目的 探讨结直肠癌肝转移瘤的CT 成像特点及规律分析。方法 回顾性分析我院2016 年3 月—2018年3 月的84 例结直肠癌肝转移瘤患者的CT 动态增强图像及临床资料记录并统计其不同血流汇入情况下、不同增强时期的CT 成像结果,根据原发灶部位,将患者分为左半结肠组和右半结肠组,左半结肠组再按照血管重建情况分组。结果 原发灶在左半结肠时,转移瘤的左、右叶分布无差异（P>0.05）,而原发灶在右半结肠时,转移瘤的右叶优势分布多于左叶优势（P<0.001）;左半结肠组内比较,甲组转移瘤的左叶优势分布多于右叶,分布差异有统计学意义（P<0.001）,其左右叶构成比约为4∶1;乙组转移瘤的左、右叶分布差异不具有统计学意义（P>0.05）;丙组转移瘤的右叶优势分布多于左叶优势（P<0.001）;84 例患者中,共发现338 个肝转移灶。平扫中,低密度灶多于高密度灶,最少是等密度灶;动态CT 增强扫描中,环状强化灶多于结节状强化灶,其他不典型强化灶最少,且门脉期时强化灶显示最为清晰。结论 结直肠癌肝转移患者的CT 肝扫描图像特点有一定规律,可以为诊断结直肠癌原发灶及结直肠癌的早期转移提供一定理论依据。

Objective To investigate the characteristics and regularity of CT imaging of colorectal cancer liver metas tases. Methods A retrospective analysis of 84 cases of colorectal cancer liver metastases from March 2016 to March 2018 in our hospital. CT dynamic imaging images and clinical data were recorded and statistically analyzed for different blood flow in flows and different enhancement periods. For the CT imaging results, the patients were divided into the left colon group and the right colon group according to the primary tumor site, and the left colon group was grouped according to the blood vessel reconstruction. Results There was no statistic difference in the distribution of left and right lobe between the primary tumor and the left colon in the left colon （P>0.05） . However, in the right colon, the dominant distribution of the right lobe in the metastatic tumor was more than that in the left lobe. The advantage （P=0.00） in the left colon group, the left leaf dom inant distribution of the metastatic tumor of group A was more than that of the right lobe, and the difference was statistically significant （P=0.00）, and the ratio of left and right lobe was about 4∶1;There was no statistic difference in the distribu tion of left and right leaves between group B metastases （P>0.05） . The right leaf dominant distribution of group C metasta ses was more than that of left lobe （P=0.00） . Among 84 patients, a total of 338 liver metastases were found. In the plain scan, the low-density foci were more than the high-density foci, and at least the iso-density foci;in the dynamic CT-en-hanced scan, the annular intensified foci were more than the nodular intensive foci, and the other atypical intensive foci were the least, and the portal vein period enhanced stove display is the clearest. Conclusion The characteristics of CT liver scan in patients with liver metastases from colorectal cancer do have certain regularity, which may provide a theoretical basis for the diagnosis of primary colorectal cancer and early metastasis of colorectal cancer.

目的 筛选结直肠癌（CRC）差异性表达的长链非编码RNA（lncRNA）,并进行临床标本验证,研究其对结肠癌细胞HCT116功能的作用。方法 利用lncRNA PCR芯片对3对CRC组织和癌旁对照组织筛选差异性表达的lncRNA,确定候选研究lncRNA GAPLINC,RT-qPCR对21例临床样本进行验证其表达的差异性;同时构建GAPLINC表达质粒及其沉默体siRNA转染HCT116细胞,研究其对细胞凋亡、迁移及侵袭能力的影响。结果 lncRNA芯片实验结果提示CRC组织中存在大量的差异性表达的lncRNA,其中GAPLINC在CRC组织表达稳定增加,21例临床样本进一步验证了其在肿瘤组织中表达增加（P<0.05）;转染GAPLINC表达质粒后,HCT116细胞凋亡被抑制,同时其迁移及侵袭能力增强,转染siRNA抑制GAPLINC的表达后,则出现相反的结果。结论 利用lncRNA芯片可对CRC差异性表达lncRNA进行批量筛选,GAPLINC在CRC组织中表达稳定增加,具有促癌作用,在CRC发生发展中可能起着重要作用。

