TACE联合毒痰瘀脾虚方治疗原发性肝癌患者临床疗效研究

Clinical efficacy of auxiliary DutanyuPixu Formulae therapy after TACE in the treatment of patients with primary liver cancer

目的探讨采用肝动脉化疗栓塞术(TACE)联合毒痰瘀脾虚方治疗原发性肝癌(PLC)患者的近期疗效,以及对血清血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(b-FGF)和凝血酶敏感蛋白-1(TSP-1)水平的影响。方法2020年6月~2022年1月我院收治的68例PLC患者被随机分为对照组34例和观察组34例,分别给予以顺铂、表阿霉素和氟尿嘧啶为主的TACE治疗,观察组在对照组治疗的基础上联合毒痰瘀脾虚方辅助治疗12周。使用流式细胞仪检测外周血淋巴细胞亚群,采用COBAS E601电化学发光分析仪检测血清甲胎蛋白(AFP)、癌胚抗原(CEA)、CA19-9和CA125,采用ELISA法检测血清VEGF、b-FGF和TSP-1水平。结果在治疗后3个月末,观察组部分缓解、疾病稳定和疾病进展发生率分别为14.7%、61.7%和23.5%,与对照组的11.7%、52.9%和35.2%比,无显著性差异(P>0.05);观察组外周血CD3+、CD4+、NK细胞百分比和CD4+/CD8+细胞比值分别为(66.1±5.4)%、(39.8±4.2)%、(14.7±2.8)%和(1.5±0.2),与对照组【分别为(60.2±5.3)%、(35.5±3.4)%、(10.2±2.4)%和(1.4±0.2)】比,无显著性差异(P>0.05);观察组血清AFP、CEA、CA19-9和CA125水平分别为(284.7±29.4)μg/L、(13.2±3.4)ng/mL、(36.1±10.7)U/mL和(26.4±13.7)U/mL,显著低于对照组【分别为(334.4±27.6)μg/L、(17.7±3.4)ng/mL、(44.6±11.2)U/mL和(35.8±14.4)U/mL,P<0.05】;观察组肝功能指标改善也显著优于对照组(P<0.05);观察组血清VEGF、b-FGF和TSP-1水平分别为(126.3±52.1)pg/mL、(32.1±8.3)pg/mL和(68.3±31.2)μg/mL,均显著低于对照组【分别为(194.3±62.2)pg/mL、(44.7±9.5)pg/mL和(91.9±32.4)μg/mL,P<0.05】。结论加用毒痰瘀脾虚方辅助TACE治疗PLC患者近期疗效不明显,但可能有助于改善肝功能和肿瘤指标,并可能通过调节血管生成因子水平而抑制肿瘤进展。

Objective The aim of this study was to investigate the short-term efficacy of auxiliary DutanyuPixu Formulae,herbal medicine compound,therapy after transcatheter arterial chemoembolization(TACE)in the treatment of patients with primary liver cancer(PLC)and to observe the changes of serum vascular endothelial growth factor(VEGF),basic fibroblast growth factor(b-FGF)and thrombospondin-1(TSP-1)levels.Methods 68 patients with PLC were encountered in our hospital between June 2020 and January 2022,and were randomly divided into control and observation group,with 34 cases in each group.The patients in the control group was treated with TACE,with cisplatin,epirubicin and fluorouracil infusion,and those in the observation group was treated with DutanyuPixu Formulae after TACE.The percentages of peripheral blood lymphocyte subsets were detected by FCM,serum AFP,CEA,CA19-9 and CA125 were assayed.Serum VEGF,b-FGF and TSP-1 levels were detected by ELISA.Results At the end of three month treatment,the partial remission,stable disease and disease progression rates in the observation group were 14.7%,61.7%and 23.5%,not significantly different compared to 11.7%,52.9%and 35.2%in the control(P>0.05);the percentages of CD3+,CD4+,NK and ratio of CD4+/CD8+were(66.1±5.4)%,(39.8±4.2)%,(14.7±2.8)%and(1.5±0.2),not significantly different compared to[(60.2±5.3)%,(35.5±3.4)%,(10.2±2.4)%and(1.4±0.2),respectively,P>0.05];serum AFP,CEA,CA19-9 and CA125 levels were(284.7±29.4)μg/L,(13.2±3.4)ng/mL,(36.1±10.7)U/mL and(26.4±13.7)U/mL,all significantly lower than[(334.4±27.6)μg/L,(17.7±3.4)ng/mL,(44.6±11.2)U/mL and(35.8±14.4)U/mL,respectively,P<0.05]in the control;the improvement of liver function tests was also superior to that in the control(P<0.05);serum VEGF,b-FGF and TSP-1 levels were(126.3±52.1)pg/mL,(32.1±8.3)pg/mL and(68.3±31.2)μg/mL,all significantly lower than[(194.3±62.2)pg/mL,(44.7±9.5)pg/mL and(91.9±32.4)μg/mL,respectively,P<0.05]in the control group.Conclusion The auxiliary DutanyuPixu Formulae therapy after TACE in treatment of patients with PLC do not improve the short-term clinical efficacy,but it seems to improve the liver function tests and tumor indicators,which might inhibit the tumor progression by reducing serum angiogenic factor levels.