目的 探究維生素 C聯(lián)合同步放化療（CCRT）對 III期非小細胞肺癌（NSCLC）患者近期療效、生存質量及免疫球蛋白（IgA、IgM、IgG）和炎癥因子水平的影響。方法 將2019年3月—2021年3月貴州省黔西南布依族苗族自治州人民醫(yī)院收治的 60例 III期 NSCLC患者隨機分為對照組（n＝30）與試驗組（n＝30）。對照組患者采用 CCRT治療。放療方案：6MV-X 直線加速器掃描，每次 1.8～2.0 Gy，每周 5 次，總劑量 60～66 Gy?；煼桨福喉樸K（50 mg·m^-2）第 1 天（d1）、d8、d29、d36靜脈滴注，依托泊苷（50 mg·m^-2）d1～d5、d29～d33靜脈滴注。36 d為 1個療程，共治療 1個療程。試驗組患者采用維生素 C聯(lián)合 CCRT治療，CRRT方案同對照組，CCRT治療方案開始后即給予靜脈輸注維生素 C，每天 10 g，每周2次（間隔3 d）至放化療結束，放化療全程口服維生素C，每天4 g，連續(xù)治療36 d。觀察兩組患者治療后近期療效、生存質量（KPS 評分）以及血清腫瘤壞死因子-α（TNF-α）、IgA、C 反應蛋白（CRP）、IgM、白細胞介素 6（IL-6）、IgG 水平。結果 試驗組客觀緩解率為 53.33%，略高于對照組的 46.67%，但差異無顯著性（P＞0.05）。試驗組化療后生存質量穩(wěn)定改善率 83.33% 顯著高于對照組 56.67%（P＜0.05）。試驗組總不良反應發(fā)生率 33.33%，顯著低于對照組的 60.00%（P＜0.05）。治療前，兩組的 IgA、IgG、IgM 和 IL-6、CRP、TNF-α 水平比較，差異無統(tǒng)計學意義（P＞0.05）；治療后，兩組IgA、IgG、IgM水平均較本組治療前顯著升高（P＜0.05），IL-6、CRP、TNF-α水平較本組治療前降低（P＜0.05）；與對照組治療后比較，試驗組 IgA、IgG、IgM 水平顯著升高（P＜0.05），IL-6、CRP、TNF-α水平降低（P＜0.05）。結論 維生素C聯(lián)合CCRT治療III期NSCLC可顯著降低不良反應發(fā)生率，改善生存質量及機體免疫功能。

Objective To investigate the influences of vitamin C combined with concurrent chemoradiotherapy (CCRT) on the shortterm response rate, quality of life and immunoglobulin (IgA, IgM, IgG) andinflammatory factor levels in patients with stage III nonsmall cell lung cancer (NSCLC). Methods Sixty patients with stage III NSCLC who were treated in People's Hospital of Qianxinan Buyei and Miao Autonomous Prefecture from March 2019 to March 2021 were randomly grouped into control group (n=30) and experimental group (n=30). Control group was treated with CCRT. Radiotherapy regimen: 6MV-X linear accelerator scanning, 1.8—2.0 Gy each time, five times a week, total dose 60—66 Gy. Chemotherapy regimen: Cisplatin (50 mg·m^-2) (d1), d8, d29, d36 intravenous infusion, etoposide (50 mg·m^-2) d1—d5, d29—d33 intravenous infusion. A total of 36 days of treatment, 36 days as a course of treatment. The experimental group was treated with vitamin C combined with CCRT, and the CCRT scheme was the same as that of the control group. After the beginning of the CCRT treatment, the patients were given intravenous infusion of vitamin C, 10 g a day, twice a week (3 d interval), until the end of radiotherapy and chemotherapy. During the whole course of radiotherapy and chemotherapy, oral vitamin C, 4 g a day, was continuously treated for 36 d. The short-term effective rate, quality of life (KPS score), and the levels of serum tumor necrosis factor-α (TNF-α), IgA, C-reactive protein (CRP), IgM, interleukin-6 (IL-6) and IgG in two groups after treatment were observed. Results The short-term effective rate of experimental group was 53.33%, slightly higher than that of control group 46.67%, but the difference was not significant (P＞0.05). The stable improvement rate of quality of life after chemotherapy in experimental group was 83.33%, which was obviously higher than 56.67% in control group (P＜0.05). The incidence of total adverse reactions in the experimental group was 33.33%, which was obviously lower than that in control group (60.00%) (P＜0.05). Before treatment, there were no significant differences in the levels of IgA, IgG, IgM, IL-6, CRP and TNF-α between the two groups (P＞0.05). After treatment, the levels of IgA, IgG and IgM in two groups were significantly increased compared with before treatment (P＜0.05), while the levels of IL-6, CRP and TNF- α were decreased compared with before treatment (P＜0.05). Compared with the control group after treatment, the levels of IgA, IgG and IgM in experimental groups were significantly increased (P＜0.05), while the levels of IL-6, CRP and TNF- α were decreased (P＜0.05). Conclusion Vitamin C combined with CCRT in the treatment of stage III NSCLC can significantly reduce adverse reactions, and improve the quality of life and immune function.

R979.1

黔西南州科技計劃項目（2018-2-36）