0.05). Conclusion Paclitaxel for Injection (albumin binding type) combined with carboplatin and targeted drugs-trastuzumab has a significant curative effect in treatment of HER-2 positive breast cancer, which can improve the immune function of patients and up-regulate tumor suppressor genes, thereby improving survival rate and benefiting prognosis.

R979.1

邢台市重点研发计划项目(2020ZC383)