参芪十一味颗粒联合FOLFOX4方案化疗对晚期结直肠癌患者的近期疗效及其对血清IL-35、IL-37和T淋巴细胞亚群的影响

Shenqishiyiwei granules combined with FOLFOX4 chemotherapy for treatment of patients with advanced colorectal cancer:short-term efficacy and effect on serum IL-35,IL-37,and T lymphocyte subsets

目的探讨参芪十一味颗粒联合FOLFOX4方案化疗对晚期结直肠癌患者的近期疗效及其对血清白细胞介素-35(IL-35)、IL-37和T淋巴细胞亚群的影响。方法选择2018年1月至2021年3月上饶市人民医院收治的晚期结直肠癌患者80例,采用随机表字法分为观察组与对照组,各40例,年龄分别为(58.97±8.95)岁和(59.82±9.04)岁。对照组患者采用FOLFOX4化疗方案,观察组患者采用参芪十一味颗粒联合FOLFOX4化疗方案治疗。两组均以21 d为一个周期,治疗2个周期评价。比较两组近期疗效和生存质量改善情况,化疗前后血清IL-35和IL-37、T淋巴细胞亚群变化及毒副反应情况。结果观察组患者治疗2个周期后的有效率(RR)为80.0%,对照组为60.0%,组间比较差异有统计学意义(P<0.05);观察组生活质量的有效率为100.00%,对照组为90.00%,组间比较差异有统计学意义(P<0.05);化疗后,观察组血清IL-35水平较化疗前降低,而IL-37、CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)均较化疗前升高(均P<0.05);化疗后,对照组血清IL-35、CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)水平均较化疗前降低,而IL-37较化疗前升高(均P<0.05);化疗后,观察组血清IL-35低于对照组,而IL-37、CD_(3)^(+)、CD_(4)^(+)和CD_(4)^(+)/CD_(8)^(+)均高于对照组,分别为[(48.31±7.49)ng/L vs(59.24±5.89)ng/L,P<0.001]、[(58.97±2.97)%vs(47.89±3.71)%,P<0.001]、[(39.54±3.05)%vs(30.91±2.08)%,P<0.001]、(1.65±0.19 vs 1.02±0.14,P<0.001)、[(508.15±28.78)μg/L vs(461.23±25.64)μg/L,P<0.001]。观察组治疗期间胃肠道反应、乏力、肝功能异常、白细胞减少、血小板减少的发生率均低于对照组,差异均有统计学意义(均P<0.05)。结论参芪十一味颗粒联合FOLFOX4化疗方案可显著提高晚期结直肠癌患者近期疗效,下调IL-35水平,上调IL-37水平,提高免疫功能并减轻毒副反应。

Objective To investigate the short-term curative effect of Shenqishiyiwei granules combined with FOLFOX4 chemotherapy in patients with advanced colorectal cancer and their effect on serum interleukin-35(IL-35),interleukin-37(IL-37),and T lymphocyte subsets.Methods A total of 80 patients with advanced colorectal cancer admitted to Shangrao People's Hospital from January 2018 to March 2021 were selected and divided into either an observation group or a control group using the random number table method,with 40 cases in each group.The mean age of the two groups was(58.97±8.95)years and(59.82±9.04)years,respectively.The control group was treated with FOLFOX4 chemotherapy alone.The observation group was treated with Shenqishiyiwei granules combined with FOLFOX4 chemotherapy.The two groups were treated for 21 days as a cycle,and the curative effect was calculated after two cycles of treatment.The short-term efficacy and improvement of quality of life were compared between the two groups.The changes of serum IL-35,IL-37,and T lymphocyte subsets and toxic reactions were also compared between the two groups.Results The response rate(RR)of the observation group was 80.0%after two cycles of treatment,and it was 60.0%in the control group(P<0.05).The improvement rate of quality of life in the observation group was 100.0%,and it was 90.0%in the control group(P<0.05).After chemotherapy,the level of IL-35 in the observation group was lower than that before chemotherapy,while IL-37,CD_(3)^(+)T cells,CD_(4)^(+)T cells,and CD_(4)^(+)/CD_(8)^(+)ratio were higher than those before chemotherapy(P<0.05).After chemotherapy,the levels of IL-35,CD_(3)^(+)T cells,CD_(4)^(+)T cells,and CD_(4)^(+)/CD_(8)^(+)T cell ratio in the control group were lower than those before chemotherapy,while the level of IL-37 was higher than that before chemotherapy(P<0.05).After chemotherapy,serum IL-35 in the observation group was lower than that in the control group,while IL-37,CD_(3)^(+)T cells,CD_(4)^(+)T cells,and CD_(4)^(+)/CD_(8)^(+)T cell ratio were higher than those in the control group[(48.31±7.49)ng/L vs(59.24±5.89)ng/L,P<0.001;(58.97±2.97)%vs(47.89±3.71)%,P<0.001;(39.54±3.05)%vs(30.91±2.08)%,P<0.001;(1.65±0.19 vs 1.02±0.14,P<0.001);and(508.15±28.78)μg/L vs(461.23±25.64)μg/L,P<0.001,respectively].The incidences of gastrointestinal reactions,fatigue,abnormal liver function,leucopenia,and thrombocytopenia in the observation group were all significantly lower than those in the control group(P<0.05).Conclusion Shenqishiyiwei granules combined with FOLFOX4 chemotherapy can significantly improve the short-term curative effect in patients with advanced colorectal cancer,down-regulate the level of IL-35,up-regulate the level of IL-37,improve immune function,and reduce toxic and side effects.