Objective To screen the differentiational expression of lncRNA in CRC tissue,confirm it in large simple of clinical specimens,and study its effects on human colorectal cells HCT116 cell line. Methods We screened the lncRNA which expressed differently in 3 CRC tissues and their pair-non carcinour tissues by lncRNA arrays;chose the over expressed lncRNA which played the potential role of oncogene for further researching,and tested the difference in 21 clinical specimens by RT-qPCR. We cultured the HCT166 cells,and then constructed expressed plasmids pcCDNA3.1-GAPLINC and synthesized GAPLINC siRNA,transfected the plasmids and siRNA into HCT116 cells;to study the changes of HCT116 cells behavior,the transwell assays were carried on;the changes of apoptosis of HCT116 cells were tested by flow cytometry. Results There existed many lncRNA which expressed differently between CRC tissues and normal control tissues by lncRNA arrays,there were 21 lncRNA down expressed,and 3 lncRNA up expressed;among these lncRNA,GAPLINC over expressed stably,and its high level of expression was approved in 21 clinical specimens by the test of RT-qPCR. We constructed the expressed plasmids pcCDNA3.1-GAPLINC and synthesizing GAPLINC siRNA successfully;after transfecting pcCDNA3.1-GAPLINC into HCT116 cells,the over expression of GAPLINC increased the migration and invasion of the HCT166 cells （P<0.05）,decreased the proportion of cell apoptosis （P <0.05）;by contraries,knocked down the expression of GAPLINC inhibited invasion and migration of HCT116 cells （P<0.05）,and promoted the apoptosis of the HCT116 cells （P <0.05）. Conclusion It could screen the different expression of lncRNA in large quantities by lncRNA arrays,and GAPLINC expressed highly and stably in CRC tissues. GAPLINC played a role of oncogene,which promoted the proliferation and invasion of CRC cells,and inhibited the apoptosis of CRC cells,which meant playing an important role in the carcinoma and development of CRC.

目的 对信息协作平台的社区结直肠癌三级防治及干预体系进行探索与实践。方法 对纳入本次研究的2 492名社区人群进行问卷调查,包括健康人群1 118人,1 374例肿瘤患者。分析健康人群和肿瘤患者关于肿瘤防治知识及途径的认知情况,比较健康人群和肿瘤患者就诊首选医院,了解肿瘤患者就诊流向和行为以及发现患癌的途径。结果 在肿瘤患者中知道癌前病变、早期肿瘤症状、高危人群的比例显著高于健康人群[26.93%(370/1 374)、39.96%(549/1 374)、46.00%(632/1 374)比14.49%(162/1 118)、21.91%(245/1 118)、26.92%(301/1 118)]。健康人群认为肿瘤三级防治网络可行、会参加三级防治网、有必要开展癌症筛查、会参加筛查的比率显著高于肿瘤患者[98.83%(1 105/1 118)、91.95%(1 028/1 118)、98.12%(1 097/1 118)、98.03%(1 096/1 118)比81.95%(1 126/1 374)、79.98%(1 099/1 374)、80.93%(1 112/1 374)、85.95%(1 181/1 374)],差异均有统计学意义(P<0.05)。健康人群把三甲医院视为就诊首选医院的比率显著低于肿瘤患者[32.56%(364/1 118)比86.97%(1 195/1 374)](P<0.05)。肿瘤患者中发现肿瘤及确诊医院、肿瘤复诊、康复医院的选取主要以三甲综合医院为主。在肿瘤患者中因身体不适到医院就诊发现患癌的比率显著高于单位员工体检、自检发现、社区卫生服务中心体检发现的比率。结论 我国目前肿瘤发病率和死亡率正处在快速上升的阶段,利用网络优势,加大肿瘤防治知识的宣传力度,建立社区、区域二级医院、三级医院优势互补的三级肿瘤防控体系,是当前我国肿瘤防治的迫切需求。

