肺抑瘤合剂联合AP化疗方案治疗非小细胞肺癌临床疗效观察
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摘要
目的:观察肺抑瘤合剂联合AP(培美曲塞+顺铂)化疗方案治疗非小细胞肺癌临床疗效及对细胞炎性因子的影响。方法:选择符合纳入标准的非小细胞肺癌患者62例,采用简单数字的随机方法分为对照组和治疗组,每组31例。两组均采用规范的西药治疗,对照组给予AP(培美曲塞+顺铂)化疗方案,在此基础上给予复方斑蝥胶囊口服,3粒/次,2次/d。治疗组在AP(培美曲塞+顺铂)方案基础上给予肺抑瘤合剂口服,每次100 m L,3次/d。观察两组患者治疗前后生活质量评分、临床证候积分、血清中细胞炎性因子白细胞介素(IL)-6,IL~(-1)7,前列腺素E2(PGE2)水平变化,以及治疗后两组间瘤体改善情况、不良事件发生率,统计临床疗效。结果:治疗组治疗后在生活质量评分、证候积分(咳嗽、咳血、胸痛、乏力、发热)、血清中细胞炎性因子(IL-6,IL~(-1)7,PGE2)水平较治疗前明显改善,且优于对照组(P<0.05);治疗组治疗后瘤体的稳定率明显优于对照组(P<0.05),且不良事件发生率低于对照组(P<0.05)。结论:肺抑瘤合剂联合AP化疗方案能更有效地改善非小细胞肺癌患者生活质量、临床症状及实体瘤大小,降低细胞炎性因子在患者血清中的表达,降低临床不良事件的发生,值得进一步推广研究。
Objective: To observe the clinical efficacy of Feiyiliu mixture and AP chemotherapy(pemetrexed + cis-platinum) in the treatment of non-small cell lung cancer and its effect on inflammatory factors.Method: The 62 patients with non-small cell lung cancer who met the inclusion criteria were randomly divided into the control group and the treatment group,with 31 patients in each group. The control group was given AP chemotherapy regimen and compound cantharis capsule,3 pills/time,bid; the treatment group was orally given Feiyiliu mixture in addition of AP regimen,100 m L/time,tid. The changes in scores of quality of life,symptom scores,interleukin(IL)-6,IL~(-1)7,prostaglandin E2(PGE2) solid tumor after treatment,and incidence of adverse events were observed in two groups before and after treatment,and the clinical efficacy was evaluated.Result: The treatment group's scores of quality of life,integral syndrome(cough,hemoptysis,chest pain,fatigue and fever) and cytokines(IL-6,IL~(-1)7,PGE2) after treatment were significantly lower than those of control group(P < 0. 05); the rate of tumor stability after treatment was significantly better than that of control group(P <0. 05); the incidence of adverse events was lower than that of control group(P < 0. 05). Conclusion: Feiyiliu mixture combined with AP chemotherapy can effectively improve quality of life,clinical symptoms and tumor size in patients with non-small cell lung cancer,and decrease the expressions of inflammatory cytokines in serum of the patients,and is worth further promotion.
Objective: To observe the clinical efficacy of Feiyiliu mixture and AP chemotherapy(pemetrexed + cis-platinum) in the treatment of non-small cell lung cancer and its effect on inflammatory factors.Method: The 62 patients with non-small cell lung cancer who met the inclusion criteria were randomly divided into the control group and the treatment group,with 31 patients in each group. The control group was given AP chemotherapy regimen and compound cantharis capsule,3 pills/time,bid; the treatment group was orally given Feiyiliu mixture in addition of AP regimen,100 m L/time,tid. The changes in scores of quality of life,symptom scores,interleukin(IL)-6,IL~(-1)7,prostaglandin E2(PGE2) solid tumor after treatment,and incidence of adverse events were observed in two groups before and after treatment,and the clinical efficacy was evaluated.Result: The treatment group's scores of quality of life,integral syndrome(cough,hemoptysis,chest pain,fatigue and fever) and cytokines(IL-6,IL~(-1)7,PGE2) after treatment were significantly lower than those of control group(P < 0. 05); the rate of tumor stability after treatment was significantly better than that of control group(P <0. 05); the incidence of adverse events was lower than that of control group(P < 0. 05). Conclusion: Feiyiliu mixture combined with AP chemotherapy can effectively improve quality of life,clinical symptoms and tumor size in patients with non-small cell lung cancer,and decrease the expressions of inflammatory cytokines in serum of the patients,and is worth further promotion.
