免疫增效方联合DC疫苗拮抗结直肠癌免疫耐受的临床观察

Clinical Observation on the Antagonism of Tumor Immune Tolerance by Mianyizengxiao Decoction Combinded with Immunotherapy of Colorectal Cancer

目的:观察自拟方免疫增效方联合树突状细胞(Dendritic cells,DC)疫苗对结直肠癌患者免疫功能的影响,并探索其拮抗肿瘤免疫耐受的作用。方法:将60例结直肠癌患者随机分为两组,观察组(免疫增效方联合DC疫苗)和对照组(DC疫苗),每组30例。观察患者肿瘤标志物、迟发型超敏反应(Delayed-type hypersensitivity,DTH)、免疫功能(T细胞亚群,包括调节性T细胞)、卡氏评分、生活质量评分等在治疗前后的变化。结果:受试者治疗后CD+4T细胞水平均有所上升,CD+8T细胞水平下调,CD+4/CD+8相应升高,经t检验差异有统计学意义(P<0.01),而Treg/CD+4在观察组治疗后水平下调,在对照组反而上升,差异有统计学意义(P<0.01)。中晚期患者或肿瘤标志物异常者CD+4/CD+8偏低,差异有统计学意义(P<0.05),而Treg/CD+4虽有同样的趋势,但差异无统计学意义(P>0.05)。治疗后DTH阳性率观察组为60.0%,对照组为43.3%(P>0.05)。两组患者生活质量评分均有改善趋势(P>0.05)。结论:免疫增效方与DC疫苗相结合,可提高CD+4T细胞比例及CD+4/CD+8,下调CD+8T细胞比例及Treg/CD+4,具有改善机体抗肿瘤免疫功能及生活质量,拮抗机体免疫耐受的作用。

Objective：To observe the effect on immune fuction and tumor immune tolerance by Mianyizengxiao Decoction com- bined DC vaccine in the treatment of colorectal cancer. Methods ：60 cases of CRC patients were divided into two groups （30 cases in each group） randomly,including observation group （treated with Mianyizengxiao Decoction ＋ DC vaccine） and control group （treated with DC vaccine alone）. All features were observed before and after treatment, including the patients vital signs, tumor markers, delayed hypersensitivity （DTH） ,immune function （T cell subsets,including Treg ）, Karnofsky score and quality of life scores. Results ：After treatment, CD4＋ T cells level and CD4/CDs of all subjects are increased （ P 〈 0.01 ）. The change of Treg/ CD4 in two groups have statistical significance different, which in observation group is down and the level in control group is up （ P 〈 0.01 ）. CD4＋/CDs level in patients with advanced stage or the abnormal tumor markers are lower （ P 〈 0.05 ）. The Treg/ CD4 has the same trend （P 〉 0.05 ）. There is no statistically significant difference of DTH in two groups （P 〉 0.05 ） ,60% （ob- servation group） versus 43.3% （ control group）. After treatment,the quality of life scores in both groups are improved （ P 〉 0. 05 ）. Conclusion：DC vaccine with TCM can increase the proportion of CD4＋ T cells and CD4＋/CD8＋ while down -regulate the pro- portion of CD8＋ T cells and Treg/CD4 . So the therapy can improve the immune function, antagonize immune tolerance and has cer- tain curative effect on improving the quality of life.