目的 探討注射用培美曲塞二鈉聯(lián)合伽馬刀治療非小細(xì)胞肺癌腦轉(zhuǎn)移瘤的臨床療效。方法 選取2012年1月-2016年1月徐州礦務(wù)集團(tuán)總醫(yī)院收治的非小細(xì)胞肺癌的腦轉(zhuǎn)移瘤患者90例，將全部患者隨機(jī)分為對照組和治療組，每組各45例。對照組采用伽馬刀進(jìn)行治療，劑量是40%~60%等劑量線12~13 Gy，依據(jù)瘤體大小分1~2次做完，間隔3~5 d。治療組在對照組的基礎(chǔ)上靜脈滴注注射用培美曲塞二鈉，500 mg/m²（溶于生理鹽水），1次/21 d，治療3次。觀察兩組的臨床療效，比較兩組的血清中腫瘤標(biāo)志物癌胚抗原（CEA）、細(xì)胞角質(zhì)素片段抗原21-1（CYFRA21-1）水平。結(jié)果 治療后，對照組和治療組的有效率分別為64.44%、84.44%，腫瘤局部控制率分別為77.78%、93.33%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組CEA、CYFRA21-1水平均顯著下降，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療組這些觀察指標(biāo)明顯低于對照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 注射用培美曲塞二鈉聯(lián)合伽馬刀治療非小細(xì)胞肺癌腦轉(zhuǎn)移瘤具有較好的臨床療效，可降低CEA、CYFRA21-1水平，安全性較好，具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of Pemetrexed Disodium for injection combined with gamma knife in treatment of brain metastasis of non small cell lung cancer. Methods Patients (90 cases) with brain metastasis of non small cell lung cancer in General Hospital of Xuzhou Mineral Group Company from January 2012 to January 2016 were randomly divided into control and treatment groups, and each group had 45 cases. Patients in the control group were given gamma knife treatment. The doses ranged from 40% to 60%, and the dose line was set 12-13 Gy. Patients were treated for 1-2 times according to the size of the tumor with an interval of 3-5 d. Patients in the treatment group were iv administered with Pemetrexed Disodium for injection on the basis of the control group, 500 mg/m² (soluble in normal saline), once every 21 days, treated for 3 times. After treatment, the clinical efficacies were evaluated, and the levels of CEA and CYFRA21-1 in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 64.44% and 84.44%, respectively, and the local tumor control rates in the control and treatment groups were 77.78% and 93.33%, respectively, and there was difference between two groups (P<0.05). After treatment, the levels of CEA and CYFRA21-1 in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Pemetrexed Disodium for injection combined with gamma knife has clinical curative effect in treatment of brain metastasis of non small cell lung cancer, and can decrease CEA and CYFRA21-1 levels, with good safety and a certain clinical application value.