王晓梅　王松芝　欧江华

[摘要] 目的 探讨曲妥珠单抗联合多西他赛、环磷酰胺化疗方案（TC）治疗人类表皮生长因子受体2（HER-2）过度表达乳腺癌的效果和安全性。 方法 选取2015年10月～2016年10月于新疆医科大学附属肿瘤医院就诊的79例乳腺癌患者作为研究对象，采用随机数字表法分为研究组与对照组，其中研究组38例，对照组41例。对照组患者在乳腺癌根治术前采用TC联合化疗，研究组在对照组基础上采用曲妥珠单抗治疗。治疗18周后，比较两组患者的治疗效果、不良反應发生率，比较两组治疗前后HER-2蛋白、B7同源体（B7-H1）及白细胞介素-2（IL-2）表达情况。 结果 治疗后研究组的总有效率显著高于对照组（P < 0.05）；治疗后两组HER-2过表达率均显著降低（P < 0.05），且研究组治疗后HER-2过表达率显著低于对照组（P < 0.05）；研究组治疗后B7-H1、IL-2阳性表达率均较治疗前显著降低（P < 0.05）；两组患者治疗后不良反应发生率差异无统计学意义（P > 0.05）。 结论 曲妥珠单抗联合TC方案可有效降低HER-2过度表达乳腺癌患者的HER-2蛋白、B7-H1和IL-2表达含量，提高临床治疗效果，且不会增加用药风险。

[关键词] 曲妥珠单抗；HER-2过度表达；乳腺癌

[中图分类号] R734 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0104-04

[Abstract] Objective To investigate the efficacy and safety of Trastuzumab combined with Docetaxel and Cyclophosphamide chemotherapy in the treatment of HER-2 overexpression breast cancer. Methods From October 2015 to October 2016， 79 cases of breast cancer patients in Cancer Hospital Affiliated to Xinjiang Medical University were selected. The patients were divided into the study group （38 cases） and the control group （41 cases） according to the random number table method. The control group was treated with TC combined chemotherapy before radical mastectomy. The study group was treated with Trastuzumab on the basis of control group. After 18 weeks of treatment， the curative effect and adverse reaction rate of the two groups were compared. The results of HER-2 protein， B7-H1 and IL-2 expression before and after treatment were compared. Results After treatment， the total effective rate （RR） of the study group was significantly higher than that of the control group （P < 0.05）. After treatment， HER-2 overexpression rates of the two groups were significantly reduced than before treatment （P < 0.05）， and the overexpression rate of the study group was significantly lower than that of the control group （P < 0.05）. The positive expression rates of B7-H1 and IL-2 in the study group after treatment were significantly lower than those before treatment （P < 0.05）. Adverse reactions occurred in both groups after treatment had no significant difference （P > 0.05）. Conclusion Trastuzumab combined with TC regimen in the treatment of patients with HER-2 overexpression breast cancer can effectively reduce the expression of HER-2 protein， B7-H1 and IL-2， improve the clinical curative effect， which can not increase the risk of medication.

[Key words] Trastuzumab； HER-2 overexpression； Breast cancer

在我国乳腺癌的发病率在近十几年总体呈现上升趋势，流行病学数据显示，全国城市地区女性乳腺癌每年新发病例约为15.8万，位居城市女性发病癌症之首[1]。因此，如何有针对性的治疗乳腺癌是临床工作中亟待解决的重要课题。有文献报道，20%～25%的乳腺癌患者呈表皮生长因子受体-2（human epidermal growth factor receptor 2，HER-2）的过度高表达状态，HER-2的表达与肿瘤的强侵袭性、高复发率和高死亡率有关[2]。多西他赛和环磷酰胺（Docetaxel and Cyclophosphamide，TC）联合化疗是以紫杉类为基础的化疗治疗方案，属于新辅助化疗的给药方案[4-5]，联合化疗方案多用于术前控制乳腺癌的发生发展，但对HER-2阳性的乳腺癌患者因耐药对化疗药物不敏感，导致治疗效果不理想。……