扶正抑瘤方联合新辅助化疗、腹腔镜辅助胃癌根治术治疗进展期胃癌痰瘀毒结证患者的疗效观察

Therapeutic Effect of Fuzheng Yiliu Recipe Combined with Neoadjuvant Chemotherapy and Laparoscopic Assisted Gastrectomy in Treating Patients with Advanced Gastric Cancer

目的：观察扶正抑瘤方联合新辅助化疗、腹腔镜辅助胃癌根治术治疗进展期胃癌痰瘀毒结证患者的临床疗效,并探讨其作用机制。方法：选择2012年1月至2014年6月于南华大学附属第一医院住院治疗的进展期胃癌痰瘀毒结证患者106例,采用随机数字表法将患者随机分为观察组和对照组,各53例。对照组患者给予新辅助化疗联合腹腔镜辅助胃癌根治术,新辅助化疗方案采用奥沙利铂（OXA）＋亚叶酸钙（CF）＋氟尿嘧啶（5-Fu）（FOLFOX6）方案进行,观察组在对照组治疗基础上,给予扶正抑瘤方治疗。观察并比较两组患者的临床反应率和疾病控制率,不良反应发生情况,Karnosfsky评分,生存时间,肿瘤复发及转移情况。同时,检测并比较两组患者的CD3＋,CD4＋,CD8＋,阳性T细胞以及NK细胞（CD16＋CD56＋）,炎性细胞因子肿瘤坏死因子（TNF）-α,白细胞介素（IL）-6,急性期反应蛋白（CRP）及血红素氧化酶-1（HO-1）的水平,并比较两组患者肿瘤标志物癌胚抗原（CEA）,癌抗原（CA）724,CA50及复发转移相关指标基质金属蛋白酶（MMP）-2,MMP-9,血管内皮生长因子（VEGF）-A,VEGF-C的水平变化。结果：观察组的临床反应率明显高于对照组（P〈0.05）,疾病控制率略高于对照组,但差异不具有统计学意义。观察组KPS增加≥10分,或减少〈10分37例,有效率为69.8%,明显高于对照组的39.6%（P〈0.05）。且经手术后,两组患者TNF-α,IL-6,CRP及HO-1等应激指标水平均较术后1 d明显降低（P〈0.05）,且观察组治疗后各项指标降低程度较对照组更明显（P〈0.05）。观察组患者的CD3^＋,CD4^＋,CD8^＋,CD4^＋/CD8^＋,NK细胞水平均较本组治疗前明显增高（P〈0.05）;而CEA,CA724,CA50等肿瘤标志物水平,MMP指标,VEGF指标水平明显降低（P〈0.05）。观察组患者白细胞减少、恶心呕吐、黏膜反应、乏力的发生率低于对照组（P〈0.05）。结论：扶正抑瘤方联合新辅助化疗、腹腔镜辅助胃癌根治术治疗进展期胃癌痰瘀毒结证患者临床疗效确切,可明显减轻因化疗引起的不良反应,改善术后患者的应激水平,提高患者免疫防御功能,提高患者生存质量,抑制肿瘤的复发与转移,值得临床借鉴应用。

Objective： To study the clinical efficacy of Fuzheng Yiliu recipe combined with neoadjuvant chemotherapy and laparoscopic assisted radical gastrectomy in treating advanced gastric cancer. Method： Totally106 patients with advanced gastric cancer hospitalized from January 2012 to June 2014 were selected and randomly divided into observation group and control group,with 35 cases in each group. In control group,neoadjuvant chemotherapy combined with laparoscopic assisted radical gastrectomy was provided. The neoadjuvant chemotherapy regimen was performed with FOLFOX6. The observation group was treated with Fuzheng Yiliu recipe in addition to the therapy of the control group. The clinical response rate,disease control rate,adverse reaction,Karnosfsky score,survival time,tumor recurrence and metastasis were observed and compared. The levels of CD3＋,CD4＋,CD8＋positive T cells and NK cells（CD16＋CD56＋）,inflammatory cytokines tumor necrosis factor（TNF）-α,interleukin（IL）-6,C-reactive protein（CRP） and heme oxygenase（HO）-1 were detected and compared between the two groups. The levels of matrix metalloproteinases（MMP）-2,MMP-9,vascular endothelial growth factor（VEGF）-A and VEGF-C in the tumor markers carcinoembryonic antigen（CEA）,cancer antigen（CA724 and CA50） and recurrence and metastasis were observed. Result： The clinical response rate of observation group was significantly higher than that of control group（P〈0. 05）. The disease control rate was slightly higher than that of control group,but with no statistically significant difference. The effective rate in observation group was69. 8%,which was significantly higher than 39. 6% of control group（P〈0. 05）. The levels of TNF-α,IL-6,CRP and HO-1 in two groups were significantly lower than those in control group（P〈0. 05）. The levels of CD3^＋,CD4^＋,CD8^＋,CD4^＋/CD8^＋and NK cells in observation group were significantly higher than those before treatment（P〈0. 05）,while the levels of CEA,CA724,CA50,MMP and VEGF were significantly reduced. The incidences of leukopenia,nausea,vomiting,mucosal response and fatigue were significantly lower in observation group than those in control group（P〈0. 05）. Conclusion： Fuzheng Yiliu recipe combined with neoadjuvant chemotherapy and laparoscopic assisted radical gastrectomy for the treatment of advanced gastric cancer patients can be significantly effective in relieving the adverse reactions caused by chemotherapy,alleviating the stress level of patients after operation,improving the immune defense function and the quality of life of patients,inhibiting tumor recurrence and metastasis,and is worth clinical application.