肺抑瘤合剂对晚期非小细胞肺癌患者近期疗效及对炎症因子、肿瘤标志物的影响
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摘要
目的观察肺抑瘤合剂对晚期非小细胞肺癌(NSCLC)患者近期疗效及对炎症因子、肿瘤标志物的影响。方法将107例纳入研究的阴虚热毒型晚期NSCLC患者随机分为观察组(56例)和对照组(51例)。对照组给予包括化疗在内的西医常规治疗,观察组在对照组的基础上给予肺抑瘤合剂。治疗2个化疗周期(42d),观察两组患者的近期疗效以及血清炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]、肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)及神经元特异性烯醇化酶(NSE)]的变化,并观察不良反应发生情况。结果①疗效比较观察组完全缓解(CR)6例、部分缓解(PR)29例、稳定(SD)14例、恶化7例,对照组则分别为:2例、19例、18例、12例,两组临床疗效比较差异有统计学意义(Z=-2.354,P<0.05);②血清炎症因子水平比较两组CRP、TNF-α、IL-6水平不同(F分组=10.348、11.397、9.336,P<0.05),两组指标各时间点水平不同(F时间=8.827、10.145、8.403,P<0.05),两组指标变化趋势存在差异(F交互=7.635、8.462、7.947,P<0.05);③肿瘤标志物水平比较两组肿瘤标志物CEA、CA125、NSE水平不同(F分组=23.386、16.479、13.462,P<0.05),两组指标各时间点水平不同(F时间=16.865、14.780、11.743,P<0.05),两组指标变化趋势存在差异(F交互=13.574、12.679、9.258,P<0.05);④不良反应比较观察组胃肠道反应23例、骨髓抑制28例,对照组则分别为:38例、43例,差异有统计学意义(χ2=12.177、14.077,P<0.05),其他不良反应比较无统计学意义(P>0.05)。结论肺抑瘤合剂能改善阴虚热毒型晚期NSCLC的近期疗效,能抑制炎症反应及降低肿瘤标志物水平,且有缓解不良反应的作用。
Objective To observe the short-term efficacy and effects on inflammatory factors and tumor markers of feiyiliu mixture in Patients with advanced non-small cell lung cancer(NSCLC) of yin deficiency and heat toxin type. Methods 1076 cases of patients with yin deficiency and heat toxin type NSCLC were randomLy divided into observation group(56 cases) and control group(51 cases). The control group was given routine western medicine treatment including chemotherapy, while the observation group was given feiyiliu mixture basised on control group. After 2 chemotherapy cycles(42 d),to observe the short-term efficacy and differences of inflammatory mediators [C-reactive protein(CRP), tumor necrosis factor-alpha(TNF-alpha), interleukin-6(IL-6)],tumor markers [carcinoembryonic antigen(CEA), carbohydrate antigen 125(CA125) and neuron-specific enolase(NSE)],and adverse reactions between the two groups. Results(1) Comparison of chort-term efficacy In observation group,6 cases were complete remission(CR),29 cases were partial remission(PR),14 cases were stable duration(SD),7 cases were progressive deterioration,,and those of control group was 2 cases,19 cases,18 cases,12 cases.With significant differences(Z=-2.291, P<0.05).(2) Comparison of inflammatory factors There were significantly different in CRP, TNF-α, IL-6 between the two group(F group =10.348,11.397,9.336 P<0.05).all indexes of the two groups were differents at different time points(Ftime=8.827,10.145,8.403 P<0.05), and trend of change had significant differenc es(Finteraction=7.635,8.462,7.947 P<0.05);(3) Comparison of tmor markers There were significantly different in CEA,CA125,NES between the two groups(F group =23.386,16.479,13.462 P<0.05).all indexes of the two groups were differents at different time points(Ftime=16.865,14.780,11.743 P<0.05),and trend of change had significant differences(Finteraction=13.574,12.679,9.258 P<0.05)(4) Comparison adverse reactions In observation group,23 cases had gastrointestinal reaction and 28 cases had myelosuppression,and those of control group were 38 cases,43 cases,respectively, With significant differences(χ2=12.177,14.077 P<0.05).Other adverse reactions were not statistically significant between the two groups(P>0.05). Conclusion Feiyiliu mixture can improve the short-term efficacy of NSCLC of yin deficiency and heat toxin type, can inhibit the inflammatory reaction and reduce the level of tumor markers, and alleviate the adverse reactions.