引文
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[14]裴文丽.黄芪多糖对2型糖尿病大鼠血清IL-1β、IL-6、IL-18的影响作用[J].中医临床研究,2016,8(2):10-13.
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[17]李晓芸,华晓东,陈晓淼,等.半枝莲总黄酮对巨噬细胞炎症模型中MAPK信号通路的影响[J].时珍国医国药,2016,27(10):2403-2405.
[18]罗世英,周乐,吕小华,等.白花蛇舌草总黄酮对实验性溃疡性结肠炎的作用及免疫学机制研究[J].中国中药杂志,2014,39(5):896-900.
[19]张明发,沈雅琴.女贞子抗炎、抗肿瘤和免疫调节作用的研究进展[J].现代药物与临床,2012,27(5):536-542.
[20]陈建清,林穗金,郑妮,等.荔枝核总黄酮对急性肺损伤大鼠胆碱能抗炎通路的影响[J].中国医院药学杂志,2016,36(23):2051-2054.
[21]Nishimoto N,Kishimoto T.Interleukin 6:from bench to bedside[J].Nat Clin Pract Rheumatol,2006,2(11):619-626.
[22]刘徽,朱波,林治华,等.IL-6信号通路与肿瘤[J].细胞与分子免疫学杂志,2011,27(3):353-355.
[23]Anerile B,Lim K H,Counter C M.Oncogenic Rasinduced secretion of IL-6 is required for tumorigenesis[J].Genes Dev,2007,21(14):1714-1719.
[24]苗平,陆梅生,张冬青.IL-6/IL-6受体与类风湿关节炎关联性研究新进展[J].免疫学杂志,2011,27(4):355-360.
[25]Langrish C L,CHEN Y,Blumensehein W M,et al.IL-23drives a pathogenic T cell regulation that induces autoimmune in flammation[J].J Exp Med,2005,201(2):233-240.
[26]Bush K A,Farmer K M,Walker J S,et al.Reduction of joint inflammation and bone erosion in rat adjuvant arthritis by treatment with interleukin-17 receptor Ig G1Fc fusion protein[J].Arthritis Rheum,2002,46(3):802-805.
[27]WANG L,YI T,Kortylewski M,et al.IL-17 can promote tumor growth through an IL-6-Stat3 signaling pathway[J].J Exp Med,2009,206(7):1457-1464.
[28]LIU X,Leung S,WANG C,et al.Crucial role of interleukin-7 in T helper type 17 survival and expansion in autoimmune disease[J].Nat Med,2010,16(2):191-197.
[29]郭小芹.IL-17/IL-17R通路在炎症性肠病中的免疫调节机制研究[D].北京:中国人民解放军军事医学科学院,2013.
[30]解晓媛,丁彦春.前列腺素E_2和高血压靶器官损害相关性的研究进展[J].中华高血压杂志,2016,(3):216-219.
[31]SHAO J,Evers B M,SHENG H.Prostaglandin E2synergistically enhances receptor tyrosine kinasedependent signaling system in colon cancer cells[J].J Biol Chem,2004,279(14):14287-14293.
[32]Oka M,Inaba A,Uchiyama T,et al.Prostaglandin E2levels and lymphocyte subsets in portal venous drainage of colorectal cancers[J].Am J Surg,1994,167(2):264-267.
[2]Engels E A.Inflammation in the development of lung cancer:epidemiological evidence[J].Expert Rev Anticancer Ther,2008,8(4):605-615.
[3]陈赐慧.炎症和炎性微环境在肺癌发生、发展及转移中的作用[J].医学综述,2012,18(23):3953-3956.
[4]郑东京,郑东海,郑伟鸿,等.郑伟达从瘀毒论治肺癌经验探析[J].世界中西医结合杂志,2014,9(12):1278-1280.
[5]陈平,许光兰,罗清,等.加味补中益气汤治疗慢性阻塞性肺疾病稳定期临床研究[J].辽宁中医杂志,2009,36(12):2104-2106.
[6]张文远,孟令玉,李欣.补中益气汤含药血清对Lewis肺癌细胞增殖和凋亡的影响[J].中医学报,2015,30(4):463-465.
[7]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,1995:125-129.
