目的 探讨沙利度胺联合甲地孕酮辅助治疗晚期乳腺癌对脂糖代谢及免疫功能的影响。方法 收集2013年10月—2017年10月，陕西省汉中市中心医院接受治疗的61例晚期乳腺癌患者，根据治疗方法不同，分为联合组（n=31）和对照组（n=30），对照组给予沙利度胺及常规化疗，联合组在对照组的基础上给予甲地孕酮治疗，均连续治疗3个月。比较两组临床疗效、治疗期间不良反应的发生率，分析两组治疗前后脂糖代谢功能及免疫指标水平变化。结果 联合组和对照组的客观缓解率（ORR）分别为54.84%和30.00%，联合组的ORR明显高于对照组，差异有统计学意义（P<0.05），但两组病情控制率（DCR）相比差异无统计学意义。与治疗前相比，治疗后两组IgG、IgA水平均明显下降，同组治疗前后比较差异有统计学意义（P<0.05），而联合组治疗后IgG、IgA水平均显著高于对照组，差异有统计学意义（P<0.05）。经过3个月的治疗后，联合组有9例（29.03%）出现糖代谢异常，4例（12.90%）诊断为2型糖尿病，糖代谢异常率为41.94%，明显低于对照组的66.67%（P<0.05）；治疗期间，两组均出现不同程度的胃肠道反应和骨髓抑制，其中联合组不良反应发生率明显低于对照组（P<0.05）。结论 甲地孕酮联合沙利度胺辅助治疗晚期乳腺癌，疗效显著，可减少不良反应及晚期乳腺癌患者糖代谢异常的发生，改善患者免疫功能。
Objective To investigate the effects of thalidomide combined with megestrol on lipid metabolism and immune function in patients with advanced breast cancer.Methods Selected 61 patients with advanced breast cancer were treated in Hanzhong Central Hospital of Shaanxi Province, from October 2013 to October 2017. All patients were divided into control group (n=30) and combined group (n=31) by treatment method. The control group was treated with thalidomide and conventional chemotherapy. The combined group was given megestrol on the basis of the control group. The clinical efficacy and the incidence of adverse reactions during the treatment between two groups were compared. To analyse the changes of Metabolic function and immune Indexes of Lipid and glucose in two groups.Results The ORR of the combined group and the control group were 54.84% and 30.00%. The ORR of the combined group was significantly higher than control group (P<0.05), but there was no significant difference in DCR between the two groups. After treatment, the level of IgG, IgA in both groups decreased significantly (P<0.05), while the level of IgG, IgA in the combined group was significantly higher than that in the control group (P<0.05). After 3 months of treatment, 9 patients in the combined group (29.03%) showed abnormal glucose metabolism, and 4 patients with type 2 diabetes mellitus, the abnormal rate of glucose metabolism was 41.94%, which was significantly lower than that in the control group (P<0.05). During the treatment period,gastrointestinal reaction and bone marrow suppression occurred on different degrees in both groups,and the incidence of adverse reactions in the combined group was significantly lower than that in the control group(P<0.05). Conclusions Megestrol acetate combined with thalidomide for advanced breast cancer,have a significant effect,and can reduce the incidence of adverse reactions in patients with advanced breast cancer and sugar metabolism,improve immune function of patients.