免疫治疗对老年非小细胞肺癌合并COPD病人气道高反应和肺功能的影响

doi:10.3969/j.issn.1003-9198.2022.05.010

摘要/Abstract

摘要： 目的探讨程序性细胞死亡受体1/程序性细胞死亡配体1(PD-1/PD-L1)抑制剂治疗对老年非小细胞肺癌(NSCLC)合并COPD病人气道高反应和肺功能的影响。方法纳入30例接受PD-1/PD-L1抑制剂免疫治疗的NSCLC病人,分为合并COPD组和未合并COPD组,收集治疗前后呼出气一氧化氮(FeNO)和肺功能指标,并进行统计学分析。结果 30例病人中19例合并COPD,11例未合并COPD。治疗前,2组FeNO水平差异无统计学意义(P>0.05);治疗后,COPD组FeNO水平较治疗前显著升高,且明显高于非COPD组,差异均有统计学意义(P<0.01)。COPD组治疗后FEV1、FVC水平较治疗前均明显升高(P<0.05)。非COPD组治疗前后FVC和FEV1水平比较,差异无统计学意义(P>0.05)。2组治疗前后改良呼吸困难指数(mMRC)问卷评分或COPD评估测试(CAT)评分差异均无统计学意义(P>0.05),治疗期间无COPD急性加重发生。结论 PD-1/PD-L1抑制剂免疫治疗可改变NSCLC合并COPD病人的FeNO水平和肺功能,且不会使COPD恶化。

关键词: 程序性细胞死亡受体1/程序性细胞死亡配体1抑制剂, 非小细胞肺癌, 慢性阻塞性肺疾病, 呼出气一氧化氮, 肺功能

Abstract: Objective To investigate the effects of programmed death-1(PD-1)/ programmed death-ligand 1(PD-L1) inhibitor treatment on airway hyperresponsiveness and lung function in the elderly patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD). Methods A total of 30 NSCLC patients who received PD-1 / PD-L1 inhibitor immunotherapy were divided into COPD group and non-COPD group. The levels of fractional exhaled nitric oxide(FeNO) and the lung function indexes were collected and compared. Results Among the 30 patients, 19 cases were complicated with COPD and 11 cases were not complicated with COPD. There was no statistical difference in the level of FeNO between the COPD group and the non-COPD group before treatment (P>0.05).The level of FeNO was increased significantly in the COPD group affter treatment, and the difference between the two groups was statistically significant(P<0.01).After treatment, the levels of FEV1 and FVC were increased significantly in the COPD group(P<0.05). However, there was no statistically significant difference in FVC and FEV1 before and after treatment in the non-COPD group (P>0.05). There were no significant differences in scores of Modified Medical Research Conncil (mMRC) questionnaire and COPD Assessment Test(CAT) between the two groups before and after treatment (P>0.05). Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was not observed during treatment. Conclusions PD-1/PD-L1 inhibitor immunotherapy can change FeNO level and pulmonary function in the NSCLC patients with COPD, and will not worsen COPD.

Key words: programmed death-1/ programmed death-ligand 1 inhibitors, non-small cell lung cancer, chronic obstructive pulmonary disease, fractional exhaled nitric oxide, pulmonary function

中图分类号:

霍树芬, 尚文丽, 田应选, 孙莉, 任小平, 王君, 康慧芳, 温红侠. 免疫治疗对老年非小细胞肺癌合并COPD病人气道高反应和肺功能的影响[J]. 实用老年医学, 2022, 36(5): 473-477.

HUO Shu-fen, SHANG Wen-li, TIAN Ying-xuan, SUN Li, REN Xiao-ping, WANG Jun, KANG Hui-fang, WEN Hong-xia. Effects of immunotherapy on airway hyperresponsiveness and pulmonary function in elderly patients with non-small cell lung cancer complicated with COPD[J]. Practical Geriatrics, 2022, 36(5): 473-477.

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