目的 探究改良多柔比星脂質(zhì)體TAC方案治療HER2陰性乳腺癌的臨床效果。方法 選取2019年1月—2020年1月新鄉(xiāng)市中心醫(yī)院收治的98例HER2陰性乳腺癌患者進行前瞻性研究。隨機分為對照組和治療組，每組各49例。對照組患者采用TAC方案治療，第1天靜脈滴注注射用鹽酸多柔比星，50 mg/m²；多西他賽注射液，75 mg/m²；注射用環(huán)磷酰胺，500 mg/m²。治療組患者采用改良多柔比星脂質(zhì)體TAC方案，第1天靜脈滴注鹽酸多柔比星脂質(zhì)體注射液，30 mg/m²；多西他賽注射液，75 mg/m²；注射用環(huán)磷酰胺，500 mg/m²。21 d為1個周期，兩組均治療6個周期。觀察兩組患者臨床療效，比較治療前后兩組患者腫瘤標志物糖類抗原19-9（CA19-9）、癌胚抗原（CEA）和糖類抗原15-3（CA15-3）水平，左室射血分數(shù)（LVEF）水平，心肌酶譜心肌肌鈣蛋白I（cTnI）、肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）水平，血清胸苷激酶1（TK1）、組織多肽特異性抗原（TPS）和微小核糖核酸-132（miR-132）水平，生活質(zhì)量核心量表（QLQ-C30）評分及不良反應情況。結(jié)果 治療后，治療組疾病控制率（85.71%）較對照組（67.35%）明顯升高（P＜0.05）。治療后，兩組患者血清CA19-9、CEA、CA15-3水平均較治療前顯著降低（P＜0.05），且治療組較對照組降低更明顯（P＜0.05）。治療后，兩組LVEF水平較治療前降低，而cTnI、CK、CK-MB較治療前顯著升高（P＜0.05），但治療組LVEF較對照組更高，cTnI、CK、CK-MB較對照組更低（P＜0.05）。治療后，兩組血清TK1、TPS水平均較治療前明顯下降，而miR-132明顯升高（P＜0.05）；且治療組血清TK1、TPS和miR-132水平明顯好于對照組高（P＜0.05）。治療后，兩組患者QLQ-C30評分均較治療前降低（P＜0.05），且治療組較對照組更低（P＜0.05）。治療后，治療組脫發(fā)發(fā)生率較對照組明顯降低（P＜0.05）。結(jié)論 相較于TAC方案，采用改良多柔比星脂質(zhì)體TAC方案治療HER2陰性乳腺癌效果更為顯著，可有效調(diào)節(jié)血清TK1、TPS、miR-132水平，降低腫瘤標志物水平，減輕心肌損傷，提高生活質(zhì)量，安全性更高。

Objective To explore the clinical effect of modified doxorubicin liposome TAC regimen in treatment of HER2-negative breast cancer. Methods Patients (98 cases) with HER2-negative breast cancer in Xinxiang Central Hospital from January 2019 to January 2020 were randomly divided into control and treatment group, and each had 49 cases. Patients in the control group were treated with TAC regimen for the first day, they were iv administered with 50 mg/m² of Doxorubicin Hydrochloride for injection, and 75 mg/m² of Docetaxel Injection, 500 mg/m² of Doxorubicin Hydrochloride for injection. Patients in the treatment group were treated with modified doxorubicin liposome TAC regimen for the first day, they were iv administered with 30 mg/m² of Doxorubicin Hydrochloride Liposome Injection, and 75 mg/m² of Docetaxel Injection, 500 mg/m² of Doxorubicin Hydrochloride for injection. 21 days was a cycle, and the two groups were treated for 6 cycles. After treatment, the clinical evaluation was evaluated, the levels of tumor marker levels CA19-9, CEA and CA15-3, LVEF levels, the levels of myocardial enzyme spectrum cTnI, CK and CK-MB, the levels of serum TK1, TPS and miR-132, QLQ-C30 scores, and adverse reactions in two groups before and after treatment were compared. Results After treatment, the disease control rate in the treatment group (85.71%) was significantly higher than that in the control group (67.35%) (P < 0.05). After treatment, the serum levels of CA19-9, CEA and CA15-3 in the two groups were significantly lower than those before treatment (P < 0.05), and the reduction in the treatment group was more obvious than that in the control group (P < 0.05). After treatment, the levels of LVEF in the two groups were lower than those before treatment, while the levels of cTnI, CK and CK-MB were significantly higher than those before treatment (P < 0.05), but the levels of LVEF in the treatment group were higher than those in the control group, and the levels of cTnI, CK and CK-MB were lower than those in the control group (P < 0.05). After treatment, the serum TK1 and TPS levels of the two groups were significantly decreased compared with those before treatment, while Mir-132 was significantly increased (P < 0.05). The serum levels of TK1, TPS and Mir-132 in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, the QLQ-C30 scores of the two groups were lower than those before treatment (P < 0.05), and the QLQ-C30 scores of the treatment group were lower than those of the control group (P < 0.05). After treatment, the incidence of hair loss in the treatment group was significantly lower than that in the control group (P < 0.05). Conclusion Compared with TAC regimen, modified doxorubicin liposome TAC regimen is more effective in the treatment of HER2 negative breast cancer, which can effectively regulate the levels of serum TK1, TPS and miR-132, reduce the level of tumor markers, reduce myocardial injury, improve the quality of life, and have higher safety.

R979.1

河南省醫(yī)學科技攻關(guān)計劃聯(lián)合共建項目(LHGJ20190806)