目的 探討脾多肽注射液聯(lián)合阿帕替尼治療晚期胃癌的臨床療效。方法 選取阜陽(yáng)市第二人民醫(yī)院2017年1月-2019年1月收治的晚期胃癌患者80例為研究對(duì)象，利用隨機(jī)數(shù)字表法將患者分成對(duì)照組和觀察組，每組各40例。對(duì)照組口服甲磺酸阿帕替尼片，500 mg/次，1次/d，治療過(guò)程中若出現(xiàn)不良反應(yīng)，則根據(jù)受試者耐受情況減量或暫停服用。觀察組在對(duì)照組基礎(chǔ)上靜脈滴注脾多肽注射液，每次將10 mL脾多肽注射液加入500 mL 5%葡萄糖液中充分稀釋后給藥，1次/d，連用1周后停藥3周。兩組均以4周為1個(gè)療程，連續(xù)治療2個(gè)療程。觀察兩組近期療效及毒副作用發(fā)生情況，比較治療前后兩組的血清腫瘤標(biāo)記物水平、卡氏功能狀態(tài)量表（KPS）和修訂版Piper疲乏量表（RPFS）評(píng)分。結(jié)果 經(jīng)治療，觀察組客觀有效率（ORR）和疾病控制率（DCR）分別為20.00%、70.00%；均高于對(duì)照組的12.50%、50.00%，但差異均無(wú)統(tǒng)計(jì)學(xué)意義。兩組治療后血清癌胚抗原（CEA）、糖類抗原（CA）125（CA125）和CA19-9水平均較本組治療前顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且治療后，觀察組血清腫瘤標(biāo)志物水平較對(duì)照組同期均顯著更低，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。對(duì)照組治療后外周血血小板（PLT）較本組治療前顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療后KPS評(píng)分均較本組治療前有顯著提高，RPFS評(píng)分則均顯著降低，同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后，觀察組KPS、RPFS評(píng)分的改善效果均顯著優(yōu)于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。用藥期間，觀察組乏力發(fā)生率為30.00%，顯著低于對(duì)照組的55.00%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 脾多肽注射液聯(lián)合阿帕替尼治療化療失敗的晚期胃癌能有效提高近期療效，并有助于減少單用阿帕替尼所產(chǎn)生的乏力等毒副作用，降低血清腫瘤標(biāo)志物CEA、CA125和CA19-9水平，有效維持晚期胃癌患者外周血PLT穩(wěn)定，值得臨床推廣研究。

Objective To investigate the therapeutic effect of Lienal Polypeptide Injection combined with apatinib in treatment of advanced gastric cancer. Methods Patients (80 cases) with advanced gastric cancer in the Second People's Hospital of Fuyang from January 2017 to January 2019 were divided into control group (40 cases) and observation group (40 cases) by random number table method. Patients in the control group were po administered with Apatinib Mesylate Tablets, 500 mg/time, once daily. In case of adverse reactions during the treatment, the dosage shall be reduced or suspended according to the tolerance of the subject. Patients in the observation group were iv administered with Lienal Polypeptide Injection on the basis of control group, 10 mL was added to 500 mL 5% glucose solution, once daily, stoppded medication for 3 weeks after 1 week of continuous use. The two groups were treated with 4 weeks as a course of treatment, two courses of continuous treatment. The short-term efficacy and side effects in two groups were compared, and the levels of serum tumor markers, peripheral blood PLT, KPS and RPFS before and after treatment were compared. Results After treatment, the ORR and DCR in the observation group were 20.00% and 70.00%, respectively, which were higher than 12.50% and 50.00% in the control group, but the difference was not statistically significant. After treatment, serum CEA, CA125, CA19-9 levels in two groups were significantly decreased, and the differences before and after treatment in the same group were statistically significant (P<0.05). After treatment, the serum levels of tumor markers in the observation group were significantly lower than those in the control group, and the difference between the two groups was statistically significant (P<0.05). After treatment, the peripheral blood PLT in the control group was significantly decreased, and the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, the KPS score in two groups was significantly increased, while the RPFS score was significantly decreased, the difference before and after treatment in the same group was statistically significant (P<0.05). After treatment, the improvement effect of KPS and RPFS scores in the observation group was significantly better than that in the control group, and the difference between the two groups was statistically significant (P<0.05). During the treatment period, the incidence of asthenia in the observation was 30.00%, which was significantly lower than 55.00% in the control group, with a statistically significant difference (P<0.05). Conclusion Lienal Polypeptide Injection combined with apatinib in treatment of advanced gastric cancer with chemotherapy failure can effectively improve the short-term efficacy, and help to reduce the toxicity and side effects caused by apatinib alone, reduce the levels of serum tumor markers CEA, CA125, and CA19-9, and effectively maintain the stability of peripheral blood PLT in patients with advanced gastric cancer, which is worthy of clinical promotion and research.

R979.1

安徽省衛(wèi)生健康委員會(huì)科研課題（2018R01220）