结直肠癌患者中医证型和细胞免疫功能的相关性分析
摘要
目的探讨结直肠癌(CRC)患者中医虚实证型与细胞免疫功能之间的关系,明确中药联合化疗治疗对CRC患者免疫功能的影响。方法收集2017年1月～2017年12月陕西中医药大学附属医院肿瘤科95例CRC住院患者,将其辨证分型分为实证(热毒蕴结证)、虚实错杂证(气滞血瘀证)和虚证(气阴两虚证)。检测T细胞亚群(CD3~+、CD3~+ CD4~+、CD3~+ CD8~+、CD4~+/CD8~+)、B细胞、NK细胞百分比细胞免疫功能指标,分析CRC患者中医证型与免疫功能指标之间的关系。经过半年中药联合化疗治疗后,观察CRC患者免疫功能指标的变化。结果 95例CRC患者外周血CD3~+ T细胞百分比实证组>虚证组,差别具有统计学意义(P<0.05)。外周血CD3~+ CD4~+ T细胞百分比实证组>虚证组、虚实错杂组>虚证组,差别具有统计学意义(P<0.05)。患者外周血CD4~+/CD8~+细胞比值虚实错杂组>实证组,虚实错杂组>虚证组,差别具有统计学意义(P<0.05)。患者外周血NK细胞百分比虚证组>实证组,差别具有统计学意义(P<0.05)。治疗后,气阴两虚证(虚证)患者CD3~+ T细胞(t=-4.740,P=0.000)、CD3~+CD4~+T细胞(t=-3.084,P=0.006)明显上升,有统计学意义。结论虚证CRC患者的免疫细胞功能被显著抑制,中药联合化疗治疗可显著提高CRC患者的细胞免疫功能。
引文
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[2]OTTOMAN R E,LANGDON E A,ROCHLIN D B,et al.slde-efffects of combined radiatlon and chemotherapy in the treatment of malignant tumors [J].Radiology,1963,81(6):1014-1017.
[3]PALESTY J A,WANG W,JAVLE M M,et al.Side effects of therapy:case 3.Gastric cancer after radiotherapy of pediatric Hodgkin's disease [J].Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology,2004,22(12):2507.
[4]BOULIKAS T,VOUGIOUKA M.Recent clinical trials using cisplatin,carboplatin and their combination chemotherapy drugs (review) [J].Oncology Reports,2004,11(3):559-561.
[5]高丽娜.中医内科学 [M].太原:山西科技出版社,2015.
[6]郑筱萸.中药新药临床研究指导原则(试行) [M].北京:中国医药科技出版社,2002.
[7]周岱翰.中医肿瘤学 [M].北京:中国中医药出版社,2011.
[8]任健.中医诊断学 [M].北京:中国医药科技出版社,2015.
[9]Ruidong Lee.Dynamic changes of cellular immune function and individualized adjustments of immunosup-pressant for the management of severe infection after liver transplantation [J].Chin J Transplant.2011,32 (7):411-414.
[10] TOUGERON D,MABY P,ELIE N,et al.Regulatory T Lymphocytes Are Associated with Less Aggressive Histologic Features in Microsatellite-Unstable Colorectal Cancers [J].Plos One,2013,8(4):e61001.
[11]RAMíREZ M F,HUITINK J M,CATA J P.Perioperative Clinical Interventions That Modify the Immune Response in Cancer Patients [J].Open Journal of Anesthesiology,2013,3(3):133-139.
[12]KIMURA A,KISHIMOTO T.IL-6:Regulator of Treg/Th17 balance [J].European Journal of Immunology,2010,40(7):1830-1735.
[13]BRAGA W M T,SILVA B R D,CARVALHO A C D,et al.FOXP3 and CTLA4 overexpression in multiple myeloma bone marrow as a sign of accumulation of CD4+ T regulatory cells [J].Cancer Immunology Immunotherapy,2014,63(11):1189-1197.