Objective To explore and practice the community tertiary prevention and intervention system for colorectal cancer based on information collaboration platform. Methods A questionnaire survey was conducted among 2 492 community residents which were included in this study, including the healthy crowd of 1 118 people, 1 374 cases of tumor patients. The study was to analyze the knowledge of cancer prevention and treatment in healthy people and cancer patients, to contrast the preferred hospital by healthy people and cancer patients, to acquaint the flow direction in seeking medical service, behavior and way to diagnosis cancer of tumor patients. Results In patients with cancer, the understanding proportion of patients with precancerous lesions, early tumor symptoms, and high risk groups was significantly higher than that in healthy people [26.93% (370/1 374), 39.96% (549/1 374), 46.00% (632/1 374) vs 14.49% (162/1 118), 21.91% (245/1 118), 26.92% (301/1 118)]. In healthy people, the proportion of identification of tumor three-grade prevention and control network, willing to participate in the tertiary prevention and control network, necessity to carry out cancer screening, willing to participate in screening was significantly higher than that in patients with cancer [98.83% (1 105/1 118), 91.95% (1 028/1 118), 98.12% (1 097/1 118), 98.03% (1 096/1 118) vs 81.95% (1 126/1 374), 79.98% (1 099/1 374) and 80.93% (1 112/1 374), 85.95% (1 181/1 374)]. There were significantly differences (P<0.05). Healthy people preferred to choose common hospital instead of 3A hospital as the first choice [32.56% (364/1 118) vs 86.97% (1 195/1 374)] (P<0.05). Discovery and diagnosis of cancer, further consultation, and rehabilitation were mainly carried out in 3A hospital. In patients with cancer, the cancer discovery ratio because of physical discomfort for medical attention was significantly higher than that in unit staff physical examination, self-inspection found, and physical examination in community health service center. Conclusion At present, the incidence and mortality of cancer in our country is in a stage of rapid rising. It's an urgent need for cancer prevention and control in China that making use of the advantage of network to improve the propaganda of the knowledge of cancer prevention and control, and establishing complementary advantages of the tertiary cancer prevention and control system by community, regional hospitals, and 3A hospitals.

目的 探讨个体化健康管理对超高龄结直肠癌患者希望水平的影响效果。方法 对66例超高龄结直肠癌患者实施个体化健康管理,3个月后对患者进行希望水平、肛门括约肌功能、生活质量的测评。结果 3个月后患者排便功能恢复良好的达90.91%,与出院前比较差异有统计学意义(P＜0.01);3个月后患者HHI各维度和SF-36各维度的得分明显提高,与干预前比较差异均有统计学意义(P＜0.01)。结论 对超高龄结直肠癌患者实施个体化健康管理,可提高其生存希望水平,改善生活质量。

Objective To explore the effect of individualized health management on the hope level of patients with advanced colorectal cancer. Methods Using individualized health management for 66 elderly patients with colorectal cancer for 3 months, the level of hope, anal sphincter function and quality of life were evaluated. Results After 3 months, the defecation function of the patients recovered well to reach 90.91%, and the difference was statistically significant (P<0.01); After 3 months, the scores of each dimension of Herth Hope Index (HHI) and SF-36 were significantly improved, and the difference was statistically significant (P<0.01). Conclusion The implementation of individualized health management for the elderly patients with colorectal cancer may improve the survival level and improve the quality of life.

