2025 年第 12 期 第 20 卷

注射用紫杉醇（白蛋白结合型）联合吡咯替尼治疗人表皮生长因子受体2阳性乳腺癌伴肺转移的效果及预后分析

Analysis of the efficacy and prognosis of paclitaxel for injection (albumin-bound) combined with pyrotinib in the treatment of human epidermal growth factor receptor 2 positive breast cancer with lung metastasis

作者：张胜尧叶江涛刘辉姜丽娜张维

英文作者：Zhang Shengyao Ye Jiangtao Liu Hui Jiang Lina Zhang Wei

单位：河北医科大学附属沧州市中心医院甲状腺乳腺外科,沧州061000

英文单位：Department of Thyroid and Breast Surgery Cangzhou Central Hospital Hebei Medical University Cangzhou 061000 China

关键词：乳腺癌；人表皮生长因子受体2；注射用紫杉醇（白蛋白结合型）；吡咯替尼；预后

英文关键词：Breastcancer;Humanepidermalgrowthfactorreceptor2;Paclitaxelforinjection(albumin-bound);Pyrotinib;Prognosis

• 摘要：

• 目的 探究注射用紫杉醇（白蛋白结合型）联合吡咯替尼治疗人表皮生长因子受体2（HER-2）阳性乳腺癌伴肺转移患者的效果及预后分析。方法 选取2023年1月至2024年1月河北医科大学附属沧州市中心医院肿瘤科收治的80例HER-2阳性乳腺癌且伴有肺转移的患者，按照随机数字表法分为对照组和观察组，各40例。对照组给予注射用紫杉醇（白蛋白结合型）静脉注射治疗，观察组在对照组基础上联合吡咯替尼治疗，以21 d为1个治疗周期，共治疗4个周期。评估2组治疗效果，以流式细胞术和化学发光免疫分析法分别检测治疗前后的T淋巴细胞亚群水平和血清肿瘤标志物癌胚抗原、糖类抗原153（CA153）水平。2组治疗前后的生存质量依据中国癌症患者化学生物治疗生存质量量表（QLQ-CCC）评价。记录2组患者治疗期间不良反应及2组治疗随访1年后的总体生存率。结果 观察组疾病控制率高于对照组［95.0%(38/40)比77.5%(31/40)］，差异有统计学意义（P=0.023）。治疗前，2组各项免疫指标、癌胚抗原、CA153水平比较，差异均无统计学意义（均P＞0.05）。治疗后，观察组的CD+8细胞水平低于对照组，而CD+4、CD+3细胞水平和CD+4/CD+8比值均高于对照组（均P＜0.05）。治疗后，2组癌胚抗原、CA153水平均显著低于治疗前，且观察组均低于对照组（均P＜0.05）。治疗后，2组QLQ-CCC评分均显著高于治疗前且观察组显著高于对照组［（83±9）分比（72±8）分］（均P＜0.05）。2组不良反应发生率比较，差异无统计学意义（P=0.157）。截至2025年5月随访结束，观察组生存率为95.0%（38/40），对照组生存率为77.5%（31/40）。2组患者生存曲线比较，差异有统计学意义（Log-rank χ2=5.165，P=0.023）。结论 注射用紫杉醇（白蛋白结合型）联合吡咯替尼治疗HER-2阳性乳腺癌伴肺转移具有显著的效果，能够有效调节细胞免疫功能，降低血清肿瘤标志物水平，提高患者的生存质量，改善患者预后，且不良反应可管理、可耐受，具有较好的安全性。

• Objective To investigate the efficacy and prognosis of paclitaxel for injection (albumin-bound) combined with pyrotinib in the treatment of human epidermal growth factor receptor 2 (HER-2) positive breast cancer with lung metastasis. Methods A total of 80 patients with HER-2 positive breast cancer and lung metastasis admitted to the Department of Oncology, Cangzhou Central Hospital, Hebei Medical University from January 2023 to January 2024 were selected. According to the random number table method, they were divided into the control group and the observation group, with 40 cases in each group. The control group was treated with paclitaxel for injection (albumin-bound) intravenous injection, and the observation group was treated with pyrotinib on the basis of the control group, with 21 d as a treatment cycle, a total of 4 cycles of treatment. The therapeutic effects of the two groups were evaluated. The levels of T lymphocyte subsets and serum tumor markers carcinoembryonic antigen and carbohydrate antigen 153 (CA153) were detected by flow cytometry and chemiluminescence immunoassay before and after treatment, respectively. The quality of life of the two groups before and after treatment was evaluated according to the Quality of life of Chemobiological Therapy scale for Cancer patients in China (QLQ-CCC). The adverse reactions during treatment and the overall survival rate of the two groups after 1-year follow-up were recorded. Results The disease control rate of the observation group was higher than that of the control group ［95.0%(38/40) vs 77.5%(31/40)］(P=0.023). Before treatment, there were no significant differences in the levels of immune indexes, carcinoembryonic antigen and CA153 between the two groups (all P＞0.05). After treatment, the level of CD+8 cells in the observation group was lower than that in the control group, while the levels of CD+4, CD+3 cells and CD+4/CD+8 ratio were higher than those in the control group (all P＜0.05). After treatment, the levels of CEA and CA153 in the two groups were significantly lower than those before treatment, and those in the observation group were lower than those in the control group (all P＜0.05). After treatment, the QLQ-CCC scores of the two groups were significantly higher than those before treatment, and that in the observation group was significantly higher than that in the control group ［(83±9) vs (72±8)］(all P＜0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P=0.157). At the end of follow-up in May 2025, the survival rate of the observation group was 95.0%(38/40), and the survival rate of the control group was 77.5%(31/40). There was statistically significant difference in the survival curve between the two groups (Log-rank χ2=5.165, P=0.023). Conclusion Paclitaxel for injection (albumin-bound) combined with pyrotinib in the treatment of HER-2 positive breast cancer with lung metastasis has a significant effect, which can effectively regulate cellular immune function, reduce serum tumor marker levels, improve the quality of life of patients, improve the prognosis of patients, and the adverse reactions can be managed and tolerated, with good safety.