活血化瘀法逆转瘀血内阻型乳腺癌患者P-gp、BCRP的临床研究
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摘要
研究目的:
本研究拟观察活血化瘀法对瘀血内阻型乳腺癌患者化疗疗效的影响,探讨其作用机制。通过对比检测三组乳腺癌病人化疗前后肿块的大小,观察桃红四物汤联合化疗及川芎嗪注射液联合化疗治疗瘀血内阻型晚期乳腺癌的临床疗效。通过免疫组化法检测桃红四物汤联合化疗及川芎嗪注射液联合化疗与单纯化疗三组病人的跨膜糖蛋白及乳腺癌耐药蛋白的表达情况的变化,来客观评定活血化瘀药物对化疗耐药逆转的效果。
研究方法:
采用随机对照试验研究方法将60例符合纳入标准的患者随机分为3组设立治疗组和对照组:桃红四物汤+化疗组(治疗组)25例;川芎嗪注射液+化疗组(治疗组)15例;单纯化疗组(对照组)20例。采用粗针穿刺活检获取肿物组织进行病理检查,将穿刺取得的癌组织行SP免疫组化法测定P—gp、BCRP表达情况。行三个疗程的治疗后观察疗效,分为完全缓解(CR):部分缓解(PR);疾病稳定(SD);进展(PD)。行乳腺癌改良根治术,将手术标本再行SP免疫组化法测定P—gp、BCRP表达情况。统计分析三组病例P—gp、BCRP表达情况的变化,来客观评定活血化瘀药物对化疗耐药逆转的效果。全部数据采用SPSS13.0进行统计分析。
研究结果:
入组60例病人,脱落4例,实际入组56例,三组乳腺癌患者治疗前P—gp、BCRP阳性率无统计学差异,具有可比性(P＞0.05)。经过3个月的治疗,化疗组的P—gp、BCRP阳性率升高,治疗组的P—gp、BCRP阳性率均有不同程度的降低。而且通过观察治疗前后肿物大小评定临床疗效组间有显著差异,差异具有统计学意义(P＜0.05)。
结论:
用桃红四物汤和川芎嗪注射液协同化疗作为治疗组,与单纯化疗对照组相比有统计学意义。治疗组的疗效优于对照组,治疗组蛋白的阳性表达率下降较对照组蛋白的阳性表达率上升具有差异,治疗组能够逆转肿瘤耐药蛋白P—gp、BCRP的阳性表达。采用中药协同化疗能够有效地逆转肿瘤耐药,增加化疗效果,提高疗效,可推广用于所有的瘀血内阻型癌症患者,同时也为更深入地进行中医药逆转肿瘤耐药的临床和实验研究提供一定的研究基础。
[Objective] This research plans to observe the contribution that Taohongsiwu Decoction how to play on the Chem curative effect of the patient who is the type of blood-stasis obstructing in the interior and to approache the mechanism of action. By contrasting the change of the tumor magnitude between the treated groups and the control group observes the clinic curative effec of Taohongsiwu Decoction and Chuanxiongzine combined chemotherapy to the breast cancer' type of blood-stasis obstructing in the interior. By detecting the change of the positive expression of P—gp and BCRP with immunohistochemical method between three groups, evaluates the reveral effect to the Chem of the drug for invigorating blood circulation and eliminating stasis objectivly.
[Methods] 60 cases who are consistent with the norm of internalization were divided into 3 groups(the group of Taohongsiwu Decoction; group of Chuanxiongzine Inj; group of Chem) by RTC. The texture which were obtained by bodkin puncturing were determined the expression of P—gp and BCRP by pathoscopy of immunohistochemical method. After 3 course of treatment, all the cases were assessed the curative effect : CR; PR; SD; PD and were operated the improved radical correction of breast cancer. The texture were determined the expression of P—gp and BCRP by pathoscopy of immunohistochemical method again. Contrast the change of the two expression of P—gp and BCRP by statistical analysis, and evaluate the effect of the drug for invigorating blood circulation and eliminating stasis to revers the MDR. All the data were analysised by SPSS13.0.
[Results] There are 56 cases which are put into our research practically , and 4 cases fell off in the 60 cases. There is comparability and is not statistical difference at the positive expression of P—gp and BCRP prior treatment between the 3 groups(P>0.05). However; after 3 course of treatment, the positive expression of P—gp and BCRP of the Chem group step up, simultaneously, the positive expression of P—gp and BCRP of the Treated group cut down in varying degree. There is statistical difference at clinic curative effect by observing the magnitude of the swelling between the 3 groups (P <0.05).
[Conclusion] By contrasting the treated groups with the control group, the difference between the three groups' result has statistical significance. The curative effect of the treated groups surpasses the control group. Comparing the ascensus of proteinic expression of the control groups, the descent of proteinic expression of the treated groups has distinction. The treated groups can reverse positive expression of P—gp and BCRP. Traditional Chinese medicine in coordination with Chem could reverse MDR efficiently, increases the result of Chem, improve the therapeutic effect. Tt can extend all the patient who is the type of blood-stasis obstructing in the interior. Simultaneously,this research can offer foundation in order to the further study of the reversal of MDR more deeply.
