王清睿

【摘要】 目的：探討立体定向放疗（stereotactic body radiation therapy，SBRT）治疗早期非小细胞肺癌（non-small cell lung cancer，NSCLC）的效果及对患者血清中E-selectin和炎症因子的影响。方法：选取2016年5月-2018年11月于本院行根治性肺叶切除术或SBRT治疗的80例早期NSCLC患者，根据治疗方法的不同将其分成两组，每组40例。于术前及术后7 d测定外周血中E-selectin和IL-6、IL-8、CRP、PGE2等炎症因子含量，比较两组手术前后E-selectin、炎症因子水平及生存情况。结果：术后7 d，两组IL-6、IL-8、CRP、PGE2水平均较术前升高，且手术组上述指标均高于SBRT组，差异均有统计学意义（P<0.05）。术后7 d，两组E-selectin水平均较术前降低，差异均有统计学意义（P<0.05）。术后7 d，两组E-selectin水平比较，差异无统计学意义（P>0.05）。SBRT组的1、3、5年生存率分别为92.5%、86.7%、72.7%，与手术组的90.0%、85.3%、70.8%比较，差异均无统计学意义（P>0.05）。SBRT组并发症发生率低于手术组，差异有统计学意义（P<0.05）。结论：与胸腔镜肺癌根治术相比，SBRT对机体的创伤较小，并发症少，可以明显降低机体的急性炎症反应，且不影响患者的远期疗效。

【关键词】 早期非小细胞肺癌 胸腔镜 SBRT 炎症因子

Effects of Stereotactic Radiotherapy in the Treatment of Early Non-small Cell Lung Cancer and Its Effects on E-selectin and Inflammatory Cytokines/WANG Qingrui. //Medical Innovation of China， 2021， 18（30）： 0-046

[Abstract] Objective： To study on stereotactic body radiation therapy （SBRT） in the treatment of early non-small cell lung cancer （NSCLC） and its effect on serum E-selectin and inflammatory cytokines in patients. Method： A total of 80 patients with early NSCLC who underwent radical lobotomy or SBRT treatment in our hospital from May 2016 to November 2018 were selected， according to different treatment methods， they were divided into two groups， 40 cases in each group. The levels of E-selectin and inflammatory factors such as IL-6， IL-8， CRP and PGE2 in peripheral blood were determined before and 7 d after surgery， the levels of E-selectin and inflammatory factors and survival situation were compared between the two groups before and after surgery. Result： 7 d after surgery， the levels of IL-6， IL-8， CRP and PGE2 in both groups were increased compared with those before surgery， and the above indexes in surgery group were higher than those in SBRT group， the differences were statistically significant （P<0.05）. 7 d after surgery， the level of E-selectin in both groups were lower than those before surgery， the differences were statistically significant （P<0.05）. There was no significant difference in the level of E-selectin between two groups at 7 d after surgery （P>0.05）. The 1-year， 3-year and 5-year survival rates of SBRT group were 92.5%， 86.7% and 72.7%， respectively， compared with 90.0%， 85.3% and 70.8% of surgery group， and there were no statistical significance （P>0.05）. The incidence of complications in the SBRT group was lower than that in the surgery group， the difference was statistically significant （P<0.05）. Conclusion： Compared with thoracoscopic radical resection of lung cancer， SBRT has less trauma and fewer complications， can significantly reduce the acute inflammatory response of the body， and does not affect the long-term efficacy of patients.

[Key words] Early non-small cell lung cancer Thoracoscope SBRT Inflammatory cytokines

First-authors address： The Sixth Hospital of Wuhan， Wuhan 430015， China

doi：10.3969/j.issn.1674-4985.2021.30.010

肺癌是全世界最常见的恶性肿瘤之一，调查显示，2015年我国肺癌的发病率约35/10万，全年发病人数达73万，死亡率为28/10万[1-2]。由于肺癌的早期症状不具特异性，及我国肺癌的常规筛查未全面普及，绝大多数患者发现时分期较晚，就诊时已属中晚期，5年生存率仅为16.1%，预后较差[3-4]。非小细胞肺癌（non-small cell lung cancer，NSCLC）占所有肺癌的80%左右，其中15%～20%的病例为早期肺癌，对于早期NSCLC，肺叶切除联合肺门、纵隔淋巴结清扫是标准治疗方式[5-7]。传统情况大多采用创伤较大的开胸手术，术后患者应激反应较强，外周血中炎症因子升高，不同程度地对术后治疗效果产生影响。近年来，立体定向放疗（stereotactic body radiation therapy，SBRT）有着创伤小、并发症少以及患者恢复速度快等优点，在早期NSCLC的治疗中得到了广泛应用，但其和胸腔镜肺癌根治术的疗效对比及对全身炎症反应的影响目前仍存在较大的争议[8-10]。因此……