探讨益气扶正固本法对老年肺癌患者化疗期骨髓抑制的改善机制及造血机能的保护作用

Exploration of the Improvement Mechanism of Yiqi Fuzheng Guben Method on Myelosuppression and the Protection of Hematopoiesis in the Elderly Patients with Lung Cancer During Chemotherapy

目的探讨益气扶正固本法对老年肺癌患者化疗期骨髓抑制的改善机制及造血机能的保护作用。方法将医院2018年8月—2019年12月收治的128例非小细胞肺癌(NSCLC)老年患者按照随机数字表法分为实验组和对照组。实验组入选64例,采用TP化疗方案联合益气扶正固本法治疗,脱落3例,完成61例;对照组入选64例,采用单独TP化疗方案治疗,脱落4例,完成60例。共进行4个化疗周期治疗后,比较两组骨髓抑制发生情况、中医证候积分、卡式(KPS)评分、白细胞(WBC)、血红蛋白(HGB)、血小板(PLT)、中性粒细胞(NC)、免疫抑制细胞调节性T细胞(Treg)、自然杀伤细胞(NK)、髓源性抑制细胞(MDSC)及临床疗效。结果实验组骨髓抑制发生率50.82%低于对照组70.00%,差异有统计学意义(χ^(2)=4.650,P<0.05)。治疗后两组WBC、HGB、PLT、NC水平均低于本组治疗前(P<0.05),其中实验组WBC、HGB、PLT、NC水平均高于对照组,差异具有统计学意义(t=4.115、3.374、5.964、5.745,P<0.05)。治疗后两组Treg、NK、MDSC细胞比例均低于本组治疗前(P<0.05),且实验组Treg、MDSC细胞比例明显低于对照组,差异具有统计学意义(t=3.997、4.276,P<0.05),NK细胞比例与对照组比较差异无统计学意义(P>0.05)。治疗后两组中医证候积分降低,KPS升高(P<0.05),且实验组中医证候积分低于对照组,KPS评分高于对照组(t=3.797、4.376,P<0.05)。实验组疾病缓解率52.46%高于对照组36.67%,但未见明显差异(χ^(2)=3.053,P>0.05),稳定率100.00%与对照组95.00%比较差异无统计学意义(χ^(2)=3.128,P>0.05),秩和检验显示,两组总体疗效比较差异有统计学意义(Z=2.047,P<0.05)。实验组中医治疗总有效率80.33%高于对照组68.33%,但差异无统计学意义(χ^(2)=2.284,P>0.05);经秩和检验,实验组中医证候总体疗效与对照组比较差异有统计学意义(Z=2.464,P<0.05)。两组均未发生神经系统、心功能损伤等严重不良反应,胃肠道反应、肝功能损伤、肾功能损伤等发生率比较差异无统计学意义(P>0.05)。结论在老年肺癌患者化疗期应用益气扶正固本法治疗可预防或减轻骨髓抑制,保护骨髓造血机能,其作用机制可能与调节免疫抑制,下调Treg、MDSC细胞水平有关。

Objective To investigate the mechanism of Yiqi Fuzheng Guben method in improving bone marrow suppression and the protective effect of APS on hematopoiesis in elderly patients with lung cancer during chemotherapy.Methods 128 elderly patients with(nonsmall-cell lung cancer)NSCLC admitted to the hospital from August 2018 to December 2019 were divided into experimental group and control group according to the random number table method.In the experimental group,64 cases were selected and treated with TP and Yiqi Fuzheng Guben method,3 cases were dropped off and 61 cases were completed.64 cases were selected and treated with TP alone in the control group,4 cases were dropped off and 60 cases were completed.After four chemotherapy cycles,the occurrence of myelosuppression,TCM syndrome score,KPS score,WBC,HGB,PLT,NC,Treg,NK and MDSC were compared.Results The incidence of myelosuppression in the experimental group was 50.82%lower than that in the control group(70.00%)(χ^(2)=4.650,P<0.05).After treatment,WBC,HGB,PLT and NC levels in the two groups were lower than those before treatment(P<0.05).WBC,HGB,PLT and NC levels in the experimental group were higher than those in the control group.The difference was statistically significant(t=4.115,3.374,5.964,5.745,P<0.05).The ratio of Treg,NK and MDSC cells in the two groups after treatment was lower than that before treatment(P<0.05),the percentage of Treg and MDSC cells in the experimental group was significantly lower than that of Treg and MDSC cells in the control group(t=3.997,4.276,P<0.05),there was no significant difference in the proportion of NK cells between the control group and the control group(P>0.05).After treatment,the TCM syndrome score of the two groups decreased and KPS increased(P<0.05),and the TCM syndrome score of the experimental group(7.71±1.85)points was lower than that of the control group(8.96±1.77)points,and the KPS score of the experimental group(80.72±6.48)was higher than that of the control group(t=3.797,4.376,P<0.05).The disease remission rate of the experimental group was 52.46% higher than that of the control group(36.67%),but there was no significant difference(χ^(2)=3.053,P>0.05),the stability rate was 100.00% and 95.00%of the control group had no significant difference(χ^(2)=3.128,P>0.05).Rank sum test showed there was significant difference between the two groups(Z=2.047,P<0.05).The total effective rate of the experimental group was 80.33% higher than that of the control group(68.33%),but there was no statistical difference(χ^(2)=2.284,P>0.05);By the rank sum test,there was a significant difference between the experimental group and the control group(Z=2.464,P<0.05).There were no serious adverse reactions such as nervous system and heart function injury in the two groups.There was no significant difference in the incidence of gastrointestinal reaction,liver function injury and kidney function injury(P>0.05).Conclusion Yiqi Fuzheng Guben method can prevent or reduce bone marrow suppression and protect bone marrow hematopoietic function in elderly patients with lung cancer during chemotherapy.Its mechanism may be related to the regulation of immunosuppression and the downregulation of Treg and MDSC levels.