苏为华 郑浪

【摘要】 目的：分析表皮生長因子受体（epidermal growth factor receptor，EGFR）阳性Ⅲ、Ⅳ期老年局部鼻咽癌患者应用尼妥珠单抗配合同步放化疗的效果及对血清正五聚蛋白3（pentraxin 3，PTX3）、转移相关蛋白1（metastasis associated protein 1，MTA1）水平的影响。方法：将2014年1月-2017年8月本院收治的80例EGFR阳性Ⅲ、Ⅳ期老年局部晚期鼻咽癌患者采用随机数字表法分为观察组（n=40）和对照组（n=40）。对照组采用顺铂同步放化疗，观察组采用尼妥珠单抗配合同步放化疗，比较两组血清PTX3、MTA1水平、治疗总有效率、不良反应。结果：放疗前，两组血清PTX3、MTA1水平比较，差异均无统计学意义（P>0.05）;放疗3个月后，两组血清PTX3、MTA1水平均低于放疗前，且观察组均显著低于对照组，差异均有统计学意义（P<0.05）。观察组治疗总有效率为65.00%，显著高于对照组的42.50%（P<0.05）。两组0～2、3～4级血红蛋白下降、恶心呕吐、黏膜反应、食欲下降发生率比较，差异均无统计学意义（P>0.05）。结论：应用尼妥珠单抗配合同步放化疗具有降低EGFR阳性Ⅲ、Ⅳ期老年局部鼻咽癌患者血清PTX3、MTA1表达水平，治疗效果较好及不良反应未加重的优势，可在临床上进一步推广。

【关键词】 鼻咽癌 尼妥珠单抗 化学疗法 放射疗法

Curative Effect of Nimotuzumab Combined with Concurrent Chemoradiotherapy on Patients with EGFR Positive Locally Advanced Nasopharyngeal Carcinoma at Stage Ⅲ and Ⅳ and Its Influence on PTX3 and MTA1/SU Weihua， ZHENG Lang. //Medical Innovation of China， 2021， 18（28）： 0-048

[Abstract] Objective： To analyze the curative effect of Nimotuzumab combined with concurrent chemoradiotherapy on patients with EGFR positive locally advanced nasopharyngeal carcinoma at stage Ⅲ and Ⅳ， and the influence on serum pentraxin 3 （PTX3） and metastasis associated protein 1 （MTA1） levels. Method： Eighty elderly patients with EGFR positive locally advanced nasopharyngeal carcinoma at stage Ⅲ and Ⅳ were selected between January 2014 and August 2017， and divided into observation group and control group using random number table method with 40 patients in each group. The control group was treated with Cisplatin concurrent chemoradiotherapy， while the observation group was treated with Nimotuzumab combined with concurrent chemoradiotherapy. Serum levels of PTX3 and MTA1， overall response rate and adverse reactions were compared between two groups. Result： Before radiotherapy， there were no statistically significant differences in serum PTX3 and MTA1 levels between two groups （P>0.05）. After 3 months of radiotherapy， the serum PTX3 and MTA1 levels in two groups were lower than those before radiotherapy， and the observation group were significantly lower than those in control group （P<0.05）. The overall response rate in the observation group was 65.00%， which was significantly higher than 42.50% in the control group （P<0.05）. There were no statistically significant differences in the incidences of grade 0-2 and grade 3-4 hemoglobin decline， nausea and vomiting， mucosal reactions， and loss of appetite between two groups （P>0.05）. Conclusion： Nimotuzumab combined with concurrent chemoradiotherapy can reduce the expression levels of PTX3 and MTA1 in patients with EGFR positive locally advanced nasopharyngeal carcinoma at stage Ⅲ and Ⅳ， with good therapeutic effect and without aggravation of adverse reactions.

[Key words] Nasopharyngeal carcinoma Nimotuzumab Chemotherapy Radiotherapy

First-author’s address： Wuyi Hospital of Traditional Chinese Medicine， Jiangmen 529000， China

doi：10.3969/j.issn.1674-4985.2021.28.011

鼻咽癌作为头颈部发病率较高的恶性肿瘤之一，该疾病的主要临床症状表现为头痛、听力下降、复视、涕中带血、鼻塞等[1]。发病比较隐匿，在发病初期大多数症状由于不具任何的特异性，因此许多患者在确诊后病情已发展至中晚期[2]。鼻咽癌发病原因较多，临床研究表明发病原因多为病毒感染、易感基因、地域因素、种族因素及家庭聚集因素所致[3]。目前针对鼻咽癌的治疗，临床上通常采用放化疗，但因该手段不能完全控制病灶转移和肿瘤的发展，仅对早期患者可取得一定效果，而对中晚期鼻咽癌患者效果不佳[4]。……