何江涛　王伟

[摘要]目的 探讨曲妥珠单抗联合吉西他滨或卡培他滨一线治疗HER-2阳性晚期乳腺癌的临床效果。方法 分析我院2012年8月～2016年8月收治的65例HER-2阳性晚期乳腺癌患者的临床资料，依据治疗方式不同分为曲妥珠单抗联合吉西他滨治疗组（30例）和曲妥珠单抗联合卡培他滨治疗组（35例）。观察两组不同转移部位的临床疗效及不良反应发生情况。结果 两组不同转移部位的总缓解率比较，差异无统计学意义（P>0.05）。两组的脱发、白细胞减少、血小板减少、血红蛋白降低、胃肠道反应、肝功能异常、肾功能异常、手足综合征、腹泻等不良反应发生率比较，差异无统计学意义（P>0.05）。结论 曲妥珠单抗联合吉西他滨或卡培他滨一线治疗HER-2阳性晚期乳腺癌的缓解率较高，不良反应可以耐受，值得临床推广应用。

[关键词]曲妥珠单抗；吉西他滨；卡培他滨；HER-2阳性；晚期乳腺癌

[中图分类号] R737.9 [文献标识码] A [文章编号] 1674-4721（2017）05（a）-0097-03

[Abstract]Objective To explore clinical effect of Trastuzumab combined with Gemcitabine or Capecitabine in the first-line treatment of HER-2 positive advanced breast cancer.Methods 65 cases clinical data of HER-2 positive advanced breast cancer patients in our hospital from August 2012 to August 2016 were analyzed，which waere divided into the Herceptin combined with GEM group （30 cases） and the Herceptin combined with capecitabine group （35 cases） by different treatment method.The clinical efficacy and adverse reactions were observed in the two groups.Results There was no significant difference between the two groups in the total remission rate of different metastatic sites （P>0.05）.There was no significant difference between the two groups in the incidence rate of adverse reactions，such as alopecia，leukopenia，thrombocytopenia，lower hemoglobin，gastrointestinal reaction，liver dysfunction，renal dysfunction，hand and foot syndrome and diarrhea （P>0.05）.Conclusion The remission rate of Trastuzumab combined with Gemcitabine or Capecitabine in the first-line treatment of HER-2 positive advanced breast cancer is higher，adverse reactions can be tolerated，it is worthy of clinical promotion and application.

[Key words]Trastuzumab；Gemcitabine；Capecitabine；HER-2 positive；Advanced breast cancer

乳腺癌为女性最常见的恶性肿瘤之一，其发生率居于各类恶性肿瘤总发生率第1位，全球每年有近140万女性乳腺癌患者，有40万患者死亡[1-2]。常规治疗手段包括手术、化疗、放疗等，虽然可以降低患者复发的风险[3-4]，但疾病一旦进展至晚期，基本上不可以治愈，且不同分子分型的乳腺癌具有不同的生物学特征。有资料显示，25%～30%的乳腺癌患者高度表达人表皮生长因子受体-2（HER-2），HER-2阳性表达患者恶性程度高，预后较差[5-6]。曲妥珠单抗、吉西他滨、卡培他滨是临床上常用的治疗HER-2阳性晚期乳腺癌患者的药物，其之间对比的研究相对较少[7-8]。本研……