薏苡仁酯配合化学药物治疗晚期鼻咽癌的临床研究

Clinical Studies on the Results of Chemotherapy Combined with Coixenolide in Late Nasopharyngeal Carcinoma

目的 :探讨薏 以艹 仁酯 (coixenolide,CXL)配合 PFB方案治疗晚期鼻咽癌 (NPC)的疗效与机制。方法 :将 60例 期伴远处转移的 NPC患者随机分为两组。对照组单纯化疗 ,试验组化疗加 CXL。两组的化疗方案、剂量及疗程均相同。顺铂 (DDP) 2 0 mg/(m2· d) ,静脉滴注 ,第 1～ 5天 ;5-氟尿嘧啶 (5- Fu) 50 0 mg/(m2· d) ,静脉滴注 ,第 1～ 5天 ;博来霉素(BLM) 7mg/(m2 · d) ,肌肉注射 ,第 1、5天 ;共 3个疗程。试验组加滴 CXL注射液 2 0 0 ml/次 ,1次 /d,直至化疗结束。同时 ,在治疗前后采用 APAAP、MTT方法分别检测 T淋巴细胞及其亚群、NK细胞和 IL- 2活性。结果 :对照组有效率63.3% ,试验组 86.7% ,差异显著 (P<0 .0 5)。化疗后对照组 CD3 、CD4、CD4、/CD8下降明显 (前后比较 ,P<0 .0 5或0 .0 1 ) ,试验组则回升 (P<0 .0 5或 0 .0 1 ) ,并高于对照组 (P<0 .0 1 )。NK细胞和 IL- 2活性也显示相似的变化。随访 1年 ,对照组无瘤生存 0例 ,病情稳定 1 6例 ,恶化 7例 ,死亡 7例 ;试验组分别是 5、2 0、3、2例 ,优于对照组 (P<0 .0 2 5)。结论 :CXL配合 PFB方案提高晚期 NPC的疗效。可能的机理是 ,CXL增加癌细胞对化疗药物的敏感性 ,或直接抑制癌细胞的增殖 。

Objective:To study the efficacy and mechanism of chemotherapy combined with coixenolide (CXL,extracted from coix seeds) in late nasopharyngeal carcinoma (NPC).Methods:60 patients with NPC (stage Ⅳ with distant metastasis) were randomly devided into two groups.The control group received PFB regimen including cisplatin (DDP) 20mg·(m 2) -1 ·d -1 ,iv drip,d1~5;5 fluorouracil (5 Fu) 500mg·(m 2) -1 ·d -1 ,iv drip,d1~5;blemycin (BLM) 7mg·(m 2) -1 ·d -1 ,im,d1,5;with 3 courses of treatment.Moreover,200ml/d of CXL was used in the test group,iv drip,qd,to the end of chemotherapy.T cell subgroups,IL 2 and NK cell activities were determined using APAAP and MTT assays in order to investigate the effect of these drugs on immunology function.Results:The response rate was 63.3% in the control group,86.7% in the test group,with statistical difference ( P <0.05).The significant decrease of CD 3,CD 4 and ratio of CD 4/CD 8 were observed after treatment in the control group.These immunology criteria in the test group,on the contrary,increased significantly ( P <0.05 or 0.01,when compared with pretreatment and the control group,respectively).The similar changes of IL 2 and NK cell activities were also observed.After follow up of one year,free,steady,progressive diseases and death were found in 0,16,7 and seven patients in the control group,but in 5,20,3 and 2 cases in the test group,respectively,with statistical difference ( P <0 025).Conclusion:CXL plus PFB regimen can improve outcome in the treatment of advanced NPC,which might correlate with that this drug enhances susceptibility of the tumor to chemotherapeutic agent,or directly suppresses its proliferation,and regulates cellular immune status that plays an important role in preventing it from recurrence.