益气养阴法对微小残留白血病多药耐药相关因子的影响

Effect of Yiqi Yangyin method on the multiple resistance factors of minimal residual leukemia

[目的]观察微小残留白血病病患者的气阴两虚证候,并评估益气养阴法辨病及辨证论治微小残留白血病的临床疗效、探讨其多药耐药作用机制。[方法]将68例微小残留白血病病患者随机分为治疗组(34例)和对照组(34例)。治疗组使用联合化疗配合口服益气养阴中药治疗,对照组单独使用联合化疗方法。两组治疗前、后用逆转录-聚合酶链式反应(RT-PCR)法检测拓扑酶(TopoⅡ)表达,用化学间接免疫荧光法(碱性磷酸酶-抗碱性磷酸酶桥联酶标法,APAAP)法检测P170的表达,探讨益气养阴法对微小残留白血病多药耐药因子的影响。[结果]益气养阴法可以改善微小残留白血病患者气阴两虚证候。治疗组气阴两虚证与对照组气阴两虚证候有显著性差异(P<0.05)。还能够上调TopoⅡ含量,增加白血病细胞DNA的断裂,从而使白血病细胞死亡。其作用机制可能是通过降低P-gp的表达率,减少化疗药物外排,增加细胞内化疗药物的浓度。联合化疗配合益气养阴法治疗后能够降低气阴两虚白血病患者P170阳性表达例数。[结论]益气养阴法对逆转微小残留白血病多药耐药有一定的疗效。

[Objective] To observe the syndrome of deficiency of both Qi and Yin in patients with minimal residual leukemia, evaluate the clinical therapeutic effect of tonifying Qi and Yin method according to differentiation and treatment both of the diseases and syndrome, and discuss its mechanism of multiple resistant. [Methods] Sixty-eight patients with minimal residual leukemia were divided into treatment group （34 cases） and control group （34 cases） randomly. The patients of treatment group used combined chemotherapy along with Chinese medicine of tonifying Qi and Yin orally. The patients of control group were treated with combined chemotherapy only. The expression of TopoⅡ was observed by RT-PCR method before and after treatment, and the expression of P170 by APAAP method. Then, the effect of tonifying Qi and Yin method to the multiple resistance factors in minimal residual leukemia was discussed. [Results] Tonifying Qi and Yin could improve the deficiency of both Qi and Yin syndrome in patients with minimal residual leukemia. The deficiency syndrome of both Qi and Yin in treatment group had significantly difference when compared with that in control group （P〈0.05）. Besides, it could up-regulate the content of Topo Ⅱ, increase the breakdown of leukemia cells DNA, leading death of leukemia cell. What＇s more, it could also decrease the expression of P-gp, reduce the excretion of chemotherapy medicine, and increase the consistence inside cells. Combined chemotherapy along with Chinese medicine of tonifying Qi and Yin method could decrease the case of P170 positive expression of deficiency of Qi and Yin leukemia. [Conclusion] The results showed that tonifying Qi and Yin method had its effect on reversing multiple resistance in minimal residual leukemia.