Abstract: Objective　To analyze the clinical effect of apatinib combined with tegafur in the treatment of patients with advanced gastric cancer, and to observe the effect of the combination regimen on the levels of inflammatory factors and the cytokines of T helper 1 cells (Th1) and T helper 2 cells (Th2). Methods　Eighty-eight patients with advanced gastric cancer who were admitted to Department of Gastroenterology, Liaocheng Second People's Hospital from March 2019 to February 2020 was selected for the study. They were divided into a control group and an observation group by the random number table method, with 44 cases in each group. There were 24 males and 20 females in the control group; they were (65.25±2.42) years old; they were treated with tegafur. There were 25 males and 19 females in the observation group; they were (65.33±2.35) years old; they were treated with tegafur and apatinib. χ² test was used for the enumeration data, and t test for the measurement data. The clinical efficacies, serum tumor marker levels before and after the treatment, Th1 and Th2 cytokine levels, adverse reactions, and survival were compared between the two groups. Results　The disease control rate (DCR) was 59.09% (26/44) in the control group, and was 79.55% (35/44) the observation group, with a statistical difference (χ²=4.328, P=0.037). The levels of cancer-associated carbohydrate antigen (CA19-9), carcinoembryonic antigen (CEA), and tumor-specific growth factor (TSGF) after the treatment were (9.20±4.23) U/ml, (2.53±0.41) μg/L, and (61.75±14.25) U/ml in the control group, and were (4.98±2.87) U/ml, (1.96±0.39) μg/L, and (53.20±16.37) U/ml in the observation group, with statistical differences between these two groups (t=5.476, 6.682, and 2.613; all P<0.05). After the treatment, the levels of interferon-γ (INF-γ), tumour necrosis factor-α (TNF-α), interleukin (IL)-4, and IL-10 were (9.83±1.68) μg/L, (4.98±0.83) pg/ml, (5.62±1.58) μg/L, and (12.83±2.41) μg/L in the control group, and were (12.45±1.65) μg/L, (6.12±1.47) pg/ml, (3.18±1.17) μg/L, and (8.76±2.11)  μg/L in the observation group, with statistical differences between these two groups (t=7.380, 4.479, 8.232, and 8.428; all P<0.05). The median progression time and survival time were (7.23±1.31) months and (5.10±1.39) months in the control group, and were (5.31±0.75) months and (9.33±2.54) months in the observation group, with statistical differences (t=8.437 and 9.691; both P<0.05). Conclusion　Apatinib combined with tegafur in the treatment of patients with advanced gastric cancer can effectively improve their clinical symptoms and signs, the levels of serum tumor markers, and Th1 and Th2 cytokines, and does not increase the incidence of adverse reactions, and the patients have better survival.

Key words: Apatinib, Tegafur, Advanced gastric cancer, Curative effect, Tumor markers, Th1 and Th2 cytokine levels, Survival rate

摘要：

目的　分析阿帕替尼联合替吉奥治疗晚期胃癌患者的临床效果，观察该联合用药方案对炎性因子、辅助型T细胞1（T helper 1 cell，Th1）和辅助型T细胞2（T helper 2 cell，Th2）类细胞因子水平的影响。方法　选取聊城市第二人民医院消化内科自2019年3月至2020年2月收治的晚期胃癌88例，采取随机数字表法分为对照组与观察组，各44例。对照组中男24例，女20例，年龄（65.25±2.42）岁，给予替吉奥治疗；观察组中男25例，女19例，年龄为（65.33±2.35）岁，在对照组基础上加用阿帕替尼行联合治疗。计数资料采用χ²检验，计量资料采取t检验，对比两组临床疗效、治疗前后血清肿瘤标志物水平、Th1和Th2细胞因子水平、不良反应以及生存情况。结果　对照组疾病控制率（DCR）为59.09%（26/44），观察组DCR为79.55%（35/44），差异有统计学意义（χ²=4.328，P=0.037）。治疗后，对照组癌相关糖类抗原（CA）19-9、癌胚抗原（CEA）及肿瘤特异生长因子（TSGF）水平分别为（9.20±4.23）U/ml、（2.53±0.41）μg/L、（61.75±14.25）U/ml，观察组CA19-9、CEA及TSGF水平分别为（4.98±2.87）U/ml、（1.96±0.39）μg/L、（53.20±16.37）U/ml，两组比较，差异均有统计学意义（t=5.476、6.682、2.613，均P<0.05）。治疗后，对照组γ-干扰素（INF-γ）、肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-4和IL-10水平分别为（9.83±1.68）μg/L、（4.98±0.83）pg/ml、（5.62±1.58）μg/L、（12.83±2.41）μg/L，观察组分别为（12.45±1.65）μg/L、（6.12±1.47）pg/ml、（3.18±1.17）μg/L、（8.76±2.11）μg/L，差异均有统计学意义（t=7.380、4.479、8.232、8.428，均P<0.05）。对照组中位进展时间、中位生存期分别为（7.23±1.31）个月、（5.10±1.39）个月，观察组分别为（5.31±0.75）个月、（9.33±2.54）个月，差异均有统计学意义（t=8.437、9.691，均P<0.05）。结论　阿帕替尼联合替吉奥治疗晚期胃癌患者可有效改善患者的临床症状及体征，改善血清肿瘤标志物、Th1和Th2细胞因子水平，生存情况更好，同时在治疗期间并不会增加不良反应，安全性较高。

关键词: 阿帕替尼, 替吉奥, 晚期胃癌, 疗效, 肿瘤标志物, Th1和Th2细胞因子水平, 生存率