【目的】 分析华蟾素片联合雷替曲塞治疗晚期胃癌的疗效及其对患者血清 Dickkopf 相关蛋白 1（DKK-1）、环氧合酶 2 （COX2）水平的影响。【方法】 选择2022年1月到2024年3月空军军医大学第二附属医院收治的140例胃热炽盛型晚期胃癌患 者作为研究对象，按照用药方式不同分为对照组63例和研究组77例，其中对照组给予雷替曲塞治疗，研究组给予华蟾素片 联合雷替曲塞治疗，2组均以 3周为 1个疗程，共治疗 2个疗程。观察 2组患者治疗前后血中辅助性 T 细胞（Th17）、调节性 T 细胞（Treg）及血清 DKK-1、COX2 和肿瘤标志物癌胚抗原（CEA）、糖类抗原（CA）199、CA242、CA724 表达水平的变化情 况，并比较 2组患者的临床疗效和不良反应发生情况。【结果】（1）疗效方面，治疗 2个疗程后，研究组的客观缓解率（ORR） 和疾病控制率（DCR）分别为 46.75%（36/77）、80.52%（62/77），均显著高于对照组的 26.98%（17/63）、55.56%（35/63），组间 比较（χ2 检验），差异均有统计学意义（P＜0.05 或 P＜0.01）。（2）血清 DKK-1、COX2 水平方面，治疗后，2 组患者的血清 DKK-1、COX2水平均较治疗前明显下降（P＜0.05），且研究组对血清DKK-1、COX2水平的下降幅度均明显优于对照组（P＜ 0.05或P＜0.01）。（3）T细胞水平方面，治疗后，2组患者血中Th17和Treg水平均较治疗前明显下降（P＜0.05），且研究组对血 中Th17和Treg水平的下降幅度均明显优于对照组（P＜0.05或P＜0.01）。（4）肿瘤标志物方面，治疗后，2组患者的血清CEA、 CA199、CA724、CA242水平均较治疗前明显下降（P＜0.05），且研究组对血清 CEA、CA199、CA724、CA242水平的下降幅 度均明显优于对照组（P＜0.05或P＜0.01）。（5）不良反应方面，治疗期间，研究组的胃肠道反应、肝功能损害、白细胞减少、 血小板减少等不良反应发生率均明显低于对照组，组间比较，差异均有统计学意义（P＜0.05或P＜0.01）。【结论】 使用华蟾素 片联合雷替曲塞治疗胃热炽盛型晚期胃癌患者效果显著，可有效缩小瘤体，改善患者免疫功能，降低血清DKK-1、COX2和肿 瘤标志物水平，减少不良反应发生率。

Objective To analyze the efficacy of Huachansu Tablets combined with raltitrexed in the treatment of advanced gastric cancer and its impact on serum levels of Dickkopf-related protein 1（DKK-1） and cyclooxygenase-2（COX2）. Methods A total of 140 patients with advanced gastric cancer of exuberance of stomach heat syndrome admitted to the Second Affiliated Hospital of Air Force Medical University from January 2022 to March 2024 were selected as the studying subjects. The patients were divided into a control group （63 cases）and a study group （77 cases） based on the treatment regimens. The control group received raltitrexed monotherapy， while the study group received Huachansu Tablets combined with raltitrexed. Both groups were treated for 2 cycles， with 3 weeks per cycle. Changes in levels of helper T cells （Th17），regulatory T cells （Treg），serum DKK-1， COX2，and tumor markers including carcinoembryonic antigen （CEA），carbohydrate antigen （CA）199，CA242， and CA724 were observed before and after treatment. Clinical efficacy and the incidence of adverse reactions were compared between the two groups. Results （1） Regarding efficacy， after 2 cycles of treatment， the objective response rate（ORR） and disease control rate（DCR） in the study group were 46.75%（36/77） and 80.52%（62/77）， respectively， significantly higher than 26.98% （17/63） and 55.56% （35/63） in the control group. Intergroup comparisons （by chi-square test） showed statistically significant differences （P＜0.05 or P＜0.01）.（2） Regarding serum DKK-1 and COX2 levels，after treatment，serum levels of DKK-1 and COX2 were significantly decreased in both groups compared with those before treatment （P＜0.05）， and the reduction in the study group was significantly greater than that in the control group （P＜0.05 or P＜0.01）.（3） Regarding T-cell levels， after treatment，levels of Th17 and Treg in blood were significantly decreased in both groups compared with those before treatment （P＜0.05），and the reduction in the study group was significantly greater than that in the control group （P＜0.05 or P＜0.01）.（4） Regarding tumor markers，after treatment，serum levels of CEA，CA199，CA724， and CA242 were significantly decreased in both groups compared with those before treatment （P＜0.05），and the reduction in the study group was significantly greater than that in the control group （P＜0.05 or P＜0.01）. （5）Regarding adverse reactions， the incidences of gastrointestinal reactions， liver function impairment， leukopenia，and thrombocytopenia during treatment were significantly lower in the study group than in the control group，with statistically significant differences between groups（P＜0.05 or P＜0.01）. Conclusion The combination of Huachansu Tablets and raltitrexed demonstrates significant efficacy in treating patients with advanced gastric cancer of exuberance of stomach heat syndrome. It effectively reduces tumor size， improves immune function， lowers serum levels of DKK-1，COX2，and tumor markers，and reduces the incidence of adverse reactions.

R273.352

陕西省自然科学基金基础研究计划项目（编号：2020JQ-863）