完带汤辨治子宫内膜癌术后患者的临床分析
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摘要
目的:观察完带汤辨证治疗子宫内膜癌(EC)术后患者的症状、生活质量和免疫功能的影响,并从EC微环境的调控方面探讨了其作用机制。方法:将109例EC术后患者,采用随机按数字表法分为对照组54例和观察组55例。对照组术后根据不同分期给予放射治疗或(和)化疗;观察组在对照组治疗的基础上,采用完带汤辨证治疗,1剂/d。两组疗程均为连续治疗3个月。进行治疗前后症状、体征评分,进行癌症治疗前后功能评价量表(FACT-G)评分;检测治疗前后T淋巴细胞亚群(CD3~+,CD4~+,CD8~+,CD4~+/CD8~+)和自然杀伤细胞(NK)水平;检测治疗前后血管内皮生长因子(VEGF),转化生长因子-β(TGF-β),胰岛素样生长因子(IGF-1),白细胞介素-17(IL-17)和IL-10水平。结果:治疗后观察组患者各症状、体征评分和总积分均低于对照组(P <0. 01);观察组FACT-G量表各维度评分和总分均高于对照组(P <0. 01);治疗后观察组NK,CD3~+,CD4~+和CD4~+/CD8~+均高于对照组(P <0. 01),CD8~+低于对照组(P <0. 01);治疗后观察组患者血清VEGF,TGF-β,IGF-1,IL-17和IL-10水平均低于对照组(P <0. 01)。结论:完带汤辨证治疗EC术后患者,可进一步改善患者的临床症状,提高患者生活质量和机体免疫功能,可改变子宫内膜癌肿瘤微环境,对患者多种细胞因子具有调节作用。
Objective: To observe the effect of syndrome differentiation and treatment with Wandaitang on symptoms,quality of life and function of immunologic after operation of endometrial carcinoma( EC),in order to discuss the mechanism of action according to regulation of microenvironment of EC. Method: The 109 patients were divided into control group( 54 cases) and observation group( 55 cases) by random number table. Patients in control group got radiotherapy and/or chemotherapy according to different stages after operation. Patients in observation group were additionally given syndrome differentiation and treatment with Wandaitang,1 dose/day.And a course of treatment was 3 months. Before and after treatment,symptoms,sign,functional assessment of cancer therapy-general( FACT-G) were scored. And levels of T lymphocyte subsets( CD3~+,CD4~+,CD8~+,CD4~+/CD8~+),natural killer cell( NK),vascular endothelial growth factor( VEGF),transforming growth factor-β( TGF-β),insulin-like growth factor-1( IGF-1),interleukin-17( IL-17) and IL-10 were detected.Result: After treatment,the scores of symptoms,signs and total scores of the patients in the observation group were lower than the control group( P < 0. 01). The scores of each dimension and total score of FACT-G scale in the observation group were higher than those in the control group( P < 0. 01). After treatment,NK,CD3~+,CD4~+ and CD4~+/CD8~+ in the observation group were higher than those in the control group( P < 0. 01),lower than the control group( P < 0. 01). After treatment,the serum levels of VEGF,TGF-β,IGF-1,IL-17 and IL-10 in the observation group were lower than those in the control group. Conclusion: Wandaitang can ameliorate clinical symptoms,improve quality of life of patients and immune function of organism,regulate multiple cytokines,change the tumor microenvironment of endometrial carcinoma.
Objective: To observe the effect of syndrome differentiation and treatment with Wandaitang on symptoms,quality of life and function of immunologic after operation of endometrial carcinoma( EC),in order to discuss the mechanism of action according to regulation of microenvironment of EC. Method: The 109 patients were divided into control group( 54 cases) and observation group( 55 cases) by random number table. Patients in control group got radiotherapy and/or chemotherapy according to different stages after operation. Patients in observation group were additionally given syndrome differentiation and treatment with Wandaitang,1 dose/day.And a course of treatment was 3 months. Before and after treatment,symptoms,sign,functional assessment of cancer therapy-general( FACT-G) were scored. And levels of T lymphocyte subsets( CD3~+,CD4~+,CD8~+,CD4~+/CD8~+),natural killer cell( NK),vascular endothelial growth factor( VEGF),transforming growth factor-β( TGF-β),insulin-like growth factor-1( IGF-1),interleukin-17( IL-17) and IL-10 were detected.Result: After treatment,the scores of symptoms,signs and total scores of the patients in the observation group were lower than the control group( P < 0. 01). The scores of each dimension and total score of FACT-G scale in the observation group were higher than those in the control group( P < 0. 01). After treatment,NK,CD3~+,CD4~+ and CD4~+/CD8~+ in the observation group were higher than those in the control group( P < 0. 01),lower than the control group( P < 0. 01). After treatment,the serum levels of VEGF,TGF-β,IGF-1,IL-17 and IL-10 in the observation group were lower than those in the control group. Conclusion: Wandaitang can ameliorate clinical symptoms,improve quality of life of patients and immune function of organism,regulate multiple cytokines,change the tumor microenvironment of endometrial carcinoma.
引文
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[21]高恒宇,郭林娜,刘丹.人参多糖注射液对肝细胞癌的增殖抑制作用及机制探讨[J].中国实验方剂学杂志,2016,22(16):134-138.
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[23]陈茜,陈丽娟,党媛媛,等.姜黄素对人子宫内膜癌细胞HEC-1-B侵袭转移的影响[J].西安交通大学学报:医学版,2016,37(1):134-138.
[24]满其倩,左琳,蒋海强,等.半枝莲体外抗子宫内膜癌活性的研究[J].现代妇产科进展,2015,24(4):269-272.
