消癌解毒方联合化疗对弥漫大B细胞淋巴瘤外周血CD4+CD25+CD127^(low)调节性T细胞的影响

Effects of Xiaoai Jiedu prescription combined with chemotherapy regimen on peripheral blood CD4+CD25+CD127^(low) regulatory T cells in diffuse large B-cell lymphoma

目的检测初诊弥漫大B细胞淋巴瘤(DLBCL)采用R-CDOP(利妥昔单抗联合环磷酰胺、脂质体多柔比星、长春新碱及泼尼松)方案联合或不联合消癌解毒方治疗前后外周血调节性T细胞(Treg)百分比的变化,探讨Treg对于DLBCL发病及预后可能的影响以及消癌解毒方是否具有调控Treg表达的作用。方法入组2018年1月至2022年1月南京中医药大学附属医院收治的初诊DLBCL病人共47例(治疗组24例,对照组23例)和健康对照45例,治疗组采用消癌解毒方联合R-CDOP方案,对照组单纯采用R-CDOP方案治疗,两组均化疗6个周期,采用流式细胞术检测两组病人治疗前后及健康对照的外周血CD4+CD25+CD127^(low) Treg百分比,观察两组病人的临床疗效以及治疗前后CD4+CD25+CD127^(low) Treg百分比的变化。结果治疗前,治疗组及对照组两组病人和健康对照的CD4+CD25+CD127^(low) Treg百分比中位数分别为6.01%、5.73%、7.32%,两组病人外周血Treg百分比均低于健康人(P<0.05)。治疗6周期结束后,治疗组及对照组两组病人的CD4+CD25+CD127^(low) Treg百分比中位数分别为7.33%和5.85%,治疗组Treg百分比较治疗前明显上升(P<0.05),对照组治疗前后Treg百分比变化差异不明显(P>0.05)。治疗组和对照组相比,治疗组比对照组的CD4+CD25+CD127^(low) Treg百分比明显上升(P<0.05)。两组病人临床疗效评估结果比较,治疗组和对照组的总缓解率(ORR)分别为79.17%和69.56%,两组ORR差异无统计学意义(P>0.05)。结论消癌解毒方有可能通过上调DLBCL病人失衡的Treg百分比发挥调控肿瘤免疫环境的作用。

Objective To study the changes of regulatory T cell(Treg)percentage in peripheral blood before and after treatment of newly diagnosed diffuse large B-cell lymphoma(DLBCL)with R-CDOP(rituximab,cyclophosphamide,liposomal doxorubicin,vincristine,and prednison)chemotherapy regimen combined with or without Xiaoai Jiedu prescription,and to explore the possible impact of Treg on pathogenesis and prognosis of DLBCL,and whether Xiaoai Jiedu prescription plays a role in regulating Treg expression.Methods A total of 47 newly diagnosed DLBCL patients(24 in treatment group and 23 in control group)and 45 healthy volunteers from The Affiliated Hospital of Nanjing University of Chinese Medicine from January 2018 to January 2022 were enrolled.Patients in treatment and control group were given Xiaoai Jiedu prescription combined with 6 cycles of R-CDOP chemotherapy regimen and 6 cycles of R-CDOP chemotherapy regimen alone,respectively.The CD4+CD25+CD127^(low) Treg percentage in patients'peripheral blood of these two groups before and after treatment and that of the healthy controls as well were detected by flow cytometry.The clinical outcome of these two groups of patients and changes in the percentage of CD4+CD25+CD127^(low)Treg before and after treatment were observed.Results Before treatment,the median percentages of CD4+CD25+CD127^(low) Treg in treatment group,control group and healthy control group were 6.01%,5.73%and 7.32%,respectively,and the percentage of these two groups(treatment group and control group)was lower than that of the healthy volunteers(P<0.05).After 6 cycles of treatment,the median percentages of CD4+CD25+CD127^(low) Treg in the treatment group and the control group were 7.33%and 5.85%,respectively,and the percentage of Treg in the treatment group was significantly higher than that before treatment(P<0.05).The percentages of Treg in the control group showed no significant difference before and after treatment(P>0.05).Compared with the control group,the percentage of CD4+CD25+CD127^(low) Treg in the treatment group was significantly higher than that in the control group(P<0.05).Comparison of clinical efficacy evaluation results between the two groups showed that the overall response rates(ORR)of the treatment group and the control group were 79.17%and 69.56%,respectively,and the ORR of the treatment group was higher than that of the control group,but the difference was not statistically significant(P>0.05).Conclusion Xiaoai Jiedu prescription may play a role in regulating tumor immune environment by upregulating the percentage of imbalanced Treg in DLBCL patients.