Objective To observe the short-term efficacy and effects on inflammatory factors and tumor markers of feiyiliu mixture in Patients with advanced non-small cell lung cancer(NSCLC) of yin deficiency and heat toxin type. Methods 1076 cases of patients with yin deficiency and heat toxin type NSCLC were randomLy divided into observation group(56 cases) and control group(51 cases). The control group was given routine western medicine treatment including chemotherapy, while the observation group was given feiyiliu mixture basised on control group. After 2 chemotherapy cycles(42 d),to observe the short-term efficacy and differences of inflammatory mediators [C-reactive protein(CRP), tumor necrosis factor-alpha(TNF-alpha), interleukin-6(IL-6)],tumor markers [carcinoembryonic antigen(CEA), carbohydrate antigen 125(CA125) and neuron-specific enolase(NSE)],and adverse reactions between the two groups. Results(1) Comparison of chort-term efficacy In observation group,6 cases were complete remission(CR),29 cases were partial remission(PR),14 cases were stable duration(SD),7 cases were progressive deterioration,,and those of control group was 2 cases,19 cases,18 cases,12 cases.With significant differences(Z=-2.291, P<0.05).(2) Comparison of inflammatory factors There were significantly different in CRP, TNF-α, IL-6 between the two group(F group =10.348,11.397,9.336 P<0.05).all indexes of the two groups were differents at different time points(Ftime=8.827,10.145,8.403 P<0.05), and trend of change had significant differenc es(Finteraction=7.635,8.462,7.947 P<0.05);(3) Comparison of tmor markers There were significantly different in CEA,CA125,NES between the two groups(F group =23.386,16.479,13.462 P<0.05).all indexes of the two groups were differents at different time points(Ftime=16.865,14.780,11.743 P<0.05),and trend of change had significant differences(Finteraction=13.574,12.679,9.258 P<0.05)(4) Comparison adverse reactions In observation group,23 cases had gastrointestinal reaction and 28 cases had myelosuppression,and those of control group were 38 cases,43 cases,respectively, With significant differences(χ2=12.177,14.077 P<0.05).Other adverse reactions were not statistically significant between the two groups(P>0.05). Conclusion Feiyiliu mixture can improve the short-term efficacy of NSCLC of yin deficiency and heat toxin type, can inhibit the inflammatory reaction and reduce the level of tumor markers, and alleviate the adverse reactions.
引文
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[15]Wang X, Yang X, Tsai Y, et al. IL-6 mediates macrophage infiltration after irradiation via up-regulation of CCL2/CCL5 in non-small cell lung cancer[J].RADIAT RES, 2017, 187(1):50-59.
[16]Yigit M, De?irmencio?lu S, Ugurlu E, et al. Effect of serum interleukin-1receptor antagonist level on survival of patients with non-small cell lung cancer[J]. Molecular and clinical oncology,2017,6(5):708-712.
[17]王纯,卢宏达.新辅助化疗对局部晚期非小细胞肺癌肿瘤标记物和淋巴细胞亚群的影响[J].重庆医学,2014,43(01):61-63,66.
[18]军,杨梅,黄锦蓉.血清HCY,CYFRA21-1和CEA在晚期NSCLC患者化疗疗效评估中的临床应用[J].现代检验医学杂志,2014,(1):147-149.
[19]马蕾,王芳,柳江.新疆地区汉族、维吾尔族晚期非小细胞肺癌患者血清中CA125表达的差异性[J].现代肿瘤医学,2015,(11):1536-1538.
[20]苏文利.胃泌素释放肽前体、神经元特异性烯醇化酶、碳酸酐酶IX联合诊断非小细胞肺癌诊断价值研究[J].临床肺科杂志,2016,(12):2165-2167,2168.
[21]李蓉,焦丽静,许玲.非小细胞肺癌的中医证型分布规律[J].上海中医药杂志,2012,46(09):95-97.
[22]顾优娜,邬燕萍.山慈菇方治疗中晚期肺癌阴虚热毒证45例临床观察[J].新中医,2016,48(05):205-207.
[23]向卉楠,方志红.加味四君子汤通过调控肿瘤相关巨噬细胞干预肺癌转移的研究进展[J].现代中西医结合杂志,2018,26(15):1704-1707.
[24]刘丽梅,赖红华.四君子汤合沙参麦冬汤加减治疗中晚期非小细胞肺癌160例[J].环球中医药,2018,11(01):123-126.
[25]李雁,黄景玉.白花蛇舌草注射液配合化疗治疗晚期非小细胞肺癌53例[J].河南中医药学刊,2000,25(04):45-46.
[26]徐晓卫,林观样,袁拯忠,等.康莱特联合化疗治疗非小细胞肺癌的系统评价[J].中华中医药学刊,2014,32(04):733-739.
[2]乔路敏,张培彤.清热解毒法治疗肺癌辨析[J].中国肿瘤,2014,23(04):316-321.
