扶正法治疗晚期非小细胞肺癌对于肿瘤微环境的影响

Effect of Method of Strengthening Genuine Qi on Tumor Microenvironment of Advanced Non-small Cell Lung Cancer

目的:通过观察晚期非小细胞肺癌患者经过中医综合治疗后肿瘤微环境相关细胞因子的变化,初步探讨中医扶正法对于肺癌免疫微环境的影响,进一步探索论证中医药治疗晚期NSCLC的作用机制。方法 :将69例晚期NSCLC病人根据中医辨证分为气虚组(31例)、阴虚组(9例)和气阴两虚组(29例),分别行中医综合辨证论治2个疗程,1个疗程为28 d。比较观察不同组别之间患者治疗前后的干扰素(IFN-γ)、血管内皮生长因子(VEGF)、白细胞介素2(IL-2)、可溶性白介素-2受体(SIL-2R)水平变化。结果 :不同治疗组患者在性别、年龄、分期、病理类型方面差异无统计学意义,具有可比性。在治疗前阴虚组患者的IFN-γ分布高于其余两组(P=0.006),治疗后气阴两虚组患者的IFN-γ水平分布高于其余两组(P=0.042)。3组治疗前后的自身比较显示气虚组患者IL-2水平分布有提高,且差异有统计学意义(P=0.045);阴虚组患者VEGF降低,且差异有统计学意义(P=0.015);气阴两虚组患者治疗后IFN-γ、IL-2水平分布升高,且差异有统计学意义(P=0.002,P=0.045)。结论 :运用中医扶正法治疗晚期非小细胞肺癌对于调节患者机体免疫功能具有一定的作用,不同扶正法均可不同程度的改善晚期肺癌患者肿瘤微环境,从而提高细胞免疫功能。为今后开展大样本、前瞻性临床研究提供了新的佐证。

Objective ： To investigate the effect of method of strengthening genuine Qi on the tumor- microenvironment of non-small cell lung cancer （ NSCLC ） by observing the change of the related cytokine levels after traditional Chinese medicine therapy in patients with advanced NSCLC. Method： 69 advanced NSCLC cases were divided into three groups based on the TCM syndrome： Qi-deficiency group （ 31 cases ）, Yin-defieiency group （ 9 cases ） and Qi-Yin deficiency group （ 29 cases ） .All cases were given treatment based on syndrome differentiation and treated by 2 courses, 1 course of treatment was 28 days.The change of the cytokine levels included interferon- y （ IFN- y ）, vascular endothelial growth factor （ VEGF ）, interleukin-2 （ IL-2 ）, intcrleukin-2 receptor （ SIL-2R ） after TCM therapy were observed. Results ： There were no statistically significant differences between the groups in terms of baseline characteristics such as gender, age, pathology type, TNM-system and prognosis.The IFN- y levels in Yin-deficiency group were significantly higher than other groups before treatment （ P=0.006 ） .The IFN- 3, levels in Qi- Yin deficiency group were significantly higher than other groups after treatment （ P=0.042 ） .The IL-2 levels in Qi-deficiency group had been significantly increased before and after treatment （P=0.045）.The VEGF levels in Yin-deficiency group had been significantly decreased before and after treatment （ P=0.015 ）. Both the IFN- y and the IL-2 levels in Qi-Yin deficiency group had been significantly increased before and after treatment （ P=0.002, P=0.045 ）. Conclusions ： The methods of strengthening genuine Qi can regulate immune function in patients with NSCLC.AI1 the methods which include tonifying Qi, nourishing Yin and both of them, can improve the overall tumor microenviromnent and cellular immune function in patients with NSCLC.The result of this study will be the new evidence of a prospective and controlled clinical trial.