目的 研究核磁共振（MR）引导的海马保护技术应用于小细胞肺癌全脑放射治疗（放疗）的效果。方法 对确定行全脑放疗的30例小细胞肺癌脑转移患者,行常规放疗CT定位后以定位体位行全头颅MR平扫,将计算机断层扫描（CT）和MR的T1加权像在Monaco 5.1计划系统上进行精准融合,勾画全脑放疗及海马区域,在海马区域三维方向上分别外扩5、15 mm作为海马与计划靶区之间的剂量跌落,每一例患者在Monaco 5.1计划系统上按照不保护海马组织以及外扩5、15 mm进行保护设计3个容积旋转调强技术（VMAT）放疗计划,观察海马组织的平均及最大放疗剂量。结果 增加保护海马组织之后,3个放疗计划的D100均≥95%,每例的3个放疗计划间D100比较差异无统计学意义（P>0.05）;设置外扩5、15 mm的剂量跌落区后,左、右海马的平均剂量、最大剂量均明显降低,而且3个放疗计划的海马平均剂量、最大剂量之间对比差异有统计学意义。结论 小细胞肺癌脑转移患者进行全脑放疗时,利用MR引导的海马保护技术并设置外扩15 mm的剂量跌落区,能够显著降低海马的剂量,达到保护目的。

Objective To explore the application of MR guided hippocampal avoidant whole brain radiotherapy（WBRT）for small cell lung cancer（SCLC）．Methods Thirty SCLC patients with brain metastases who underwent WBRT were enrdled．After routine CT localization was performed,and a head MR was performed in a the same position．T1 weighted images of MR and CT images were accurately fused on the Monaco 5.1 planning system．The entire brain tissue and hippocampus region were delineated． The dose drop areas between the hippocampus and the planned target area were expanded 5mm and 15mm in the three-dimensional direction of the hippocampus,respectively．Three volumetric modulated arc therapy（VMAT）radiotherapy plans were designed for each patient on the Monaco 5.1 planning system based on whether the hippocampal tissue was avoid．The average and maximum doses of hippocampal tissue were observed．Results After the avoidance of hippocampal tissue,the D100 of the three radiotherapy plans reached ≥95%,and there was no significant difference in D100 between the three radiotherapy plans in each case．After setting dose drop areas of 5mm and 15mm for external expansion,the average and maximum doses of the left and right hippocampus were significantly reduced,and there was a significant difference in the comparison between the average and maximum doses in the hippocampus of the three radiotherapy plans．Conclusions MR guided hippocampal avoidant technology and the setting of a 15 mm dose drop area can significantly reduce the dose to the hippocampus in patients with SCLC undergo whole brain radiotherapy．

目的 探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法 对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析,将其分为观察组,另选取82例肺部良性肿瘤患者作为对照组,收集其术前CT增强延迟扫描结果,以术后病理诊断结果为金标准,分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值,采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果 CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ²=26.560、24.680,P<0.05）,观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ²=43.330、64.600,P<0.05）;82例非小细胞肺癌通过CT增强延迟扫描共确诊79例,CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82）,与病理诊断结果100.00%对比差异无统计学意义（χ²=3.060,P=0.080）;82例非小细胞肺癌平均CT增强值为（39.14±7.31）,不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P>0.05）,不同病理类型[腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）]、细胞分化程度[中、低分化（45.71±7.21）vs 高分化（32.81±5.11）]、临床分期[Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）]患者、淋巴结转移[是（42.75±4.21）vs 否（35.77±8.13）]CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378,P<0.05）;Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008,P<0.05）。结论 CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值,其诊断准确率与病理诊断并无显著差异,且可通过CT增强延迟扫描技术确定患者CT增强值,从而为非小细胞肺癌患者术后病理特征判断提供参考。

