扶正解毒祛浊法方药联合EC化疗方案治疗广泛期小细胞肺癌患者的回顾性研究

A retrospective study of Fuzheng Jiedu Quzhuo prescription combined with EC chemotherapy in patients with extensive-stage small cell lung cancer

关键词:  扶正解毒祛浊法  广泛期小细胞肺癌  依托泊苷  卡铂  淋巴细胞亚群  炎性细胞因子

Key words:  Fuzheng Jiedu Quzhuo prescription  extensive-stage small cell lung cancer  etoposide  carboplatin  lymphocyte subsets  inflammatory cytokines

摘要:

[目的] 观察扶正解毒祛浊法方药联合化疗对广泛期小细胞肺癌（ES-SCLC）患者免疫功能及临床疗效的影响。[方法] 采用回顾性研究方法，通过电子病历系统收集2022年1月1日—2023年6月30日于天津中医药大学第一附属医院肿瘤科住院治疗的符合纳排标准的广泛期小细胞肺癌患者60例，根据患者化疗期间是否联用扶正解毒祛浊法方药治疗，将其分为暴露组30例和非暴露组30例，观察扶正解毒祛浊法方药联合化疗对ES-SCLC患者无进展生存期、客观缓解率、淋巴细胞亚群、细胞因子、中医证候、karnofsky生活质量评分（KPS）及化疗相关不良反应的影响。[结果] 远期疗效比较，暴露组与非暴露组比较中位无进展生存期（mPFS）显著延长（P＜0.05）；近期疗效比较，疾病控制率（ORR）差异无统计学意义（P＞0.05）。在免疫功能方面，淋巴细胞亚群比较，暴露组较非暴露组CD31、CD4⁺T淋巴细胞、NK细胞明显上升，调节T细胞（Treg）细胞下降，差异具有统计学意义（P＜0.05）；炎性细胞因子表达影响的比较显示，治疗后白细胞介素（IL）-4、IL-6、IL-10血清水平暴露组较非暴露组明显降低，干扰素-γ（IFN-γ）暴露组较非暴露组升高，差异具有统计学意义（P＜0.05）。临床症状方面，与非暴露组比较，暴露组中医证候评分及KPS评分均明显改善，化疗相关白细胞减少、胃肠道反应明显减少，差异具有统计学意义（P＜0.05）。[结论] 扶正解毒祛浊法方药联合化疗与单纯化疗相比，能够提高ES-SCLC患者免疫功能，辅助化疗增效减毒，一定程度上改善患者的生活质量。

Abstract:

[Objective] To observe the effect of Fuzheng Jiedu Quzhuo prescription combined with chemotherapy on the immune function and clinical efficacy of patients with Extensive Stage Small Cell Lung Cancer(ES-SCLC). [Methods] A retrospective study was conducted to collect 60 patients with extensive-stage small cell lung cancer who met the inclusion criteria and were hospitalized in the department of oncology of The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 1,2022 to June 30,2023 through the electronic medical record system. According to whether the patients were treated with Fuzheng Jiedu Quzhuo prescription during chemotherapy,they were divided into 30 cases in the exposed group and 30 cases in the non-exposed group. To observe the effects of Fuzheng Jiedu Quzhuo prescription combined with chemotherapy on progression-free survival,objective remission rate,lymphocyte subsets,cytokines,traditional Chinese medicine(TCM) syndromes,KPS scores and chemotherapy-related adverse reactions in ES-SCLC patients. [Results] In the long-term efficacy,the mPFS was significantly prolonged between the exposed group comparing with the non-exposed group(P<0.05). There was no significant difference in ORR in the short-term efficacy(P>0.05). In terms of immune function,compared with the non-exposed group,CD3⁺,CD4⁺ T lymphocytes and NK cells in the exposed group increased significantly,while Treg cells decreased,and the difference was statistically significant(P<0.05). The comparison of the effects of inflammatory cytokines expression showed that the serum levels of IL-4,IL-6 and IL-10 were significantly lower in the exposed group than in the non-exposed group after treatment,and the IFN-γ exposed group was higher than that in the non-exposed group,and the difference was statistically significant(P<0.05). In terms of clinical symptoms,compared with the non-exposure group,the TCM syndrome score and KPS score of the exposed group were significantly improved,and the chemotherapy-related leukopenia and gastrointestinal reactions were significantly reduced,and the difference was statistically significant(P<0.05). [Conclusion] Compared with chemotherapy alone,Fuzheng Jiedu Quzhuo prescription combined with chemotherapy can improve the immune function of ES-SCLC patients,increase the efficiency of adjuvant chemotherapy and reduce toxicity,and improve the quality of life of patients to a certain extent.