[25]李柳叶,邢玉,包晓霞,等.白花蛇舌草黄酮和多糖对与肿瘤相关巨噬细胞共培养的人子宫内膜癌Ishikawa细胞的影响[J].中国妇产科临床杂志,2015,16(2):150-153.
[26]吴雅冬,王丽娜,胡玉红.子宫内膜癌相关分子机制的研究进展[J].医学综述,2015,21(17):3135-3137.
[27]于丹军,樊静,刘广贤,等.子宫内膜癌患者外周血调节性T细胞与肿瘤免疫的相关性[J].贵阳医学院学报,2016,41(9):1099-1103.
[28]吕巧英,赵洪波,陈晓军.子宫内膜癌肿瘤微环境的免疫调控机制进展[J].复旦学报:医学版,2016,43(4):475-478.
[2]中国抗癌协会妇科肿瘤专业委员会.子宫内膜癌诊断与治疗指南[J]. 4版.中国实用妇科与产科杂志,2018,34(8):880-886.
[3]杨曦,马珂,吴成.子宫内膜癌的流行病学及高危因素[J].实用妇产科杂志,2015,31(7):485-488.
[4]蔡昱,翟建军,段仙芝,等.子宫内膜癌术后10年生存因素的分析[J].实用癌症杂志,2014,29(3):301-303.
[5]黄彩梅,夏亦冬,胡国华.中药治疗子宫内膜癌作用机制研究进展[J].吉林中医药,2015,35(9):969-972.
[6]雷智锋,王忠民.中西医结合论治子宫体癌综合征经验[J].世界中西医结合杂志,2017,12(8):1172-1176.
[7]王晓丹,常惠,戴建锋.傅氏完带汤临床应用[J].长春中医药大学学报,2014,30(1):47-49.
[8]王珺.加味完带汤联合中药外用干预宫颈上皮内瘤变术后临床观察[J].广西中医药,2013,36(5):31-32.
[9]陈书琴,任青玲.夏桂成活用完带汤治疗绝经过渡期功血经验撷要[J].江苏中医药,2016,48(7):15-17.
[10] Colombo N,Creutzberg C,Amant F,et al. ESMOESGO-ESTRO consensus conference on endometrial cancer:diagnosis,treatment and follow-up[J]. Int J Gynecol Cancer,2015,117(3):559-581.
[11] Koh W J,Greer B E,Abu-Rustum N R,et al. Uterine sarcoma,version 1. 2016[J]. J Natl Compr Cancer Network Jnccn,2015,13(11):1321-31.
[12]中华中医药学会.中医妇科常见病诊疗指南[M].北京:中国中医药科技出版社,2012:45-49.
[13] Sorosky J I. Endometrial cancer[J]. Obstet Gynecol,2012,120(21):383-389.
[14]马文,蔡辉,蔡宏懿,等.放化疗联合与单纯放疗辅助治疗子宫内膜癌的Meta分析[J].中国老年学,2016,36(13):3213-3216.
[15]赵淑萍,马德花.子宫内膜癌术后生存质量影响因素[J].中国实用妇科与产科杂志,2011,27(11):857-859.
[16]王金莲,刘宇新,梁卓,等.连花汤联合放化疗对中晚期子宫内膜癌患者免疫功能的影响及其疗效[J].肿瘤药学,2018,8(4):608-611,616.
[17]崔彭华,王会民,张玉娟,等.腹腔镜与开腹手术治疗对早期子宫内膜癌患者血清肿瘤标志物、凝血功能及免疫功能的影响[J].海南医学院学报,2017,23(15):2109-2112.
[18]李军,薛晓鸥,刘小丽,等.子宫内膜病变的中医证型研究[J].中国中医基础医学杂志,2011,17(3):300-301.
[19]刘婉利,周京晶.解毒益气方联合益元汤加减用于子宫内膜癌术后效果及对机体免疫功能的影响[J].现代中西医结合杂志,2017,26(26):2940-2942.
[20]刘喜华,黄敏琪,林忠文,等.抗肿瘤药物人参皂苷新型给药系统研究进展[J].中国实验方剂学杂志,2015,21(9):231-234.
[21]高恒宇,郭林娜,刘丹.人参多糖注射液对肝细胞癌的增殖抑制作用及机制探讨[J].中国实验方剂学杂志,2016,22(16):134-138.
[22]杨娥,钟艳梅,冯毅凡.白术化学成分和药理作用的研究进展[J].广东药学院学报,2012,28(2):218-221.
[23]陈茜,陈丽娟,党媛媛,等.姜黄素对人子宫内膜癌细胞HEC-1-B侵袭转移的影响[J].西安交通大学学报:医学版,2016,37(1):134-138.
[24]满其倩,左琳,蒋海强,等.半枝莲体外抗子宫内膜癌活性的研究[J].现代妇产科进展,2015,24(4):269-272.
[25]李柳叶,邢玉,包晓霞,等.白花蛇舌草黄酮和多糖对与肿瘤相关巨噬细胞共培养的人子宫内膜癌Ishikawa细胞的影响[J].中国妇产科临床杂志,2015,16(2):150-153.
[26]吴雅冬,王丽娜,胡玉红.子宫内膜癌相关分子机制的研究进展[J].医学综述,2015,21(17):3135-3137.
[27]于丹军,樊静,刘广贤,等.子宫内膜癌患者外周血调节性T细胞与肿瘤免疫的相关性[J].贵阳医学院学报,2016,41(9):1099-1103.
[28]吕巧英,赵洪波,陈晓军.子宫内膜癌肿瘤微环境的免疫调控机制进展[J].复旦学报:医学版,2016,43(4):475-478.