基于肝癌免疫微环境探讨活血化痰解毒法在肝癌中的作用机制

Mechanism of Therapeutic Methods of Activating Blood,Resolving Phlegm,and Removing Toxins in Liver Cancer Based on Immune Microenvironment

原发性肝癌是我国常见肿瘤之一,严重危害人类健康。随着医药科技进步,肝癌临床治疗已取得一定成绩,但是对于晚期肝癌患者亟需寻找一种安全有效的方案。中医药作为我国特色优势疗法,其具有多靶点、多通路等特点,在治疗恶性肿瘤中发挥一定作用。该文旨在通过文献研究以阐明中医药祛邪法在肝癌治疗中的起效机制。中医认为肝癌病因病机以正气不足,痰瘀毒等邪气内盛为主,治疗以扶正祛邪为法,历代医者也普遍认为肿瘤细胞本身为“邪气”,患者机体免疫功能为“正气”,在治疗恶性肿瘤、调节肿瘤患者免疫功能时常提倡以扶正为主,达到“养正则积自除”之目的。而随着肿瘤及肿瘤微环境研究知识的不断更新,也认识到肿瘤的免疫微环境中亦存在“正气”与“邪气”,如其中抑制肿瘤生长的免疫细胞和免疫因子可归属于具有中医属性的“正气”,相反具有促进肿瘤生长的免疫细胞和因子,可划分为“邪气”,同时通过临床资料和实验研究也证明了以“活血化痰解毒”为代表的祛邪法在治疗肝癌中,既可以打击肿瘤细胞,又可以调节肝癌免疫微环境中的“正气”和“邪气”,达到相对的阴阳平衡。基于此,该文通过从中医理论和西医相关机制进行探讨,以期为中医药祛邪法治疗恶性肿瘤提供理论支持,并为中医药抗肿瘤提供一定思路。

Primary liver cancer is one of the common tumors in China,which seriously endangers human health. With the advancement in medical science and technology,some achievements have been made in the clinical treatment of liver cancer,but there is an urgent need to find a safe and effective solution for patients with advanced liver cancer. As a unique therapy in China, traditional Chinese medicine(TCM) has the characteristics of multiple targets and multiple pathways and plays a certain role in the treatment of malignancies.The present study aimed to clarify the mechanism of action of "dispelling pathogens" in the treatment of liver cancer through literature research. In TCM etiology and pathogenesis,deficient healthy Qi and exuberance of pathogenic Qi,such as phlegm,blood stasis,and toxins,lead to the development of liver cancer. The treatment should follow the principles of reinforcing healthy Qi and eliminating pathogens. It has been generally believed that tumor cell is the "pathogenic factor" and the immune function serves as the "healthy Qi". In the treatment of malignancies and the regulation of the immune function of patients,it is often advocated to reinforce healthy Qi to eliminate the accumulation. With the continuous updating of knowledge on tumors and tumor microenvironment, it is also recognized that there are "healthy Qi" and "pathogenic Qi" in the immune microenvironment of tumors. For example,the immune cells and immune factors that inhibit tumor growth can be classified as "healthy Qi" with TCM attributes,while those promoting tumor growth can be classified as "pathogenic Qi". Additionally,as proved by clinical data and experimental research,the elimination methods represented by "activating blood,resolving phlegm,and removing toxins" in the treatment of liver cancer can combat tumor cells and also regulate the "healthy Qi" and "pathogenic Qi" in the immune microenvironment of liver cancer to achieve the balance of Yin and Yang. Based on this,the present study reviewed from the TCM theory and the mechanisms of western medicine to provide theoretical support for the TCM treatment of malignancies by elimination methods and some ideas for TCM in tumor resistance.