目的 通过检测结直肠癌患者血清及组织中癌胚抗原(CEA)及β₂微球蛋白(β₂MG)的表达,探讨结合两者在结直肠癌诊断中的作用。方法 对30例结直肠癌患者的血清、癌组织和癌旁组织进行CEA及β₂MG检测,设置对照组为行肠镜检查的正常健康体检者30例。分别对比CEA及β₂MG在结直肠癌中的关系,进一步对比CEA及β₂MG两者在结直肠癌在结直肠癌患者中的肿瘤大小、分期、浸润深度及转移的关系。 同时对结直肠癌及健康体检者的一般情况如性别、年龄、CEA、β₂MG、血红蛋白及白蛋白进行对比,以进一步了解CEA及β₂MG 在结直肠癌中的重要性。结果 CEA在结直肠癌患者癌组织、癌旁组织及血清中升高的比例为100%、10%、47%;β₂MG在结直肠癌患者癌组织、癌旁组织及血清升高的比例为60%、57%、23%;联合血清中CEA及β₂MG升高的比例为63%;正常对照组中的CEA升高的比例为33%,β₂MG升高的比例为67%;无论CEA还是β₂MG在结直肠癌中均有一定比例的升高,联合两者升高更明显。结论 CEA及β₂MG是恶性肿瘤特别是结直肠癌的重要指标,联合两者的检测提高结直肠癌的早期诊断。

Objective To detect the expression of carcinoembryonic antigen and β₂ microglobulin in serum and tissue of patients with colorectal cancer, and to explore their roles in the diagnosis of colorectal cancer. Methods 30 patients with colorectal cancer were examined for CEA and β₂MG in serum, cancer and para-cancer tissues, and 30 healthy persons with normal colonoscopy were selected as the control group. The expressions of CEA and β₂MG in serum and tissues were compared, and the relationship between CEA and β₂MG and tumor size, stage, depth of invasion and metastasis were analyzed. Results The increased in proportion of CEA in cancer tissue、para-carcinoma tissue and serum of colorectal cancer was 100%、10%、47%; Similarly, the increased in proportion of β₂MG was 60%、57%、23%;Combined calculation the increased in proportion ofCEA and β₂MG in serum of colorectal cancer was 63%;In the normal control, the increased in proportion of CEA was 33%;The increased in proportion of β₂MG was 67%.Both CEA and β₂MG in colorectal cancer had a certain proportion, the rise of joint both was obviously more. Conclusion CEA and β₂MG are important markers of malignancy, especially colorectal cancer. Combined detection of CEA and β₂MG can improve the early diagnosis of colorectal cancer.

目的 探讨ε-3多不饱和脂肪酸在胃肠道肿瘤患者化疗后的胃肠道毒性及生活质量的作用。方法 在研究前经过化疗筛选,按照WHO化疗副反应在2级或者以上的50名住院的胃癌或者直结肠癌患者,随机分为对照组(单纯化疗)(n=25)和研究组(化疗加ε-3多不饱和脂肪酸)(n=25),两组的化疗方案均为化疗筛选的方案。预防性每天静脉使用ε-3多不饱和脂肪酸 200 mg,连续5天,记录评估胃肠道并发症,如恶心、呕吐和腹泻,以及KPS评分、血清白蛋白、IL-2、IFN-γ和CRP。结果 与对照组比较,恶心、呕吐和腹泻评分、IL-2、IFN-γ和CRP低于于对照组,相反,生活质量评分研究组高于对照组,差异有统计学意义(P<0.05)。结论 预防性使用ε-3多不饱和脂肪酸能够减轻胃肠道肿瘤患者化疗后的胃肠道毒性症状、降低全身炎症因子反应并改善生活质量。

Objective To explore the effect omega-3polyunsaturated fatty acid omega-3 FA on clinical manifestations of gastrointestinal toxicity and quality of life (QOL) induced by chemotherapy for patients with gastric or colorectal cancer. Methods After screening chemotherapy, Fifty patients with gastric or colorectal cancer, according to developing WHO side-effect grading system of grade 2 or higher were randomly divided into either control group (n=25) or omega-3 FAs group (n=25) during next cycle of chemotherapy. In the control group, the patients received the same chemotherapy regimens as screening cycle and in the omega-3 FA group, received chemotherapy and omega-3 FAs. Prophylactic intravenous 200 mL /d was given for 5 days. The gastrointestinal complications such as nausea,vomiting or diarrhoea and Karnofsky performance status(KPS ),IL-2,IFN-γandCRP,ect, were evaluated respectively. Results Compared with the control group, the scores of nausea vomiting and diarrhea and IL-2,IFN-γor CRP levels decreased , significantly,on the contrary, the score of QOL increased. There was significantly statistical difference (P<0.05). Conclusion Prophylactic intravenous omega-3 FA can ameliorate clinical manifestations of gastrointestinal toxicity and systemic inflammatory response syndrome(SIRS) induced by chemotherapy and improve QOL for patients with gastric or colorectal cancer.

