戈舍瑞林联合比卡鲁胺治疗晚期前列腺癌的疗效及对免疫功能和生活质量的影响

目的 探讨戈舍瑞林联合比卡鲁胺治疗晚期前列腺癌（PCa）的疗效及对免疫功能和生活质量的影响。方法 选取2016年1月至2018年9月本院收治的94例晚期PCa患者，按照随机数字表法将其分为对照组（47例）和观察组（47例）。对照组采用戈舍瑞林联合比卡鲁胺持续性治疗，观察组采用戈舍瑞林联合比卡鲁胺间歇性治疗。比较两组患者治疗前和治疗9个月后的血清前列腺特异抗原(PSA)、游离PSA（F-PSA）水平和免疫功能指标（CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺）的变化。观察两组患者的临床疗效及不良反应发生情况以及治疗前和治疗9个月后的生活质量。结果 观察组治疗后的总有效率87.2%(41/47)]明显优于对照组68.1%(32/47)]（P<0.05）。两组治疗后的血清PSA及F-PSA水平均明显低于治疗前（P<0.05），而两组治疗后的血清PSA（4.63±1.08）vs.（5.26±1.24）ng/mL]及F PSA（1.04±0.20）vs.（1.18±0.25）ng/mL]水平比较，差异均无统计学意义（P>0.05）。两组治疗后的CD3⁺、CD4⁺及CD4⁺/CD8⁺均明显高于治疗前（P<0.05），而CD8⁺明显低于治疗前（P<0.05）。两组治疗后的CD3⁺、CD4⁺、CD8⁺及CD4⁺/CD8⁺比较，差异均无统计学意义（P>0.05）。两组治疗后的性功能、泌尿功能、肠道功能及激素功能评分均明显低于治疗前（P<0.05），且观察组治疗后的性功能、泌尿功能、肠道功能及激素功能评分均明显高于对照组（P<0.05）。观察组治疗期间的不良反应发生率19.1%(9/47)]明显低于对照组44.7%(21/47)]（P<0.05）。结论 戈舍瑞林联合比卡鲁胺间歇性给药治疗晚期PCa的临床疗效显著优于持续性给药，其能改善患者的生活质量和降低不良反应的发生率。

Effect of goserelin combined with bicalutamide in the treatment of advanced prostate cancer and its impact on immune function and quality of life

Objective  To investigate the efficacy of goserelin combined with bicalutamide in the treatment of advanced prostate cancer (PCa) and its effect on immune function and quality of life. Methods  From January 2016 to September 2018, 94 patients with advanced PCa admitted to our hospital were divided into control group (47 cases) and observation group (47 cases) according to random number table method. The control group was treated intermittently with goserelin combined with bicalutamide, while the observation group was treated intermittently with goserelin combined with bicalutamide. The changes of serum prostate specific antigen (PSA), free PSA (F-PSA) levels and immune function indexes (CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺) were compared between the two groups before treatment and nine months after treatment. The clinical efficacy and adverse reactions of the two groups were observed, and the quality of life before and after treatment for nine months were observed. Results  The total effective rate of the observation group (87.2% vs. 68.1%) after treatment was significantly better than that of the control group (P<0.05). The levels of serum PSA and F-PSA in the observation group and the control group after treatment were significantly lower than those before treatment (P<0.05), while there were no significant difference in the levels of serum PSA（4.63±1.08) ng/mL vs. (5.26±1.24) ng/mL] and F-PSA(1.04±0.20) ng/mL vs. (1.18±0.25) ng/mL]between the observation group and the control group after treatment (P>0.05). The levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the observation group and the control group were significantly higher than those before treatment (P<0.05), while the levels of CD8⁺ in the two groups were significantly lower than those before treatment (P<0.05). The scores of sexual function, urinary function, intestinal function and hormone function in observation group and control group after treatment were significantly lower than those before treatment (P<0.05). After treatment, the scores of sexual function (82.64±4.37)score vs.(76.40±4.25)score], urinary function (38.74±4.06) score vs. (29.62±3.58)] score, intestinal function (86.50±8.20) score vs. (78.35±7.42)score], and hormone function (76.52±7.48)score vs. (66.40±6.82)score] in the observation group were significantly higher than those in the control group (P<0.05). The incidence of adverse reactions in the observation group (19.1% vs. 44.7%) was significantly lower than that in the control group(P<0.05). Conclusions  The clinical efficacy of intermittent administration of goserelin combined with bicalutamide in the treatment of advanced PCa is significantly better than that of continuous administration, which can improve the quality of life of patients and reduce the incidence of adverse reactions.