目的 观察阿帕替尼联合卡培他滨＋奥沙利铂（XELOX）化疗治疗中晚期结直肠癌患者的近期疗效。方法 选取2019年6月—2023年3月北京石景山医院和山西省肿瘤医院收治的76例中晚期结直肠癌患者，按1∶1原则将患者随机分为对照组和试验组，每组各38例。对照组采用XELOX化疗方案，试验组在XELOX化疗基础上同时口服甲磺酸阿帕替尼片，每次850 mg，每天1次，餐后服用，每3周为1个疗程，连续治疗至疾病进展，或无法耐受。对比两组近期疗效，比较两组治疗前后血管生成指标、肿瘤标志物、炎症指标、免疫功能指标等，比较两组治疗期间不良反应发生情况。结果 试验组在进行2个周期治疗后，近期疾病缓解率60.53%显著高于对照组的39.47%（P＜0.05）。治疗前，两组血管内皮生长因子（VEGF）、血管生成素（Ang）-1、Ang-2及白细胞介素（IL）-8、肿瘤坏死因子（TNF）-α、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、癌胚抗原（CEA）、糖类抗原19-9 （CA19-9）、糖类抗原125 （CA125）、CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、自然杀伤细胞（NK）等各项指标比较，差异均不显著（P＞0.05）。治疗2个周期后，两组Ang-1、Ang-2、VEGF、IL-8水平均较本组治疗前显著降低（P＜0.05），CEA、CA19-9、CA125水平均较本组治疗前显著降低（P＜0.05），TNF-α及NLR、PLR均较本组治疗前显著降低（P＜0.05）。治疗2个周期后，试验组的VEGF、Ang-1、Ang-2及IL-8水平均显著低于对照组（P＜0.05）； TNF-α、NLR、PLR水平均显著低于对照组（P＜0.05）；肿瘤标志物CEA、CA19-9、CA125水平显著低于对照组（P＜0.05）。治疗2个周期后，对照组CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、NK细胞较治疗前无显著变化（P ＞0.05），而试验组各项免疫功能指标较治疗前有所改善（P＜0.05），且试验组CD3⁺、CD3⁺CD4⁺、CD4⁺/CD8⁺、NK细胞均高于对照组（P＜0.05）。两组治疗期间的不良反应均可控，且3～4级不良反应发生率较低，两组骨髓抑制、胃肠道反应、肝肾功能异常、血液学毒性发生率比较，差异无统计学意义（P＞0.05）。结论 阿帕替尼联合XELOX化疗治疗中晚期结直肠癌患者的近期疗效较好，且能降低血管生成因子表达，在一定程度上改善患者免疫功能，值得临床关注。

Objective To observe the short-term efficacy of apatinib combined with capecitabine and oxaliplatin (XELOX) chemotherapy in the treatment of patients with advanced colorectal cancer. Method 76 patients with advanced colorectal cancer admitted to Beijing Luhe Hospital affiliated with Capital Medical University from June 2019 to March 2023 were randomly divided into a control group and an experimental group based on a 1∶ 1 ratio, with 38 cases in each group. The control group received XELOX chemotherapy regimen, while the experimental group received concurrent oral administration of Apatinib Mesylate Tablets at a dose of 850 mg per dose, once a day, after meals, for a course of treatment every three weeks until disease progression or intolerance. The recent therapeutic effects of two groups was compared, the angiogenesis indicators, tumor markers, inflammation indicators, immune function indicators were compared, before and after treatment. The incidence of adverse reactions during the treatment period between the two groups was compared. Results After two cycles of treatment, the recent disease remission rate of the experimental group was 60.53%, which was significantly higher than that of the control group (39.47%, P < 0.05). Before treatment, there were no significant differences in vascular endothelial growth factor (VEGF), angiopoietin (Ang) -1, Ang-2, interleukin (IL) -8, tumor necrosis factor (TNF) - α, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 125 (CA125), CD3⁺, CD3⁺CD4⁺, CD4⁺/CD8⁺, natural killer cell (NK) and other indicators between the two groups (P > 0.05). After two cycles of treatment, the levels of Ang-1, Ang-2, VEGF and IL-8 in the two groups were significantly lower than those before treatment (P < 0.05), the levels of CEA, CA19-9 and CA125 were significantly lower than those before treatment (P < 0.05), and TNF- α, NLR and PLR were significantly lower than those before treatment (P < 0.05). After two cycles of treatment, the levels of VEGF, Ang-1, Ang-2 and IL-8 in the experimental group were significantly lower than those in the control group (P < 0.05), the levels of TNF-α, NLR and PLR were significantly lower than those in the control group (P < 0.05), the levels of tumor markers CEA, CA19-9 and CA125 were significantly lower than those in the control group (P < 0.05). After two cycles of treatment, the levels of CD3⁺, CD3⁺ CD4⁺ CD4⁺ / CD8⁺, NK cells in the control group had no significant change compared with those before treatment (P > 0.05), while the immune function indexes in the experimental group were improved compared with those before treatment (P < 0.05), and the levels of CD3⁺ CD3⁺ CD4⁺ , CD4⁺ /CD8⁺ , NK cells in the experimental group were higher than those in the control group (P < 0.05). The adverse reactions in the two groups during treatment were controllable, and the incidence of grade 3—4 adverse reactions was low. There was no significant difference in the incidence of bone marrow suppression, gastrointestinal reactions, liver and kidney dysfunction, hematological toxicity between the two groups (P > 0.05). Conclusion Apatinib combined with XELOX chemotherapy has a good short-term effect in the treatment of advanced colorectal cancer patients, and can reduce the expression of angiogenic factors, improve the immune function of patients to a certain extent, which is worthy of clinical attention.

R979.1