Background and purpose:At present, the advanced lung adenocarcinoma is mainly treated by chemotherapy-oriented comprehensive therapy. Pemetrexed as a multi-target antifolate chemotherapeutic drug, combined with platinum, was approved for treatment of advanced lung adenocarcinoma because of its low toxicity and high efifcacy. The purpose of this study was to compare the short-term clinical efifcacy and toxicity of pemetrexed and docetaxel combined with cisplatin for advanced lung adenocarcinoma.Methods:Fifty patients with stageⅢ-Ⅳ lung adenocarcinoma were randomly divided into two groups. Group PC received pemetrexed (500 mg/m2, d1) combined with cisplatin (75 mg/m2, d1) and group TP received docetaxel (75mg/ m2, d1) combined with cisplatin (75 mg/m2, d1) treatment. One cycle was 21 days in both two groups. The response rate (RR), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) of the two groups were compared. The peripheral blood T lymphocyte subsets and natural killer (NK) cell activity of patients in both groups were measured before and after the treatment, while compared with healthy controls (25 cases).Results:Among 50 patients, no one got complete remission (CR), 20 patients got partial remission (PR), 17 patients had stable disease (SD) and 13 patients had progressive disease (PD).It showed no signiifcant difference in RR, DCR, PFS and OS (P>0.05) between two groups. Compared with group TP, the activity of CD3+, CD4+, CD4+/CD8+ T cells and NK cells increased and CD8+ T cells reduced in group PC after treatment, but the value had no obvious change (P>0.05). The common side effects were hematological toxicity and gastrointestinal response. The incidence of side effects in group PC was lower than that in group TP, and the degree was also slighter (P<0.05).Conclusion:The clinical efifcacy of pemetrexed combined with cisplatin is equal to docetaxel combined with cisplatin in treatment of advanced lung adenocarcinoma, but the former could reduce the adverse reaction rate.

Objective: To explore the role of D-dimer level in patients with acute exacerbation of chronic obstructive disease (AECOPD) in predicting the re-admission of patients. Methods: One hundred and twenty chronic obstructive pulmonary disease (COPD) patients in the Shanghai General Hospital of Shanghai Jiao Tong University form January 2016 to December 2018 were divided into AECOPD group (62 cases) and stable COPD group (58 cases).The level of serum D-dimer was analyzed and Pearson correlation analysis was performed with the patient′s blood gas analysis and COPD assessment test (CAT) score. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum D-dimer level for readmission. Results: Serum D-dimer level was significantly higher in AECOPD group than that in stable group: (1.24 ± 0.56) mg/L vs. (0.39 ± 0.22) mg/L, and there was statistical difference (P<0.01). Serum D-dimer level was negatively correlated with PaO₂ in COPD patients (r = 0.712, P = 0.000), but positively correlated with PaCO₂ (r = 0.683, P = 0.000) and CAT score (r = 0.652, P = 0.000). The area under the ROC curve of D-dimer level to re-admission of COPD patients within one year was 0.848. The cutoff value was 1.015 mg/L. Conclusions The level of D-dimer in COPD patients is of great value in predicting the re-admission of patients, which can be used as an independent indicator of disease progression.