扶正解毒汤辅助克唑替尼对晚期非小细胞肺癌患者血清Pokemon及AGR2表达的影响

Effect of Fuzheng Jiedu Decoction Assisting Crizotinib on the Expression of Serum Pokemon and Anterior Gradient 2 in Patients with Advanced Non-small Cell Lung Cancer

【目的】探讨扶正解毒汤辅助克唑替尼治疗晚期非小细胞肺癌(NSCLC)患者的疗效及其对血清Pokemon、前梯度蛋白2(AGR2)表达的影响。【方法】将118例晚期非小细胞肺癌患者随机分为观察组和对照组,每组各59例。对照组给予克唑替尼治疗,观察组在对照组的基础上给予扶正解毒汤治疗,连续治疗3个月。观察2组患者治疗前后免疫功能指标、血清Pokemon及AGR2水平的变化情况,比较2组患者的实体瘤疗效、中医证候疗效及末次随访时的无进展生存时间(PFS)。【结果】(1)实体瘤疗效方面,治疗3个月后,观察组的肿瘤控制率为84.75%(50/59),对照组为74.58%(44/59),组间比较,观察组的实体瘤疗效优于对照组(P<0.05)。(2)中医证候疗效方面,治疗3个月后,观察组的中医证候总改善率为77.97%(46/59),对照组为47.46%(28/59),组间比较,观察组的中医证候疗效明显优于对照组(P<0.05)。(3)免疫功能指标方面,治疗后,2组患者的T淋巴细胞亚群CD4^(+)、CD4^(+)/CD8^(+)水平均较治疗前降低(P<0.05),CD8^(+)水平均较治疗前升高(P<0.05);组间比较,观察组的CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均明显高于对照组(P<0.05)。(4)血清Pokemon及AGR2方面,治疗后,2组患者不同肿瘤直径和临床分期的血清Pokemon、AGR2水平均较治疗前降低(P<0.05),而2组患者治疗前后不同分化程度和病理类型的血清Pokemon及AGR2水平比较,差异均无统计学意义(P>0.05);组间比较,观察组不同肿瘤直径和临床分期的血清Pokemon、AGR2水平均明显低于对照组(P<0.05)。(5)随访情况方面,截止至随访时间,观察组患者的中位PFS为9.0(4.2~13.3)个月,高于对照组的8.0(3.5~11.6)个月,差异有统计学意义(P<0.05)。【结论】扶正解毒汤辅助克唑替尼治疗晚期非小细胞肺癌患者疗效确切,能有效控制病情进展,缓解症状和体征,改善机体免疫功能,降低血清Pokemon及AGR2水平,延长患者的生存时间。

Objective To investigate the therapeutic effect of Fuzheng Jiedu Decoction assisting crizotinib on the expression of serum Pokemon and anterior gradient 2(AGR2)in the patients with advanced non-small cell lung cancer(NSCLC),and to observe its effect on the expression of serum Pokemon and AGR2. Methods A total of118 patients with advanced NSCLC were randomly divided into the observation group and the control group,with59 cases in each group. The control group was given crizotinib orally,and the observation group was given Fuzheng Jiedu Decoction together with crizotinib orally, the treatment lasting for 3 consecutive months. The changes of immune function indexes and serum Pokemon and AGR2 levels in the two groups were observed before and after treatment,and the solid tumor efficacy,TCM syndrome efficacy and progression-free survival(PFS)at the last follow-up were compared between the two groups. Results(1)Solid tumor efficacy:after 3 months of treatment,the tumor-control rate of the observation group was 84.75%(50/59),and that of the control group was 74.58%(44/59). The intergroup comparison showed that the solid tumor efficacy of the observation group was superior to that of the control group(P<0.05).(2)TCM syndrome efficacy:after 3 months of treatment,the total rate for improving TCM syndrome in the observation group was 77.97%(46/59),and that in the control group was 47.46%(28/59). The intergroup comparison showed that the TCM syndrome efficacy in the observation group was significantly superior to that in the control group(P<0.05).(3)Immune function indexes:after treatment,CD4^(+)and CD4^(+)/CD8^(+)levels in the two groups were decreased compared with those before treatment(P<0.05),and CD8^(+)level was increased compared with that before treatment(P<0.05). The levels of CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in the observation group were all significantly higher than those in the control group(P<0.05).(4)Serum Pokemon and AGR2:after treatment,the serum Pokemon and AGR2 levels in the patients with various sizes of the tumor and at different clinical stages in the two groups were lower than those before treatment(P<0.05),while the differences of the serum Pokemon and AGR2 levels were insignificant among the patients with different levels of differentiation and pathological types in the two groups before and after treatment(P>0.05). The intergroup comparison showed that the serum levels of Pokemon and AGR2 in the patients with various sizes of the tumor and at different clinical stages in the observation group were significantly lower than those in the control group(P<0.05).(5)The follow-up results showed that the median PFS of patients in the observation group was 9.0(4.2-13.3)months and was higher than that in the control group of [8.0(3.5-11.6)months],and the difference was statistically significant(P<0.05). Conclusion Fuzheng Jiedu Decoction assisting crizotinib exerts certain effect in treating patients with advanced NSCLC, which can effectively control the progression of the disease, relieve symptoms and signs,improve immune function,reduce serum levels of Pokemon and AGR2,and prolong the survival time of the patients.