目的 研究超声内镜(EUS)对结直肠癌(CRC)术前分期和指导手术方案的应用价值。方法 选取我院2014年11月—2015年11月结直肠外科收治的52例CRC患者,均接受根治性切除术治疗并经术中病理观察确诊,并以手术病理TNM分期结果作为金标准。术前对入选患者行超声内镜检查,参考金标准回顾性分析超声内镜的TNM分期诊断效果。结果 该52例CRC患者EUS诊断结果显示肿瘤侵犯浸润T分期(T1～T4)准确率分别为87.50%、80.00%、94.12%、83.33%,较手术病理金标准无差异(P>0.05);EUS诊断淋巴结转移N分期(N0～N2)准确率分别为76.92%、79.17%、86.67%,其中N0、N2准确率较金标准无差异(P>0.05),但N1分期准确率较金标准偏低(P<0.05)。结论 虽然ENS对淋巴结转移程度尤其是N1的诊断准确度存在一定误差,但从整体来看EUS能较好的观察CRC患者肿瘤侵犯浸润深度和判断淋巴结转移情况,术前结合EUS诊断结果有利于患者术前病理分期,并为选择合适的手术方案提供参考依据。

Objective To study the application value of endoscopic ultrasonography (EUS) in preoperative staging of colorectal cancer (CRC) and guidance of surgical procedures. Methods 52 cases of patients with CRC who were admitted in the department of colorectal surgery of our hospital from November 2014 and November 2015 were selected. All of them underwent radical resection and were confirmed by surgical and pathological observation. Surgical and pathological TNM staging results were taken as golden standard. Before surgery, endoscopic ultrasonography was performed in the selected patients. Referring to the gold standard, TNM staging diagnostic effects of endoscopic ultrasonography were retrospectively analyzed. Results The EUS diagnostic results of 52 patients with CRC showed that the accuracy rates of tumor invasion T stage (T1-T4) were 87.50%, 80.00%, 94.12% and 83.33% respectively. There was no significant difference, compared with surgical and pathological golden standard (P>0.05); The accuracy rates of EUS in diagnosis of lymph node metastasis N stage (N0-N2) were 76.92%, 79.17% and 86.67%, respectively. There was no significant difference in accuracy rate in N0 and N2, compared with the gold standard (P>0.05), but the accuracy in N1 stage was lower than that of gold standard (P<0.05). Conclusion Although ENS has some errors in the diagnosis of degree of lymph node metastasis, especially N1, on the whole, EUS can be better to observe the depth of tumor invasion and lymph node metastasis in patients with CRC. The diagnosis combining with EUS before surgery is helpful to the preoperative pathological staging, and provide reference for the selection of appropriate surgical procedures.

目的 调查结直肠癌患者癌因性疲乏状况,研究其动态变化趋势,为临床护理提供理论依据。方法 选用癌症疲乏量表(CFS)对96例结直肠患癌患者于术前一周、术后3~4天、出院前1~2天进行调查分析。结果 三次调查患者的癌因性疲乏水平有差异(P＜0.01),术后3~4天疲乏程度最重,出院前1~2天次之,术前一周最轻;三次调查结肠癌患者的疲乏水平均高于直肠癌患者,两组疲乏水平有差异(P＜0.05)。结论 结直肠癌患者于住院不同时期存在不同程度的疲乏,应针对疾病各时期特点为患者量身裁定护理干预措施,改善其疲乏症状。