Objective To explore the application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer（NSCLC）．Methods A retrospective analysis was conducted on 82 patients with NSCLC who underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into an observation group and another 82 patients with benign lung tumors were included in the control group．The preoperative CT enhanced delayed scanning results were collected,and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared,and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs 39.29%）in the observation group was significantly lower than that in the control group（χ²=26.560,24.680,P<0.05）,while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ²=43.330,64.600,P<0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan,and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82）,with no significant difference from the pathological diagnosis result of 100.00%（χ²=3.060,P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders,ages,maximum tumor diameter,and lymph node infiltration（P>0.05）．Patients with different pathological types [adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）],degree of cell differentiation [moderate,and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）],clinical stage [I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）] and lymph node metastasis [yes（42.75±4.21）,vs no（35.77±8.13）] CT enhancement had significant difference（t/F=5.243,8.804,84.828,4.378,P<0.05）．The Spearman correlation analysis results showed that pathological type,degree of cell differentiation,clinical stage,lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008）．Conclusions CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis,and the CT enhanced value of patients can be determined through CT enhanced delayed scanning,providing reference for postoperative pathological feature judgment of NSCLC patients．

本文探讨临床药师对口服靶向药物的非小细胞肺癌患者开展药学服务的要点,以案例为依据,通过查阅药品说明书、指南及文献等,分析药学服务的内容和方向。临床药师在安全性评估、剂量调整、个体化治疗方案选择、用药教育和健康宣教等方面为患者和临床医生提供专业、全面的药学服务。临床药师通过全程参与患者的治疗过程,指导患者正确用药、优化治疗方案,利用专业优势解决临床实际问题,提升药学服务质量的同时体现了药师的职业价值。

To explore the key points of pharmaceutical care for non-small cell lung cancer patients with oral targeted drugs．Based on clinical cases,the content and direction of pharmaceutical care were analyzed with drug instructions,guidelines and literature．Clinical pharmacists provided professional and comprehensive pharmaceutical services for patients and clinicians in safety assessment,dose adjustment,individualized treatment plan selection,medication education and health education．Clinical pharmacists participate in the whole treatment process,guide patients to use drugs correctly,optimize treatment plans,use professional advantages to solve clinical practical problems,improve the quality of pharmaceutical care and reflect the professional value of pharmacists．

目的 探讨表皮生长因子受体酪氨酸酶抑制剂（EGFR-TKIs）一线治疗耐药后,二线化学治疗（化疗）联合程序性死亡蛋白1及其配体（PD-1/L1）免疫检查点抑制剂方案对晚期非小细胞肺癌（NSCLC）的疗效。方法 选取2018年 6月—2022年10月期间就诊于南通大学附属肿瘤医院院的80例有完整临床资料、应用EGFR-TKIs耐药后晚期NSCLC患者进行回顾性分析,依照不同治疗方式将患者分为观察组与对照组,均为40例。对照组一线EGFR-TKIs治疗耐药后进行二线化疗,观察组一线EGFR-TKIs治疗耐药后进行二线化疗联合PD-1/L1免疫检查点抑制剂治疗。对比两组临床疗效及无进展生存期（PFS）,化疗前后血清中人细胞角蛋白21-1片段（Cyfra21-1）、糖类抗原125（CA125）、碱性成纤维细胞生长因子（bFGF）、血管内皮生长因子（VEGF）水平变化,不良反应发生率及生存质量。结果 观察组客观缓解率与疾病控制率高于对照组（P<0.05）,对照组PFS为10（2.38,24.13）个月,观察组PFS为14（5.27~,5.27）个月,观察组高于对照组（χ²=4.536,P=0.041）;化疗后两组bFGF、VEGF,CA125、Cyfra21-1肿瘤标志物水平均比化疗前降低,且观察组[（17.85±3.32）ng/L、（310.51±88.37）ng/L、（51.62±13.66）U/mL、（10.26±3.37）ng/mL]低于对照组[（19.62±3.24）ng/L、（366.26±49.42）ng/L、（59.26±9.35）U/mL、（12.62±2.73）ng/mL],对比差异有统计学意义（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）;两组不良反应发生率对比差异无统计学意义（P>0.05）;化疗后两组世界卫生组织生存质量量表简表评分均升高,观察组[（98.62±8.24）、（101.53±12.62）、（95.28±11.15）、（97.79±10.47）分]高于对照组[（84.25±7.32）、（93.58±15.75）、（82.24±9.34）、（83.47±8.38）]分,对比差异有统计学意义（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）。结论 对EGFR-TKIs耐药后晚期非小细胞肺癌患者采取二线化疗联合PD-1/L1免疫检查点抑制剂可提升其临床疗效及生存期,改善血清相关肿瘤标志物表达水平,提升患者生存质量。