本研究拟观察活血化瘀法对瘀血内阻型乳腺癌患者化疗疗效的影响,探讨其作用机制。通过对比检测三组乳腺癌病人化疗前后肿块的大小,观察桃红四物汤联合化疗及川芎嗪注射液联合化疗治疗瘀血内阻型晚期乳腺癌的临床疗效。通过免疫组化法检测桃红四物汤联合化疗及川芎嗪注射液联合化疗与单纯化疗三组病人的跨膜糖蛋白及乳腺癌耐药蛋白的表达情况的变化,来客观评定活血化瘀药物对化疗耐药逆转的效果。
研究方法:
采用随机对照试验研究方法将60例符合纳入标准的患者随机分为3组设立治疗组和对照组:桃红四物汤+化疗组(治疗组)25例;川芎嗪注射液+化疗组(治疗组)15例;单纯化疗组(对照组)20例。采用粗针穿刺活检获取肿物组织进行病理检查,将穿刺取得的癌组织行SP免疫组化法测定P—gp、BCRP表达情况。行三个疗程的治疗后观察疗效,分为完全缓解(CR):部分缓解(PR);疾病稳定(SD);进展(PD)。行乳腺癌改良根治术,将手术标本再行SP免疫组化法测定P—gp、BCRP表达情况。统计分析三组病例P—gp、BCRP表达情况的变化,来客观评定活血化瘀药物对化疗耐药逆转的效果。全部数据采用SPSS13.0进行统计分析。
研究结果:
入组60例病人,脱落4例,实际入组56例,三组乳腺癌患者治疗前P—gp、BCRP阳性率无统计学差异,具有可比性(P＞0.05)。经过3个月的治疗,化疗组的P—gp、BCRP阳性率升高,治疗组的P—gp、BCRP阳性率均有不同程度的降低。而且通过观察治疗前后肿物大小评定临床疗效组间有显著差异,差异具有统计学意义(P＜0.05)。
结论:
用桃红四物汤和川芎嗪注射液协同化疗作为治疗组,与单纯化疗对照组相比有统计学意义。治疗组的疗效优于对照组,治疗组蛋白的阳性表达率下降较对照组蛋白的阳性表达率上升具有差异,治疗组能够逆转肿瘤耐药蛋白P—gp、BCRP的阳性表达。采用中药协同化疗能够有效地逆转肿瘤耐药,增加化疗效果,提高疗效,可推广用于所有的瘀血内阻型癌症患者,同时也为更深入地进行中医药逆转肿瘤耐药的临床和实验研究提供一定的研究基础。
[Objective] This research plans to observe the contribution that Taohongsiwu Decoction how to play on the Chem curative effect of the patient who is the type of blood-stasis obstructing in the interior and to approache the mechanism of action. By contrasting the change of the tumor magnitude between the treated groups and the control group observes the clinic curative effec of Taohongsiwu Decoction and Chuanxiongzine combined chemotherapy to the breast cancer' type of blood-stasis obstructing in the interior. By detecting the change of the positive expression of P—gp and BCRP with immunohistochemical method between three groups, evaluates the reveral effect to the Chem of the drug for invigorating blood circulation and eliminating stasis objectivly.
[Methods] 60 cases who are consistent with the norm of internalization were divided into 3 groups(the group of Taohongsiwu Decoction; group of Chuanxiongzine Inj; group of Chem) by RTC. The texture which were obtained by bodkin puncturing were determined the expression of P—gp and BCRP by pathoscopy of immunohistochemical method. After 3 course of treatment, all the cases were assessed the curative effect : CR; PR; SD; PD and were operated the improved radical correction of breast cancer. The texture were determined the expression of P—gp and BCRP by pathoscopy of immunohistochemical method again. Contrast the change of the two expression of P—gp and BCRP by statistical analysis, and evaluate the effect of the drug for invigorating blood circulation and eliminating stasis to revers the MDR. All the data were analysised by SPSS13.0.
[Results] There are 56 cases which are put into our research practically , and 4 cases fell off in the 60 cases. There is comparability and is not statistical difference at the positive expression of P—gp and BCRP prior treatment between the 3 groups(P>0.05). However; after 3 course of treatment, the positive expression of P—gp and BCRP of the Chem group step up, simultaneously, the positive expression of P—gp and BCRP of the Treated group cut down in varying degree. There is statistical difference at clinic curative effect by observing the magnitude of the swelling between the 3 groups (P <0.05).
[Conclusion] By contrasting the treated groups with the control group, the difference between the three groups' result has statistical significance. The curative effect of the treated groups surpasses the control group. Comparing the ascensus of proteinic expression of the control groups, the descent of proteinic expression of the treated groups has distinction. The treated groups can reverse positive expression of P—gp and BCRP. Traditional Chinese medicine in coordination with Chem could reverse MDR efficiently, increases the result of Chem, improve the therapeutic effect. Tt can extend all the patient who is the type of blood-stasis obstructing in the interior. Simultaneously,this research can offer foundation in order to the further study of the reversal of MDR more deeply.
引文
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[2]现代乳腺肿瘤学进展/沈镇宙,邵志敏主编.-上海:上海科技文献出版社,2002.4
[3]Ruan WJ,Lai MD,Zhou JG..Anticancer effects of Chinese herbal medicine,science or myth.J Zhejiang Univ Sci B.2006 Dec;7(12):1006-14.
[4]罗文纪,虞荣喜.中医药逆转白血病细胞多药耐药的研究近况,湖南中医杂志.1999,15(5):52-54
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