【摘要】 目的 探究信迪利单抗联用仑伐替尼对晚期肝癌患者细胞免疫和血清AFP、CA199、NLR及生存预后的影响。方法 收集2019年12月至2022年12月濉溪县医院42例接受仑伐替尼治疗晚期肝癌患者的临床资料，并纳入单药组，及同期48例接受信迪利单抗联用仑伐替尼治疗的患者的临床资料，纳入联用组。比较治疗后的近远期疗效差异；比较治疗前及治疗6个月后细胞免疫功能[自然杀伤（NK）细胞、CD4+、CD8+、CD4+/CD8+]、血清指标[甲胎蛋白（AFP）、糖类抗原199(CA199)、中性粒细胞/淋巴细胞比值（NLR）]、肝功能指标差异；记录患者不良反应发生率。结果 治疗后6个月时，联用组患者的疾病控制率显著高于单药组，差异有统计学意义（P<0.05）；组间客观缓解率差异无统计学意义（P>0.05）；随访1年，联用组患者的生存率（60.42%）显著高于单药组（38.10%），差异有统计学意义（P<0.05），联用组的无进展生存期、总生存时间显著长于单药组，差异有统计学意义（P<0.05）；治疗6个月后，两组NK细胞、CD4+、CD4+/CD8+水平均高于治疗前，且联用组高于单药组，差异有统计学意义（P<0.05），患者CD8+水平均低于治疗前，且联用组低于单药组，差异有统计学意义（P<0.05）；两组AFP、CA199、NLR水平均低于治疗前，且联用组低于单药组，差异有统计学意义（P<0.05）；治疗后，两组肝功能指标均降低，且联用组高于单药组，差异有统计学意义（P<0.05）；组间不良反应发生率差异无统计学意义，差异无统计学意义（P>0.05）。结论 在晚期肝癌患者中，仑伐替尼联用信迪利单抗比单用仑伐替尼能够获得更优的近远期疗效，改善细胞免疫功能和降低血清肿瘤标志物水平的作用更为明显。更多还原

【Abstract】 Objective To explore the influence of sintilimab combined with lenvatinib on cellular immunity, serum AFP, CA199, NLR and survival prognosis in patients with advanced liver cancer. Methods The clinical data of 42 patients with advanced liver cancer who were treated with lenvatinib from December 2019 to December 2022 were retrospectively collected. These patients were included in the single drug group, and the clinical data of 48 patients who received sintilimab combined with lenvatinib were analyzed during the same period and the patients were enrolled as the combination group. The short-term efficacy, long-term efficacy after treatment, cellular immune function(natural killer(NK) cells, CD4+, CD8+, CD4+/CD8+), serum indicators(alpha-fetoprotein(AFP), carbohydrate antigen 199(CA199), neutrophil/lymphocyte ratio(NLR) and liver function indicators before treatment and after 6 months of treatment were compared. The incidence rates of adverse reactions were also recorded. Results At six months after treatment, the disease control rate in the combination group was significantly higher than that in the single drug group(P<0.05), but there was no statistical significance in the objective remission rate between groups(P>0.05). After one year of followup, the survival rate in the combination group(60.42%) was significantly higher than that in the single-drug group(38.10%)(P<0.05), and the progression-free survival and overall survival were significantly longer than those in the single-drug group(P<0.05). The levels of NK cells, CD4+, and CD4+/CD8+ in the two groups were higher after 6 months of treatment than before treatment, and the levels in the combination group were higher than those in the single-drug group(P<0.05). The level of CD8+ in the two groups was lower than before treatment, and the level in the combination group was lower(P<0.05). The levels of AFP, CA199, and NLR in the two groups were lower than before treatment, and the levels were lower in the combination group(P<0.05). After treatment, the liver function indicators decreased in both groups, and the indicators in the combination group were higher than those in the single-drug group(P<0.05). There were no statistical differences in the incidence rates of adverse reactions between the groups(P>0.05). Conclusion For patients with advanced liver cancer, the application of sintilimab combined with lenvatinib can achieve better short-term and long-term efficacy than lenvatinib alone. Assitionally, this combination has a more pronounced effect on improving cellular immune function and reducing serum tumor markers.更多还原