[14]DILLON P M,OLSON W C,CZARKOWSKI A,et al.A melanoma helper peptide vaccine increases Th1 cytokine production by leukocytes in peripheral blood and immunized lymph nodes [J].Journal for ImmunoTherapy of Cancer,2,1(2014-07-15),2014,2(1):23.
[15]NETEA M G,JW V D M,SUTMULLER R P,et al.From the Th1/Th2 Paradigm towards a Toll-Like Receptor/T-Helper Bias [J].Antimicrobial Agents & Chemotherapy,2005,49(10):3991-3996.
[16]CHUNG A S,WU X,ZHUANG G,et al.An interleukin-17-mediated paracrine network promotes tumor resistance to anti-angiogenic therapy [J].Nature Medicine,2013,19(9):1114-1123.
[17]WILSON N,BONIFACE K,CHAN J,et al.Development,cytokine profile and function of human interleukin 17-producing helper T cells [J].Nat Immunol,2007,8(9):950-957.
[18]WHITESIDE T L.Regulatory T cell subsets in human cancer:are they regulating for or against tumor progression[J].Cancer Immunology Immunotherapy,2014,63(1):67-72.
[19]MITEVA L,STANILOV N,CIROVSKI G,et al.Upregulation of Treg-Related Genes in Addition with IL6 Showed the Significant Role for the Distant Metastasis in Colorectal Cancer [J].Cancer Microenviron,2017,10(1-3):69-76.
[20]NICCOLAI E,RICCI F,RUSSO E,et al.The Different Functional Distribution of "Not Effector" T Cells (Treg/Tnull) in Colorectal Cancer [J].Frontiers in Immunology,2017,(8):1900.
[21]JOHDI N,AIT-TAHAR K,SAGAP I,et al.Molecular Signatures of Human Regulatory T Cells in Colorectal Cancer and Polyps [J].Frontiers in Immunology,2017,13(8):620.
[22]杨瑶瑶.非小细胞肺癌患者中医证候与免疫等指标的相关性研究 [D].北京:中国中医研究院,2010.
[23]马萌.肿瘤微环境及其中医证本质—中医现代化路径之探索[J].中华中医药杂志,2018,33(6):2255-2261.
[24]CHEN T,LI Q,ZHANG X,et al.TOX expression decreases with progression of colorectal cancers and is associated with CD4 T-cell density and Fusobacterium nucleatum infection [J].Hum Pathol,2018,
[25]WHITESIDE T L.What are regulatory T cells (Treg) regulating in cancer and why?[J].Seminars in Cancer Biology,2012,22(4):327-334.
[26]OLGUíN J,MEDINA-ANDRADE I,MOLINA E,et al.Early and Partial Reduction in CD4Foxp3 Regulatory T Cells during Colitis-Associated Colon Cancer Induces CD4 and CD8 T Cell Activation Inhibiting Tumorigenesis [J].J Cancer,2018,9(2):239-249.
[27]刘永刚.康力欣胶囊联合辨证中药维持治疗晚期结直肠癌的临床观察 [J].中医临床研究,2018,10(11):53-54.
[28]曾惠锋.化疗联合中药治疗在结直肠癌术后的临床效果分析 [J].中医临床研究,2018,10(2):52-53.
[29]李会江,王会生,郝晓尊.化疗联合中药治疗在结直肠癌术后的临床效果 [J].世界最新医学信息文摘,2017,17(A1):88-89.
[30]WANG K,GONG H,CHAI R,et al.Aberrant frequency of IL-35 producing B cells in colorectal cancer patients [J].Cytokine,2018,10(2):206-210.
[31]朱伟嵘,高蓓莉,焦丽静,等.扶正治癌组方联合表皮生长因子受体酪氨酸激酶抑制剂治疗晚期非小细胞肺癌临床疗效观察[J].中华中医药杂志,2018,33(8):3692-3697.