Objective To explore the therapeutic effect of second-line chemotherapy combined with PD-1/L1 immune checkpoint inhibitor regimen on advanced non-small cell lung cancer（NSCLC） after epidermal growth factor receptor-tyrosine kinase inhibitors（EGFR-TKIs）resistance in first-line chemotherapy．Methods Retrospectively selected 80 patients with advanced NSCLC EGFR TKIs resistance,who were admitted to the Affiliated Cancer Hospital of Nantong University from June 2018 to October 2022．Patients were divided into an observation group and a control group according to different treatment methods,with 40 cases in each group．The control group received second-line chemotherapy after first-line EGFR-TKIs therapy resistance,while the observation group received second-line chemotherapy and PD-1/L1 inhibitor after first-line EGFR-TKIs therapy reactions and quality of live．Clinical efficacy and PFS,changes in serum levels of human Cyfra21-1,CA125,bFGF,VEGF,incidence of adverse chemotherapy of two groups were compared．Results The ORR and DCR of the observation group were significantly higher than those of the control group（P<0.05）．The mean PFS of the control group was 10（2.38-24.13）months,while the mean PFS of the observation group was 14（5.27-35.27）months．The observation group was higher than the control group（χ²=4.536,P=0.041）．After chemotherapy,levels of bFGF,VEGF,CA125 and Cyfra21-1 tumor markers decreased in both groups,and the observation group [（17.85±3.32）ng/L,（310.51±88.37）ng/L,（51.62±13.66）U/mL,（10.26±3.37）ng/mL] was lower than the control group [（19.62±3.24）ng/L,（366.26±49.42）ng/L,（59.26±9.35）U/mL,（12.62±2.73）ng/mL],which showed statistically significant difference in the comparison（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．After treatment,the WHO QOL-BREF scores increased in both patient groups and the observation group scores[（98.62±8.24）,（101.53±12.62）,（95.28±11.15）,（97.79±10.47）] were higher than the control group scores[（84.25±7.32）,（93.58±15.75）,（82.24±9.34）,（83.47±8.38）],which showed statistically significant difference．（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）．Conclusions The combination of second-line chemotherapy with PD-1/L1 immune checkpoint inhibitors can improve the clinical efficacy and survival of advanced NSCLC patients who are resistant to EGFR-TKIs,improve the expression levels of serum related tumor markers,and enhance the quality of life of patients．

目的 分析非小细胞肺癌化疗患者骨髓抑制发生状况及其影响因素。方法 回顾性分析2017年2月—2019年8月期间本院进行化疗治疗的80例非小细胞肺癌患者临床资料,统计非小细胞肺癌化疗患者骨髓抑制发生情况,并根据其情况分组;收集所有患者临床资料,分析非小细胞肺癌化疗患者骨髓抑制发生的相关影响因素。结果 80例非小细胞肺癌化疗患者中发生骨髓抑制45例,发生率为56.25%;经单因素及多项Logistic回归分析,年龄≥60岁、化疗方案为紫杉醇联合铂类,TNM分期在Ⅲ-Ⅳ期,发生骨转移是非小细胞肺癌化疗患者发生骨髓抑制的影响因素(OR＞1,P＜0.05)。结论 年龄≥60岁、化疗方案为紫杉醇联合铂类,TNM分期在Ⅲ-Ⅳ期,发生骨转移会增加非小细胞肺癌化疗患者骨髓抑制的发生风险,临床上可据此来制定合理的干预措施,以降低患者骨髓抑制的发生风险。

