【摘要】 目的 观察阿替利珠单抗联合靶向药物和肝动脉化疗栓塞(TACE)术治疗中晚期原发性肝癌(PLC)患者的疗效。方法 2017年3月～2021年3月我院收治的中晚期PLC患者126例，被随机分为观察组63例和对照组63例，分别给予TACE术联合磺酸阿帕替尼、或甲苯磺酸索拉菲尼和贝伐珠单抗注射液治疗或在此基础上联合阿替利珠单抗注射液治疗。随访2年，评估客观缓解率(ORR)和疾病控制率(DCR)。使用流式细胞仪检测外周血T淋巴细胞亚群，采用ELISA法检测血清癌胚抗原(CEA)、甲胎蛋白(AFP)和组织多肽抗原(TPA)水平。结果 观察组ORR和DCR分别为60.3%和87.3%,均显著高于对照组的41.3%和71.4%(P<0.05);治疗后，观察组外周血CD4~+细胞百分比和CD4~+/CD8~+细胞比值分别为(38.4±4.3)%和(1.3±0.2),均显著高于对照组【分别为(33.6±3.8)%和(1.1±0.2),P<0.05】;观察组血清AFP和TPA水平分别为(92.6±25.8)ng/mL和(308.2±50.9)U/L,均显著低于对照组【分别为(177.6±41.3)ng/mL和(359.7±56.3,P<0.05】;两组2 a生存率分别为66.1%(41/62)和45.0%(27/60),差异显著(x~2=5.518,P=0.019)。结论 在TACE术后采用阿替利珠单抗联合靶向药物治疗中晚期PLC患者能够提高生存期，可能与改善了免疫功能有关，需要扩大临床验证。更多还原

【Abstract】 Objective The aim of this study was to investigate therapeutic efficacy of attilizumab and targeting and immune checkpoint inhibitor（ICPI） combination after transhepatic arterial chemoembolization（TACE） in the treatment of patients with advanced primary liver cancer（aPLC）. Methods 126 patients with aPLC were recruited in our hospital between March 2017 and March 2021, and were randomly divided into observation and control group, with 63 cases in each group. TACE was routinely conducted in the two groups, patients in the control group were given apatinib, or sorafenib, and bevaccinium monoantibody therapy, and those in the observation group were treated with attilizumab at base of regimen in the control. All patients were followed-up for two years, and objective response rate（ORR） and disease control rate（DCR） 3 months after treatment were recorded. Peripheral blood T lymphocyte subsets were detected by flow cytometry and serum carcino-embryonic antigen（CEA）, alpha-fetoprotein（AFP） and tissue polypeptide antigen（TPA） levels were assayed by ELISA. Results ORR and DCR in the observation group were 60.3% and 87.3%, significantly higher than 41.3% and 71.4%（P<0.05） in the control; after treatment, percentage of peripheral blood CD4⁺ cells and ratio of CD4⁺/CD8 ⁺ cells in the observation group were（38.4±4.3）% and（1.3±0.2）, both significantly higher than [（33.6±3.8）% and（1.1±0.2）, respectively, P<0.05] in the control group; serum AFP and TPA levels were（92.6±25.8）ng/mL and（308.2±50.9）U/L, both much lower than [（177.6±41.3）ng/mL and(359.7±56.3, respectively, P<0.05] in the control; 2-year survival rate in the observation group was 66.1%（41/62）, much higher than 45.0%（27/60, x²=5.518, P=0.019） in the control group. Conclusion Combination of attillizumab, and target and ICPI therapy after TACE in the treatment of patients with aPLC is efficacious, which could prolong survivals, and might be related to the improvement of immune functions.更多还原