经皮125I植入联合化疗在中晚期非小细胞肺癌治疗中的应用及对CD3+、CD4+、CD8+、CD4+/CD8+的影响

Application of percutaneous radioactive iodine 125 particle implantation combined with chemotherapy in treatment of advanced non-small cell lung cancer and its effects on CD3+, CD4+, CD8+, and CD4+/CD8+

摘要:

目的 探讨经皮放射性碘125粒子（¹²⁵I）植入联合化疗在中晚期非小细胞肺癌（NSCLC）治疗中的应用及对CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺的影响。方法 选取2017年1月-2019年1月咸阳市中心医院收治的120例中晚期NSCLC患者，根据治疗方案分为研究组78例（经皮¹²⁵I植入联合化疗）和对照组42例（同步放化疗）。统计两组基线资料，并记录粒子植入情况及并发症情况，治疗6个月后评估两组临床疗效。比较两组外周血T淋巴细胞亚群CD3⁺、CD4⁺、CD8⁺占比及CD4⁺/CD8⁺治疗前后的变化。统计治疗期间不良反应发生情况。结果 两组性别、年龄、病灶部位、肿瘤直径、病理类型、临床分期及治疗前卡氏评分比较，差异无统计学意义（P >0.05）。研究组91.03%（71/78）患者植入粒子的分布符合术前模拟剂量分布；术后气胸30.77%（24/78），肺内渗血28.21%（22/78），发热19.23%（15/78），粒子移位2.56%（2/78），围术期均无死亡病例。两组临床疗效比较，差异有统计学意义（P <0.05），研究组有效率高于对照组。两组治疗后外周血CD3⁺、CD4⁺、CD4⁺/CD8⁺及治疗前后的差值比较，差异有统计学意义（P <0.05），研究组高于对照组；两组治疗后外周血CD8⁺及治疗前后的差值比较，差异无统计学意义（P >0.05）。两组不良反应（胃肠道反应、粒细胞减少及放射性食管炎发生率）比较，差异无统计学意义（P >0.05）；两组放射性肺炎发生率比较，差异有统计学意义（P <0.05），研究组低于对照组。结论 经皮¹²⁵I植入联合化疗可有效治疗中晚期NSCLC，可明显改善患者免疫功能，减少不良反应。

Abstract:

Objective To investigate the application of percutaneous radioactive iodine 125 particles (¹²⁵I) implantation combined with chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) and its effects on CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺.Methods A total of 120 patients with advanced NSCLC were selected from January 2017 to January 2019. According to the treatment plan, the patients were divided into two groups: research group (78 cases, transcutaneous ¹²⁵I implantation combined chemotherapy) and control group (42 cases, concurrent radiotherapy and chemotherapy). The baseline data of the two groups were collected, and the ion implantation and complications of the combined chemotherapy group were recorded. The changes of CD3⁺, CD4⁺, CD8⁺ ratio and CD4⁺/CD8⁺ in peripheral blood lymphocyte subsets before and after treatment of the two groups were compared, and the adverse reactions during the treatment were counted.Results There were no significant differences between the two groups in gender composition, age, location of focus composition, tumor diameter, pathological type composition, clinical stage composition, and pre-treatment score (P > 0.05). 91.03% of the patients in the research group were in accordance with the simulated dose distribution before operation, and there were 30.77% pneumothorax, 28.21% intrapulmonary hemorrhage, 19.23% fever, 2.56% particle displacement and no death in the perioperative period. There was statistically significant difference in clinical efficacy grades between the two groups (P < 0.05). The effective rate of the combination group was higher than that of the chemotherapy alone group (P < 0.05). The CD3⁺ ratio, CD4⁺ ratio and CD4⁺/CD8⁺ in peripheral blood after treatment and difference before and after treatment of the research group were higher than those of the control group (P < 0.05). There was no significant difference in the CD8⁺ ratio in peripheral blood after treatment and difference before and after treatment between the two groups (P > 0.05). There were no significant differences in the rates of gastrointestinal reaction, granulocytopenia, and radiation esophagitis between the two groups (P > 0.05). The rate of radiation pneumonia in the study group was lower than that in the control group (P < 0.05).Conclusion Percutaneous ¹²⁵I implantation combined with chemotherapy can effectively treat advanced NSCLC, which can significantly improve the immune function of patients and reduce adverse reactions