Objective To analyze the occurrence and influencing factors of bone marrow suppression in patients with non-small cell lung cancer (NSCLC) undergoing chemotherapy. Methods The clinical data of 80 patients with NSCLC who received chemotherapy in our hospital from February 2017 to August 2019 were retrospectively analyzed, the occurrence of bone marrow suppression in patients with NSCLC under chemotherapy was enrolled and grouped according to the situation; the clinical data of all patients were collected, the related influencing factors of bone marrow suppression in patients were analyzed. Results Among 80 cases of patients with NSCLC, 45 cases occurred bone marrow suppression, the incidence was 56.25%; after univariate and multivariate Logistic regression analysis, age ≥ 60 years old, chemotherapy of paclitaxel combined with platinum, TNM stage in stage III -IV, the occurrence of bone metastasis were the influencing factors of bone marrow suppression in patients with NSCLC under chemotherapy (OR>1, P<0.05). Conclusions Age ≥ 60 years old, chemotherapy of paclitaxel combined with platinum, TNM stage in stage III -IV, the occurrence of bone metastasis will increase the risk of bone marrow suppression in patients with NSCLC chemotherapy. Therefore, reasonable intervention measures can be carried out to reduce the risk.

目的 探讨气道径向超声(RP-EBUS)引导多维度联合检查对周围型肺癌的诊断价值。方法 选取2019年9月—2021年12月于佛山市第二人民医院确诊的74例周围型肺癌患者,分析RP-EBUS引导肺活检、支气管黏膜刷检、支气管肺泡灌洗细胞学及DNA甲基化检测等多维度联合检查对周围型肺癌的诊断阳性率及影响因素。结果 RP-EBUS引导肺活检、支气管黏膜刷检、支气管肺泡灌洗液细胞学、DNA甲基化检测对周围型肺癌的诊断阳性率分别为52.7%、47.3%、45.9%和51.4%,RP-EBUS引导多维度联合检查阳性率为71.6%,高于单一方法检查(P<0.05);RP-EBUS引导多维度联合检查病灶直径≥30 mm诊断阳性率高于病灶直径＜30 mm (82.9% vs 57.6%),差异有统计学意义(P<0.05);RP-EBUS引导多维度联合检查在肺上叶、中叶/舌叶、下叶病灶的阳性率分别为69.7%、66.7%和76.9%,差异无统计学意义(P>0.05);联合检查中超声探及病灶的诊断阳性率高于超声未探及病灶(76.9% vs 33.3%),差异有统计学意义(P<0.05);病灶超声图像表现为中心均实型的联合检查诊断阳性率高于非中心均实型(86.0% vs 59.1%),差异有统计学意义(P<0.05)。结论 RP-EBUS引导多维度联合检查对周围型肺癌有更高的诊断阳性率,诊断阳性率与病灶大小、超声是否探及病灶及病灶超声图像特征有关,与病灶部位无关。

Objective To investigate the value of radial probe endobronchial ultrasound (RP-EBUS)guided multi-dimensional combined examination in the diagnosis of peripheral lung cancer. Methods A retrospective analysis of 74 patients with peripheral lung cancer which were diagnosed in Foshan Second People's Hospital from September 2019 to December 2021 was carried out. RP-EBUS guided biopsy, brushing biopsy, bronchus alveolar lavage cytology and DNA methylation detection results were analyzed to obtain the positive diagnosis rate and influencing factors. Results The positive rates of RP-EBUS guided biopsy, brushing biopsy, bronchus alveolar lavage cytology and methylation for peripheral lung cancer were 52.7%, 47.3%, 45.9% and 51.4%, respectively. The positive rate of RP-EBUS guided multi-dimensional combined detection was 71.6%, which was significantly higher than single detection (P<0.05). The positive rate of RP-EBUS multi-dimensional combined examination in lesions diameter ≥30 mm was higher than that of lesion diameter ＜30 mm (82.9% vs 57.6%, P<0.05). The positive rate of RP-EBUS guided multi-dimensional combined group in the upper lobe, middle lobe/lingual lobe, and lower lobe of the lung were 69.7%, 66.7% and 76.9%, respectively, with no significant difference (P>0.05). The positive rate of ultrasound detected lesion in combined group was higher than that of undetected lesions (76.9% vs 33.3%, P<0.05). The ultrasound images of solid center lesions had higher positive rates than that of non solid center lesions (86.0% vs 59.1%, P<0.05). Conclusions RP-EBUS guided multi-dimensional combined examination has a higher positive rate for diagnosis of peripheral lung cancer. The positive rate of diagnosis are related to the size of the lesion, whether the lesion is detected by ultrasound and the characteristics of the ultrasound image of the lesion, but not related to the location of the lesion.