[3]刘苓霜,刘嘉湘,沈丽萍,等.中医辨证治疗对晚期非小细胞肺癌巩固治疗的影响[J].中医杂志,2015,56(17):1473-1478.
[4]卫生部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,2002:209-216.
[5]支修益,吴一龙,马胜林,等.原发性肺癌诊疗规范(2011年版)[J].中国肺癌杂志,2012,5(12):677-688.
[6]Douillard J Y, Ostoros G, Cobo M, et al. First-line gefitinib in Caucasian EGFR mutation-positive NSCLC patients:a phase-IV, open-label, single-arm study[J].BRIT J CANCER, 2014, 110(1):55.
[7]Planchard D, Loriot Y, Andre F, et al. EGFR-independent mechanisms of acquired resistance to AZD9291 in EGFR T790M-positive NSCLC patients[J]. ANN ONCOL, 2015, 26(10):2073-2078.
[8]Garon EB, Rizvi NA, Hui R, et al. Pembrolizumab for the treatment of nonsmall-cell lung cancer[J]. NEW ENGL J MED, 2015, 372(21):2018-2028.
[9]Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer[J]. NEW ENGL J MED,2015, 373(2):123-135.
[10]Scilla KA, Bentzen SM, Lam VK, et al. Neutrophil‐Lymphocyte Ratio Is a Prognostic Marker in Patients with Locally Advanced(Stage IIIA and IIIB)Non‐Small Cell Lung Cancer Treated with Combined Modality Therapy[J].The oncologist, 2017, 22(6):737-742.
[11]FurutaH,YoshidaT,ShimizuJ,etal.NivolumabEnhancesthe Inflammation of the Irradiation Field in Advanced Non-Small Cell Lung Cancer[J].J THORAC ONCOL, 2017, 12(11):1733-1736.
[12]Révész D, Engelhardt EG, Tamminga J J, et al. Decision support systems for incurable non-small cell lung cancer:A systematic review[J]. BMC MED INFORM DECIS, 2017, 17(1):144.
[13]佟威威,佟广辉,王婧,等.Cyfra21-1、NSE、SCCA和CRP在肺癌诊断中的应用[J].中国免疫学杂志,2015,31(03):396-400.
[14]Silva EM, Mariano VS, Pastrez PRA, et al. High systemic IL-6 is associated with worse prognosis in patients with non-small cell lung cancer[J]. PloS one,2017, 12(7):e0181125.
[15]Wang X, Yang X, Tsai Y, et al. IL-6 mediates macrophage infiltration after irradiation via up-regulation of CCL2/CCL5 in non-small cell lung cancer[J].RADIAT RES, 2017, 187(1):50-59.
[16]Yigit M, De?irmencio?lu S, Ugurlu E, et al. Effect of serum interleukin-1receptor antagonist level on survival of patients with non-small cell lung cancer[J]. Molecular and clinical oncology,2017,6(5):708-712.
[17]王纯,卢宏达.新辅助化疗对局部晚期非小细胞肺癌肿瘤标记物和淋巴细胞亚群的影响[J].重庆医学,2014,43(01):61-63,66.
[18]军,杨梅,黄锦蓉.血清HCY,CYFRA21-1和CEA在晚期NSCLC患者化疗疗效评估中的临床应用[J].现代检验医学杂志,2014,(1):147-149.
[19]马蕾,王芳,柳江.新疆地区汉族、维吾尔族晚期非小细胞肺癌患者血清中CA125表达的差异性[J].现代肿瘤医学,2015,(11):1536-1538.
[20]苏文利.胃泌素释放肽前体、神经元特异性烯醇化酶、碳酸酐酶IX联合诊断非小细胞肺癌诊断价值研究[J].临床肺科杂志,2016,(12):2165-2167,2168.
[21]李蓉,焦丽静,许玲.非小细胞肺癌的中医证型分布规律[J].上海中医药杂志,2012,46(09):95-97.
[22]顾优娜,邬燕萍.山慈菇方治疗中晚期肺癌阴虚热毒证45例临床观察[J].新中医,2016,48(05):205-207.
[23]向卉楠,方志红.加味四君子汤通过调控肿瘤相关巨噬细胞干预肺癌转移的研究进展[J].现代中西医结合杂志,2018,26(15):1704-1707.
[24]刘丽梅,赖红华.四君子汤合沙参麦冬汤加减治疗中晚期非小细胞肺癌160例[J].环球中医药,2018,11(01):123-126.
[25]李雁,黄景玉.白花蛇舌草注射液配合化疗治疗晚期非小细胞肺癌53例[J].河南中医药学刊,2000,25(04):45-46.
[26]徐晓卫,林观样,袁拯忠,等.康莱特联合化疗治疗非小细胞肺癌的系统评价[J].中华中医药学刊,2014,32(04):733-739.