不同营养制剂对癌症患者免疫功能的影响

Effects of different nutrient preparations on immune function of cancer patients

目的:观察三种营养制剂对接受化疗的肺癌及乳腺癌患者外周血免疫相关细胞因子表达谱的影响,为抗癌辅助治疗提供临床依据。方法:多中心随机纳入2015年11月至2016年10月的480例非小细胞肺癌和乳腺癌患者,设立3个实验组(化疗同时分别服用覆参片、覆花片、破壁灵芝孢子粉)和1个空白对照组(单纯化疗)。动态监测患者外周血27种细胞因子基线筛选期(第-14至0天)和治疗评估期(第42±7天)的变化,并进行治疗期间体力评分(ECOG)和安全性的评价。结果:480例癌症患者中具有完整临床动态监测数据资料患者共计119例,均衡分布于四组。治疗评估期以单纯化疗组的细胞因子浓度为对比参照,覆参片组白介素(IL)-1ra(P=0.023)、IL-9(P=0.015)、IL-12(P=0.024)、粒细胞集落刺激因子(G-CSF)(P=0.031)、单核细胞趋化因子(MCP-1)(P=0.025)升高;覆花片组IL-4(P=0.005)、IL-5(P=0.009)、IL-7(P=0.026)、IL-10(P=0.026)、IL-12(P=0.038)、IL-15(P=0.014)、G-CSF(P=0.007)升高和干扰素诱导蛋白-10(IP-10)(P=0.012)降低;破壁灵芝孢子粉组IL-2(P<0.001)升高,差异均具有统计学意义。四组患者的ECOG评分与不良事件在组间无统计学差异。结论:三种营养制剂分别与化疗联合使用,可在一定程度上通过调节外周血细胞因子表达来起到调节抗肿瘤免疫反应的效果,且不增加毒副反应。

Objective:To explore the effect of three nutritional preparations on the expression profile of peripheral blood immune-related cytokines in patients with lung cancer and breast cancer undergoing chemotherapy,so as to provide clinical evidence for anti-cancer adjuvant therapy.Methods:Multi-center randomization included 480 non-small cell lung cancer and breast cancer patients from November 2015 to October 2016.Three experimental groups(Rubus chingii Hu combined with Garden ginseng group,Rubus chingii Hu combined with Grifola frondosa group and Sporoderm-broken Ganoderma lucidum spore powder group)and a blank control group(chemotherapy alone)were set up.Dynamically monitor changes in the baseline screening period(days-14 to 0)and treatment evaluation period(day 42±7)of peripheral blood cytokines in patients and conduct physical fitness score(ECOG)and safety evaluation in treatment observation period.Results:Among 480 cancer patients,119 patients with complete clinical dynamic monitoring data were evenly distributed in 4 groups.The cytokine concentration in the chemotherapy-only group was used as a comparative reference during the treatment evaluation period.Increased concentration of interleukin(IL)-1ra(P=0.023),IL-9(P=0.015),IL-12(P=0.024),granulocyte colony-stimulating factor(G-CSF)(P=0.031),monocyte chemoattractant protein-1(MCP-1)(P=0.025)in Rubus chingii Hu combined with Garden ginseng group had statistical significance.The increased concentration of IL-4(P=0.005),IL-5(P=0.009),IL-7(P=0.026),IL-10(P=0.026),IL-12(P=0.038),IL-15(P=0.014),G-CSF(P=0.007)and the decreased concentration of interferon induced protein-10(IP-10)(P=0.012)in Rubus chingii Hu combined with Grifola frondosa group had statistical significance.The increase of IL-2(P<0.001)in Sporoderm-broken Ganoderma lucidum spore powder group was also statistically significant.There were no significant differences in ECOG scores and adverse reactions in the four groups.Conclusion:The simultaneous use of three kinds of nutritional preparations and chemotherapy can regulate the anti-tumor immune response to a certain extent,and do not increase the toxic and side effects.