目的 探讨非小细胞肺癌（NSCLC）组织中转化生长因子β激活激酶1（TAK-1）与T细胞因子-4（TCF-4）在 mRNA以及蛋白水平的表达情况及其相关性,并分析两者与NSCLC患者临床病理因素的关系。方法 收集NSCLC手术标本51例,每例均包含肺癌组织及配对癌旁组织,所有患者的术后诊断均经病理结果证实,通过RT-PCR以及Western blot法检测TAK1、TCF-4在癌组织及配对癌旁组织中的表达情况,并通过SPSS进一步分析两者的相关性及其与临床病理因素的关系。结果 TAK1与TCF-4 mRNA以及蛋白水平在NSCLC患者癌组织中均高表达,其中TAK1蛋白的表达与NSCLC的TNM分期（P=0.022）、淋巴结转移（P=0.014）相关,TCF-4蛋白的表达与NSCLC的TNM分期相关（P=0.045）。TAK1在NSCLC组织中的表达与TCF-4呈正相关（r=0.427,P=0.002）。结论 TAK1 mRNA及蛋白水平在NSCLC组织中均高表达,并与TCF-4呈正相关,TAK1有可能成为NSCLC诊断及预后的一个潜在靶标,并且TAK1与TCF-4的联合应用有可能成为一种更为理想的NSCLC辅助诊断及临床治疗方法。

Objective To investigate the mRNA and protein expressions of transforming growth factor β-activated kinase 1（TAK1）and T cell factor-4（TCF-4）in non-small cell lung cancer（NSCLC）tissues and their correlation,and to analyze the relationship between TAK1/TCF-4 and clinicopathological factors in NSCLC patients．Methods Cancer tissues and matched adjacent tissues of 51 NSCLC patients in our hospital were collected．The postoperative diagnosis of all patients was confirmed by pathological results．The expression of TAK1 and TCF-4 in cancer tissues and paired adjacent tissues were detected by RT-PCR and Western blot,then SPSS was used to further analyze the correlation between TAK1 and TCF-4 and clinicopathological factors．Results TAK1 and TCF-4 mRNA and protein were highly expressed in NSCLC tissues,and TAK1 protein expression was significantly correlated with TNM stage of NSCLC（P=0.022）and lymph node metastasis（P=0.014）;TCF-4 protein expression was significantly correlated with TNM stage of NSCLC（P=0.045）．TAK1 expression in NSCLC tissues was positively correlated with TCF-4（r=0.427,P=0.002）．Conclusions TAK1 mRNA and protein were highly expressed in NSCLC tissues and positively correlated with TCF-4．TAK1 may become a potential target for the diagnosis and prognosis of NSCLC,and the combined application of TAK1 and TCF-4 may become a more ideal method for the auxiliary diagnosis and clinical treatment of NSCLC．