Objective To investigate the dynamic changes of cancer-related fatigue (CRF) in patients with colorectal cancer. Methods Totally 96 patients with colorectal cancer were investigated by Cancer Fatigue Scale in three times: a week before patients' surgery, 3~4 days after patients' surgery and 1~2 days before discharge, respectively. Results Scores of fatigue of colorectal cancer patients were significantly different among three measurement points(P＜0.01). The scores of fatigue in the second survey were the highest. The third survey took second place and the first survey was the lowest. The score of fatigue in colon cancer patients were higher than rectal cancer patients in survey, with significant difference(P＜0.05). Conclusion There were obvious differences of fatigue in different periods for colorectal cancer patients in hospital. Inventions should tailor for patients according to characteristics of different periods to improve fatigue.

       目的   分析早期结直肠癌内镜下治疗前行窄带成像结合放大内镜 （ME-NBI）和超声内镜技术的评估价值。方法   采用回顾性分析方法，以2021年1月— 2023 年 12月中山市第五人民医院收治的102例早期结直肠癌患者为观察对象，所有患者均接受内镜下黏膜切除术（EMR）或内镜黏膜下剥离术（ESD）治疗，根据内镜下治疗前是否进行ME-NBI和超声内镜检查分为研究组与对照组各51例。比较两组年龄、性别、肿瘤大小、直乙结肠占比及组织病理特征；比较两组治疗时间、ESD治疗后非治愈性切除发生率、治愈性切除率、并发症发生情况及再次ESD或外科手术治疗率。结果   两组年龄、性别、肿瘤大小、直乙结肠占比及组织病理比较差异均无统计学意义（P＞0.05）。研究组中37例行ESD治疗，治疗时间为（120.6±140.3）min，12例行EMR治疗，治疗时间为（11.6±9.3）min，有2例不符合内镜下治疗指征，转外科手术治疗。对照组有38例行ESD治疗，治疗时间为（128.8±144.5）min，13例行EMR治疗，治疗时间为（12.5±9.5）min，两者治疗时间比较差异均无统计学意义（P＞0.05）。研究组非治愈性切除率为7.84，低于对照组27.45；治愈性切除率为88.24，高于对照组72.55；研究组ESD手术并发症为8.11%，低于对照组31.58；ESD或外科手术率为6.12，低于对照组25.49（P＜0.05），结论  ME-NBI和超声内镜对早期结直肠癌患者行内镜下治疗指征评估更准确，可提高治愈性切除率。

       Objective  To  study the application value of magnifying endoscopy combined with  narrow  band imaging （ME-NBI）and ultrasonic endoscopy system before endoscopic treatment in patients with early colorectal cancer．Methods  A retrospective analysis was carried out on  102  patients with early-stage colorectal cancer who were admitted to Zhongshan Fifth People’s Hospital from January 2021 to December 2023．All patients were treated with endoscopic mucosal resection（EMR）or endoscopic submucosal dissection（ESO）．The patients were divided into study group（51 cases）and control group（51 cases）according to whether ME-NBI and ultrasonic endoscopy was performed before endoscopic treatment or not．The patient age，sex，volume of tumor，location of tumor and pathological result of the tumor were compared between two groups．Time for treatment，curative resection rate，non-curative resection rate and the complication incidence of ESD，incidences of second ESD or surgery were compared between the two groups．Results  There were no statistical differences in age，sex，volume of tumor，location of tumor and pathological result of the tumor（P＞0.05）．In the study group，37 patients received ESD treatment，operation time was（120.6±140.3）minutes，and 12 patients received EMR treatment，operation time was（11.6±9.3）minutes，two cases were transferred to surgery due to endoscopic ultrasonography combined with magnifying endoscopy showed that they did not meet the indications for ESD treatment．In the control group，38 patients received ESD treatment，operation time was（128.8±144.5）minutes，13 patients received EMR treatment，operation time was（12.5±9.5）minutes．There was no significant difference in treatment duration between the two groups．The non-curative resection rate of the study group was 7.84%，which was significantly lower than that in the control group（27.45%），and the curative resection rate（88.24%）was significantly higher than that in the control group（72.55%）．The complications of ESD surgery in the study group were 8.11%，lower than 31.58% in the control group．The rate of second ESD or surgery was 6.12%，lower than 25.49% in the control group（P＜0.05）．Conclusions  ME-NBI and endoscopic ultrasound are more accurate in the evaluation of endoscopic indications for early colorectal cancer patients，and can improve the curative resection rate．

