【目的】探讨沙参麦冬汤加减联合卡瑞利珠单抗+化疗对晚期非小细胞肺癌（NSCLC）患者疗效、生存状态及血清细胞角 蛋白19片段（CYFRA21-1）、神经元特异性烯醇化酶（NSE）水平的影响。【方法】将40例晚期NSCLC肺胃阴虚、热毒炽盛型患 者随机分为对照组和研究组，每组各20例。对照组患者给予卡瑞利珠单抗+化疗治疗，研究组患者给予沙参麦冬汤加减联合 卡瑞利珠单抗+化疗治疗，21 d为1个疗程，共治疗4个疗程。观察2组患者治疗前后血清NSE、CYFRA21-1水平的变化情 况，比较2组患者的临床疗效、生存状态及毒副反应发生情况。【结果】（1）治疗4个疗程后，研究组的总有效率为70.00% （14/20），较对照组的45.00%（9/20）明显升高，但组间比较（χ2检验），差异无统计学意义（P＞0.05）。（2）经过2年的随访，研 究组患者的总生存期（OS）、肿瘤发生进展时间（TTP）、无进展生存期（PFS）均较对照组明显延长（P＜0.01）。（3）治疗后，2组 患者的血清NSE、CYFRA21-1水平均较治疗前降低（P＜0.05），且研究组对血清NSE、CYFRA21-1水平的降低幅度均明显优 于对照组（P＜0.01）。（4）研究组的毒副反应发生率为25.00%（5/20），明显低于对照组的65.00%（13/20），组间比较，差异有统 计学意义（P＜0.05）。【结论】沙参麦冬汤加减联合卡瑞利珠单抗+化疗方案对晚期NSCLC患者具有良好的治疗效果，能够减 轻化疗毒副反应，降低血清肿瘤标志物水平，延长患者的生存期及肿瘤发生进展时间。

Objective To investigate the influence of modified Shashen Maidong Decoction combined with Camrelizumab immunotherapy plus chemotherapy on the efficacy， survival status and serum cytokeratin 19 fragment（CYFRA21-1）and neuron-specific enolase（NSE）levels in patients with advanced non-small cell lung cancer（NSCLC）. Methods Forty patients with advanced NSCLC of lung-stomach yin deficiency with intense heattoxin type were randomly divided into a control group and a study group， with 20 patients in each group. The patients in the control group were given Camrelizumab immunotherapy plus chemotherapy，and the patients in the study group were given modified Shashen Maidong Decoction combined with Camrelizumab immunotherapy plus chemotherapy，with 21 days as a course of treatment and for a total of 4 courses of treatment. The changes of serum 广州中医药大学学报 Journal of Guangzhou University of Traditional Chinese Medicine 2024年3月第41卷第3期 606 March 2024，Vol. 41，No. 3 NSE and CYFRA21- 1 levels in the two groups before and after treatment were observed， and the clinical efficacy， survival status and the incidence of toxic and side effects were compared between the two groups. Results（1）After 4 courses of treatment，the total effective rate of the study group was 70.00%（14/20），which was significantly higher than that of the control group（9/20，45.00%），but the intergroup comparison（tested by chi-square test）showed that the difference was not statistically significant（P＞0.05）.（2）After 2 years of followup， the overall survival（OS），time to progression（TTP），and progression-free survival（PFS）of the patients in the study group were significantly prolonged compared with those in the control group（P＜0.01）.（3）After treatment，the serum NSE and CYFRA21-1 levels of the patients in the two groups were decreased compared with those before treatment（P＜0.05），and the decrease of serum NSE and CYFRA21-1 levels in the study group was significantly superior to that in the control group（P＜0.01）.（4）The incidence of toxic and side effects in the study group was 25.00%（5/20），which was significantly lower than that of 65.00%（13/20）in the control group，and the intergroup comparison showed that the difference was statistically significant（P＜0.05）. Conclusion Modified Shashen Maidong Decoction combined with Camrelizumab immunotherapy plus chemotherapy has satisfactory therapeutic effect on patients with advanced NSCLC， which can reduce the toxic and side effects of chemotherapy，lower the level of serum tumor markers，and prolong the survival period and time to progression （TTP）of the patients

R273.342

河北省中医药管理局科研计划项目（编号：2022669）