[8]全国肿瘤防治研究办公室,中国抗癌协会.中国常见恶性肿瘤诊治规范·第6分册·原发性支气管肺癌[M].北京:北京医科大学中国协和医科大学联合出版社,1991:1-3.
[9]周际昌.实用肿瘤内科学[M].2版.北京:人民卫生出版社,2003:34-35.
[10]王奇璐.肿瘤内科治疗的疗效评定[M].北京:人民卫生出版社,1999:33-34.
[11]Eisenhauer E A,Therasse P,Boqaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[12]Mantovani A,Allavena P,Sica A,et al.Cancer-related inflammation[J].Nature,2008,454(7203):436-444.
[13]陈赐慧.炎症和炎性微环境在肺癌发生、发展及转移中的作用[J].医学综述,2012,18(23):3953-3956.
[14]裴文丽.黄芪多糖对2型糖尿病大鼠血清IL-1β、IL-6、IL-18的影响作用[J].中医临床研究,2016,8(2):10-13.
[15]章敏,蒋红丽.老年冠心病支架置入术后血清IL-6与TNF-α水平改变及黄芪注射液的干预作用[J].中华实用诊断与治疗杂志,2008,22(11):832-834.
[16]周卫东,项磊,卢汉琪,等.党参多糖改善5-氟尿嘧啶诱导小肠黏膜炎的实验研究[J].辽宁中医杂志,2016,43(7):1495-1498.
[17]李晓芸,华晓东,陈晓淼,等.半枝莲总黄酮对巨噬细胞炎症模型中MAPK信号通路的影响[J].时珍国医国药,2016,27(10):2403-2405.
[18]罗世英,周乐,吕小华,等.白花蛇舌草总黄酮对实验性溃疡性结肠炎的作用及免疫学机制研究[J].中国中药杂志,2014,39(5):896-900.
[19]张明发,沈雅琴.女贞子抗炎、抗肿瘤和免疫调节作用的研究进展[J].现代药物与临床,2012,27(5):536-542.
[20]陈建清,林穗金,郑妮,等.荔枝核总黄酮对急性肺损伤大鼠胆碱能抗炎通路的影响[J].中国医院药学杂志,2016,36(23):2051-2054.
[21]Nishimoto N,Kishimoto T.Interleukin 6:from bench to bedside[J].Nat Clin Pract Rheumatol,2006,2(11):619-626.
[22]刘徽,朱波,林治华,等.IL-6信号通路与肿瘤[J].细胞与分子免疫学杂志,2011,27(3):353-355.
[23]Anerile B,Lim K H,Counter C M.Oncogenic Rasinduced secretion of IL-6 is required for tumorigenesis[J].Genes Dev,2007,21(14):1714-1719.
[24]苗平,陆梅生,张冬青.IL-6/IL-6受体与类风湿关节炎关联性研究新进展[J].免疫学杂志,2011,27(4):355-360.
[25]Langrish C L,CHEN Y,Blumensehein W M,et al.IL-23drives a pathogenic T cell regulation that induces autoimmune in flammation[J].J Exp Med,2005,201(2):233-240.
[26]Bush K A,Farmer K M,Walker J S,et al.Reduction of joint inflammation and bone erosion in rat adjuvant arthritis by treatment with interleukin-17 receptor Ig G1Fc fusion protein[J].Arthritis Rheum,2002,46(3):802-805.
[27]WANG L,YI T,Kortylewski M,et al.IL-17 can promote tumor growth through an IL-6-Stat3 signaling pathway[J].J Exp Med,2009,206(7):1457-1464.
[28]LIU X,Leung S,WANG C,et al.Crucial role of interleukin-7 in T helper type 17 survival and expansion in autoimmune disease[J].Nat Med,2010,16(2):191-197.
[29]郭小芹.IL-17/IL-17R通路在炎症性肠病中的免疫调节机制研究[D].北京:中国人民解放军军事医学科学院,2013.
[30]解晓媛,丁彦春.前列腺素E_2和高血压靶器官损害相关性的研究进展[J].中华高血压杂志,2016,(3):216-219.
[31]SHAO J,Evers B M,SHENG H.Prostaglandin E2synergistically enhances receptor tyrosine kinasedependent signaling system in colon cancer cells[J].J Biol Chem,2004,279(14):14287-14293.
[32]Oka M,Inaba A,Uchiyama T,et al.Prostaglandin E2levels and lymphocyte subsets in portal venous drainage of colorectal cancers[J].Am J Surg,1994,167(2):264-267.