目的 本研究旨在探讨肺癌合并肺栓塞的相关危险因素及肺栓塞对肺癌患者预后的影响。方法 检索2000年1月—2020年3月万方、中国知网、维普期刊、Medline Pubmed及EMBASE数据库中所有相关文献,并使用RevMan 5.3软件进行统计分析。结果 9项临床病例对照研究共1 179例患者纳入本研究。分析结果显示肺癌合并肺栓塞患者的中位生存时间明显低于单纯肺癌患者(HR=2.82,95%CI[2.06,3.87],P＜0.000 1)。危险因素分析显示腺癌发生肺栓塞的风险高于非腺癌(比值比(OR)=3.07, P＜0.000 1),III-IV期患者发生肺栓塞的风险明显高于I-II期患者(OR=2.97,P＜0.000 1),D-二聚体水平高的患者发生肺栓塞的风险是正常患者的4.32倍(P<0.000 1),白细胞(WBC) >11×109/L的患者发生肺栓塞的风险是WBC≤11×109/L患者的6.62倍(P＜0.000 1)。化疗史和中心静脉置管显著增加肺栓塞风险,OR值分别为3.02 (P＜0.000 1)和2.30 (P＜0.000 1)。然而,吸烟史、饮酒史、性别、糖尿病、COPD、高血压病等临床因素与肺栓塞发生无统计学相关性。结论 肺栓塞的发生明显影响肺癌患者的预后,其相关的危险因素为病理类型、分期、化疗史、中心静脉导管置入史、D-二聚体升高、白细胞＞11×10⁹/L。

Objective To investigate the risk factors of developing pulmonary embolism and its influence on the prognosis of lung cancer patients. Methods The following databases such as Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Weipu Database, Medline Pubmed and EMBASE were searched to identify relevant articles which were published during January 2000 to March 2020. Statistical analysis was performed using RevMan 5.3 software. Results 9 controlled trials incorporating 1 179 patients were included in this study. The results showed that the overall survival of lung cancer patients complicated with pulmonary embolism was significantly lower than that of lung cancer patients without pulmonary embolism (HR=2.82, 95%CI[2.06,3.87], P<0.000 1). The analysis on risk factors of developing pulmonary embolism showed that adenocarcinoma had a higher risk of pulmonary embolism than non-adenocarcinoma with Odds Ratio (OR)=3.07 (P<0.000 1). Patients in stage III-IV encountered significantly higher risk of pulmonary embolism than those in stage I-II (OR=3.07,P<0.000 1). Furthermore, the risk of pulmonary embolism in patients with high level of D-dimer was 4.32 times higher than in normal patients (P<0.000 1), and 6.62 times higher than those with WBC ≤11×10⁹/L (P<0.000 1). Additionally, the history of chemotherapy and central venous catheterization significantly increased the risk of pulmonary embolism, with OR of 3.02 (P<0.000 1) and 2.30 (P<0.000 1), respectively. However, smoking, alcohol consumption, gender, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease, hypertension were not statistical correlated with the occurrence of pulmonary embolism in lung cancer patients. Conclusion The occurrence of pulmonary embolism significantly affects the prognosis of patients with lung cancer, and the related risk factors were pathological type, stage, chemotherapy, central venous catheterization, increased D-dimer level, and WBC>11×10⁹/L.

目的 探讨C反应蛋白(CRP)、降钙素原(PCT)、中性粒细胞计数(NC)及中性粒细胞/淋巴细胞比值(NLR)在肺癌患者化疗后合并细菌感染早期诊断中的意义。方法 收集本院肿瘤科2019年1月—2019年12月肺癌化疗后合并细菌感染患者78例,肺癌化疗后未感染患者64 例,同期健康体检人群39例,采用固相免疫色谱法和速率散射比浊法测定血清中的PCT及CRP 的含量,采用mindray cal8000血细胞分析仪进行血细胞分类计数检查,计算N及NLR。结果 化疗后感染组CRP、PCT、NC及NLR均高于化疗未感染组及健康对照组,差异均有统计学意义(P＜0.01);化疗未感染组与健康对照组CRP、PCT、NC及NLR差异有统计学意义(P＜0.01)。CRP、PCT、NC及NLR联合使用时,其灵敏度为97.507%,而特异度升高为97.15%。细菌感染患者治疗前的PCT、CRP、NC及NLR 与治疗后相比较差异有统计学意义(P<0.05),治疗后低于治疗前。结论 PCT、CRP、NC及NLR联合检测能够提高对肺癌患者化疗后合并细菌感染早期诊断的敏感度和特异度。