       目的   分析贝伐珠单抗与化疗对晚期结直肠癌患者4种错配修复蛋白（MSH2、MLHI、MSH6、PMS2）水平影响。方法   选择2022年1月—2024年1月江苏省宿迁市中医院肿瘤科102例晚期结直肠癌患者，按抽签法分成两组，即化疗组及联合组，各51例。化疗组应用FOLFOX（亚叶酸钙+奥沙利铂+氟尿嘧啶）方案进行化疗，联合组采取贝伐珠单抗联合FOLFOX方案治疗。对比其肿瘤控制效果、免疫功能及MSH2、MLHI、MSH6和PMS2水平变化，并对比组间不良反应发生率。结果   联合组客观缓解率、疾病控制率高于化疗组（P＜0.05）；治疗后联合组患者CD4⁺ 、CD3⁺ 、CD8⁺ 、和CD4⁺ /CD8⁺数值高于化疗组，且两组治疗后均低于治疗前（P＜0.05）；治疗后两组患者MSH2、MLHI、MSH6和PMS2缺失率对比无统计学意义（P＞0.05），但其阳性、阴性表达情况对比差异有统计学意义，联合组MSH2、MLHI、MSH6和PMS2阳性率低于化疗组（P＜0.05）；两组不良反应发生率对比差异无统计学意义（P＞0.05）。结论   对晚期结直肠癌在化疗基础上增加贝伐珠单抗抗肿瘤效果显著，改善其免疫功能，虽无法改善患者错配修复蛋白缺损，但可辅助降低其阳性率，且不影响安全性。

       Objective  To analyze the effects of bevacizumab and chemotherapy on the levels of four mismatch  repair proteins（MSH2，MLHI，MSH6，PMS2）in patients with advanced colorectal cancer．Methods  A total of 102 patients with advanced colorectal cancer from the Oncology Department of Suqian Traditional Chinese Medicine Hospital in  Jiangsu Province from January 2022 to January 2024 were selected，and were divided into two groups according to the drawing method，namely the chemotherapy group and the combination group，with 51 patients in each group．The chemotherapy group received FOLFOX（calcium folinate+oxaliplatin+fluorouracil）regimen for chemotherapy，while the combination group received bevacizumab combined with FOLFOX regimen for treatment．Tumor control effect，immune function，and changes in MSH2，MLHI，MSH6，and PMS2 levels，and its incidence of adverse reactions were compared．Results  The objective remission rate and disease control rate of the combined group were higher than those of the chemotherapy group（P＜0.05）．After treatment，the CD4⁺ ，CD3⁺ ，CD8⁺ and CD4⁺ /CD8⁺ values in the combination group were higher than those in the chemotherapy group，and those after treatment were lower than those before treatment in both groups（P＜0.05）．After treatment，there were no significant differences in the deletion  rates of MSH2，MLHI，MSH6，and PMS2 between the two groups of patients（P＞0.05），but there was a significant difference in their positive and negative expression．The positive rates of MSH2，MLHI，MSH6，and PMS2 in the combination group were lower than those in the chemotherapy group（P＜0.05）．There was no significant difference in the incidence of adverse  reactions between the two groups（P＞0.05）．Conclusions  Adding bevacizumab on the basis of chemotherapy has a significant anti-tumor effect on advanced colorectal cancer，improving its immune function．Although it cannot improve the mismatch  repair protein defect in patients，it can assist in reducing its positivity rate and has high safety．