补肾健脾法联合放化疗对非小细胞肺癌患者T细胞亚群及Treg细胞影响的研究

Study on the influence of invigorating kidney and strengthening spleen principle combined with radiotherapy and chemotherapy on T cell subsets and Treg cells of non-small cell lung cancer patients

目的探讨补肾健脾中药对非小细胞肺癌患者放化疗过程中T细胞亚群及Treg细胞水平的影响。方法选取2013年1月—2015年12月就诊于本院的60例肿瘤患者,随机分为对照组及治疗组2组,根据患者病情给予规律化疗或同步放化疗,对照组及健脾补肾组在化疗同期分别口服不同中药方剂;各组患者在第1周期化疗第1天(D1)及第2周期化疗第7、14、21天(D7、D14、D21)检测患者T细胞亚群(CD_3^+、CD_3^+CD_4^+、CD_3^+CD_8^+、CD_4^+/CD_8^+)及Treg细胞(CD_4^+CD_(25)^+)变化情况水平并记录。计数资料采用χ~2检验,等级资料采用秩和检验或Ridit分析;计量资料采用t检验或One-way ANOVA分析,P<0.05为差异有统计学意义。结果对照组、治疗组与健康对照组D1比较,CD_3^+、CD_3^+CD_4^+、CD_4^+/CD_8^+、CD_3^+CD_4^+/CD_3^+显著降低,CD_3^+CD_8^+/CD_3^+、CD_4^+CD_(25)^+/CD_4^+显著升高,对比差异均有统计学意义(均P<0.05)。对照组D14与D1及D7比较,CD_4^+CD_(25)^+/CD_4^+降低,D21与D1及D7比较,CD_3^+、CD_3^+CD_4^+、CD_4^+/CD_8^+、CD_3^+CD_4^+/CD_3^+升高,CD_3^+CD_8^+/CD_3^+、CD_4^+CD_(25)^+/CD_4^+降低,D21与D14比较,CD_4^+CD_(25)^+/CD_4^+降低,对比差异均有统计学意义(均P<0.05)。治疗组D14与D1及D7比较,CD_3^+、CD_3^+CD_4^+、CD_4^+/CD_8^+、CD_3^+CD_4^+/CD_3^+升高,CD_3^+CD_8^+/CD_3^+、CD_4^+CD_(25)^+/CD_4^+降低,D21与D1及D7比较,CD_3^+、CD_3^+CD_4^+、CD_4^+/CD_8^+、CD_3^+CD_4^+/CD_3^+升高,CD_3^+CD_8^+/CD_3^+、CD_4^+CD_(25)^+/CD_4^+降低,D21与D14比较,CD_3^+、CD_3^+CD_4^+、CD_4^+/CD_8^+升高,CD_4^+CD_(25)^+/CD_4^+降低,对比差异均有统计学意义(均P<0.05)。对照组与治疗组D14比较,治疗组CD_4^+CD_(25)^+/CD_4^+低于对照组,D21比较,治疗组CD_3^+、CD_3^+CD_4^+、CD_4^+/CD_8^+高于对照组,治疗组CD_4^+CD_(25)^+/CD_4^+低于对照组,对比差异均有统计学意义(均P<0.05)。结论非小细胞肺癌患者免疫功能低于健康人群,处于免疫抑制状态,化疗药物在治疗持续期会降低患者免疫功能,但随着化疗对肿瘤的抑制和杀伤,肿瘤对机体的免疫抑制解除,患者免疫功能较治疗前得到明显改善,在治疗期间加用补肾健脾中药可更加快速、更有效地恢复患者的免疫功能,解除肿瘤对机体的免疫抑制。

Objective To research the impact of invigorating kidney and strengthening spleen principle combined with radiotherapy and chemotherapy on non-small cell lung cancer patients＇ T cell subsets and Treg cells.Method 60 cases of cancer patients were randomly divided into two groups,according to the patients＇ condition to give regular chemotherapy or concurrent chemoradiotherapy, the control group and invigorating kidney and strengthening spleen group（treatment group） take orally the different prescription of traditional Chinese medicine in the same period of chemotherapy.All patients were detected T cell subsets（CD3~＋, CD3~＋CD4~＋, CD3~＋CD8~＋, CD4~＋/CD8~＋） and Treg cells（CD4~＋CD（25）~＋） changes（flow cytometry detection method） in the first cycle of chemotherapy on the first day CDD and second cycle of chemotherapy 7th day,14 th day,21 st day（D7,D14,D21）, and recorded the results. χ~2 test,Ridit were used in count data,t test or one-way ANOVA were used in mearsurement data,P〈0.05 means differences were significant.Result Compared with the healthy control group, CD3~＋、CD3~＋CD4~＋、CD4~＋/CD8~＋、CD3~＋CD4~＋/CD3~＋ were significantly decreased, CD3~＋CD8~＋/CD3~＋,CD3~＋CD8~＋/CD3~＋, CD4~＋CD（25）~＋/CD4~＋were significantly increased, there were significant differences in two groups（all P〈0.05）.Comparison of the control group before and after treatment：D14 compared with D7 and D1,CD4~＋CD（25）~＋/CD4~＋ decreased, there was statistical differences（all P〈0.05）;D21 compared with D1 and D7,CD3~＋, CD3~＋CD4~＋, CD4~＋/CD8~＋ and CD3~＋CD4~＋/CD3~＋ increased,CD3~＋CD8~＋/CD3~＋ and CD4~＋CD（25）~＋/CD4~＋ decreased（all P〈0.05）;D21 compared with D14,CD4~＋CD（25）~＋/CD4 decreased（all P〈0.05）.Comparison of the treatment group before and after treatment：D7 after treatment compared with D1 before treatment,there was no statistical difference in the proportion of T cell subsets and Treg cells（P〈0.05）;D14 compared with D7 and D1 before treatment,CD3~＋, CD3~＋CD4~＋, CD4~＋/CD8~＋, CD3~＋CD4~＋/CD3~＋ increased, CD3~＋CD8~＋/CD3~＋, CD4~＋CD（25）~＋/CD4~＋ decreased（all P〈0.05）;D21 compared with D1 and D7,CD3~＋, CD3~＋CD4~＋, CD4~＋/CD8~＋ and CD3~＋CD4~＋/CD3~＋ increased, CD3~＋CD8~＋/CD3~＋ and CD4~＋CD（25）~＋/CD4~＋ decreased（all P〈0.05）;D21 compared with D14,CD3~＋, CD3~＋CD4~＋, CD4~＋/CD8~＋ increased,CD4~＋CD（25）~＋/CD4~＋ decreased（all P〈0.05）. Comparison of control group and treatment group after treatment,The CD4~＋ CD（25）~＋/CD4~＋ of treatment group lower than control group at D14,there was statistical difference（P〈0.05）;At D21,CD3~＋、CD3~＋CD4~＋、CD4~＋/CD8~＋in treatment group were higher than control group, CD4~＋CD（25）~＋/CD4~＋ in treatment group were lower than control group（all P〈0.05）.Conclusion The immune function of patients with non-small cell lung cancer is lower than that of healthy people, and it is in immunosuppressive state.Chemotherapy drugs will reduce the immunological function of patients in the treatment duration,but the immunefunction of the patients was significantly improved than before treatment,with the inhibition and killing of the chemotherapy drugs on the tumor and the immunesuppression of the tumor was removed.During radiotherapy and chemotherapy,combined with invigorating kidney and strengthening spleen principle of traditional,Chinese medicine can be more quickly and more effectively restore the patient＇s immunefunction and removed the immunesuppression of the tumor.