作者：周立莉，葛新国，胥荣，刘清菁，蔡茂怀

单位：盐城市第二人民医院 肿瘤内科，江苏 盐城 224000

Authors: Zhou Lili，Ge Xinguo，Xu Rong，Liu Qingjing，Cai Maohuai

Unit: Department of Oncology, Yancheng Second People's Hospital, Yancheng 224000, Jiangsu, China

摘要：

目的 探讨程序性死亡受体-1(PD-1)抑制剂对微卫星稳定型结直肠癌患者的治疗效果。方法 选择盐城市第二人民医院2019年1月至2020年1月接诊的经标准治疗后失败的微卫星稳定型结直肠癌患者30例的病历资料进行回顾性分析。依据患者的治疗用药差异分为对照组(n=15)和观察组(n=15)。对照组给予贝伐珠单抗，观察组在对照组用药基础上使用PD-1抑制剂。对比两组的近期治疗效果、治疗前后的血清VEGF、TGF-β水平。对比两组治疗前后T淋巴细胞亚群情况(CD4+、CD8+、CD4+/CD8+)。对比两组患者在治疗期间的不良反应。结果 在用药后6个月的时间点，观察组的治疗效果好于对照组(P>0.05)。经过治疗后，两组患者的VEGF、TGF-β、CD8+均降低，CD4+、CD4+/CD8+均增高(P<0.05)。在治疗后，观察组患者的VEGF、TGF-β、CD8+T细胞水平均低于对照组，观察组患者的CD4+T细胞水平、CD4+/CD8+均大于对照组(P<0.05)。两组患者在治疗期间的不良反应对比，数据差异无统计学意义(P>0.05)。结论 将PD-1抑制剂投入到微卫星稳定型结直肠癌患者的治疗过程中，有利于在近期提升患者的疗效，改善机体的免疫状态以及血管生成因子水平，PD-1抑制剂的使用具有良好的安全性。

关键词：微卫星稳定型结直肠癌；恶性肿瘤；免疫靶向治疗；贝伐珠单抗；程序性死亡受体-1

Abstract：

Objective To explore the therapeutic effect of programmed death receptor-1（PD-1）inhibitors on patients with microsatellite stable colorectal cancer . Method The medical records of 30 patients with microsatellite stable colorectal cancer who had failed standard treatment and were admitted to Yancheng Second People's Hospital from January 2019 to January 2020 were selected for retrospective analysis. The patients were divided into the control group（n=15）and the observation group（n=15）according to the differences in their treatment medications. The control group was given bevacizumab. The observation group used PD-1 inhibitors on the basis of the control group. Compare the short-term treatment effects of the two groups, and the serum VEGF and TGF -β levels before and after treatment. The T lymphocyte subsets（CD4 +, CD8 +, CD4 +/CD8 + ）before and after treatment were compared between the two groups. Compare the adverse reactions of the two groups of patients during treatment. Result At 6 months after the medication, the treatment effect of the observation group was better than that of the control group （P>0.05）. After treatment, VEGF, TGF-β, and CD8 + in the two groups were all decreased, and CD4 + , CD4 +/CD8 + were all increased（P<0.05）. After treatment, the VEGF, TGF-β, and CD8 + of the observation group were lower than those of the control group, and the CD4 + , CD4 + /CD8 + of the observation group were higher than those of the control group（P<0.05）. There was no statistically significant difference in the adverse reactions between the two groups of patients during the treatment period （P>0.05）. Conclusion Putting PD-1 inhibitors into the treatment of patients with microsatellite stable colorectal cancer will help improve the patient's curative effect in the near future, improve the body's immune status and the level of angiogenic factors. The use of PD-1 inhibitors has good safety .

Key Words: Microsatellite stable colorectal cancer；Malignant tumor；Immunotargeted therapy；Bevacizumab；Programmed cell death-1