Objective To explore the significance of C-reactive protein (CRP), procalcitonin (PCT), neutrophil count (NC) and neutrophil / lymphocyte ratio (NLR) in the early diagnosis of bacterial infection in lung cancer patients after chemotherapy. Methods From January 2019 to December 2019, 78 cases of lung cancer patients with bacterial infection after chemotherapy, 64 cases of uninfected patients after chemotherapy and 39 cases of healthy people in the same period were collected. the contents of PCT and CRP in serum were detected by solid phase immunosorbent assay and rate nephelometry.The NC and NLR were classified and counted by mindray cal8000 hematology analyzer. Results After chemotherapy, CRP, PCT, NC and NLR in the infected group were higher than those in the uninfected group and the healthy control group (P<0.01), while CRP, PCT, NC and NLR in the uninfected group were higher than those in the healthy control group (P<0.01). When CRP, PCT, NC and NLR were used together, the sensitivity was 97.507%, while the specificity increased by 97.15%. The PCT, CRP, NC and NLR of patients with bacterial infection before treatment were lower than those after treatment (P<0.05). Conclusion PCT, CRP, NC and NLR may improve the sensitivity and specificity of early diagnosis of bacterial infection in patients with lung cancer after chemotherapy.

目的 观察重组人血管内皮抑素注射液（恩度） 联合化疗治非小细胞肺癌（NSCLC）的近期疗效和安全性。方法 对2015年3月—2017年10月经病理组织学或细胞学检查确诊的Ⅲ-Ⅳ期NSCLC74例患者,采用随机数字法把受试者随机分为联合治疗组（n=35）和对照组（n=39）,联合治疗组接受恩度联合化疗的方案治疗;对照组单纯行常规化疗治疗。近期疗效评价采用RECIST标准,生活质量（QOL）采用Karnofsky评分（KPS）,抗癌药物急性与亚急性毒性反应分度标准分0~Ⅳ度。比较两组患者的近期疗效指标（疾病完全缓解（CR）、疾病稳定（ SD）、疾病进展（ PD）、客观有效率（RR）、疾病控制率（DCR ）;QOL评分及毒副反应情况。结果 联合治疗组近期疗效指标RR及DCR高于对照组（P < 0.05）;联合治疗组KPS评分高于对照组（P < 0.05）;两组间的毒副作用包括恶心/呕吐、腹泻、疲乏、脱发、血小板下降及白细胞下降等,两组间毒副反应出现数量比较,差异无统计学意义（P > 0.05）。结论 恩度与化疗药物联合使用可以提高NSCLC疗效和改善患者生活质量,未增加患者不良反应发生率。

Objective To observe the curative effect and the side effects of recombinant human vascular endostatin （Endostar） combined with the chemotherapy on nonsmall cell lung cancer（NSCLC）. Methods Seventy-four NSCLC patients confirmed by histopathology or cytopathology were randomly distributed to combined therapy group （n=35, with Endostar combined with chemotherapy） and control group （n=39, with conventional chemotherapy）. The recent efficacy of drug was evaluated according to the RECIST criteria. The quality of life （QOL） was assessed by usingto the Karnofsky scores, and the safety of drug was evaluated according to WHO side effects criteria. Results The therapeutic effectiveness was better in the combined therapy group than that in the control group（P<0.01）. The KPS was better in co-therapy group than that in the control group（P<0.05）. The common adverse reactions in both groups included neutropenia, thrombocytopenia, nausea/vomiting, diarrhea, lassitude, alopecia, thrombocytopenia and leukocytopenia. However, the incidence rates of adverse reactions between the two group was not significant （P>0.05）. Conclusion Endostar combined with the related chemotherapy may improve the curative effect and QOL of NSCLC.