清肺化痰汤联合安罗替尼对痰热阻肺证中晚期小细胞肺癌化疗患者肿瘤特异因子及免疫功能的影响

Effect of Qingfei Huatan Decoction(清肺化痰汤)Combined with Arotinib on Tumor Specific Factors and Immune Function in Patients with Middle and Advanced Lung Cancer with Phlegm Heat Obstruction Syndrome

目的 观察清肺化痰汤联合安罗替尼对痰热阻肺证中晚期小细胞肺癌化疗患者肿瘤特异因子及免疫功能的影响。方法 选取2019年6月—2021年9月在南阳市第二医院采用依托泊苷+顺铂/卡铂方案治疗的中晚期小细胞肺癌(中医辨证分型为“痰热阻肺证”)患者98例,采用简单随机法分为两组,每组49例。安罗替尼组给予依托泊苷+顺铂/卡铂方案联合安罗替尼治疗,中药组在安罗替尼组基础上给予清肺化痰汤治疗。比较两组肿瘤特异因子、免疫功能指标、Karnofsky评分、中医证候积分、疗效、不良反应。结果 与治疗前比较,中药组和安罗替尼组的角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、糖类抗原125(CA125)下降(P<0.05),中药组治疗后肿瘤特异因子水平低于安罗替尼组(P<0.05)。与治疗前比较,中药组的CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)升高,CD_(8)^(+)下降(P<0.05),安罗替尼组的免疫功能指标与治疗前比较,差异无统计学意义(P>0.05),中药组治疗后免疫功能指标较安罗替尼组改善明显(P<0.05)。与治疗前比较,中药组的Karnofsky评分升高,中医证候积分降低(P<0.05),安罗替尼组的中医证候积分降低,Karnofsky评分与治疗前比较,差异无统计学意义(P>0.05),中药组治疗后Karnofsky评分高于安罗替尼组,中医证候积分低于安罗替尼组(P<0.05)。中药组的疾病控制率(DCR)为79.59%(39/49),相较于安罗替尼组DCR的61.22%(30/49)明显更高,中药组的客观缓解率(ORP)和不良反应率分别为53.06%(26/49)和12.24%(6/49),与安罗替尼组ORP(36.73%,18/49)、不良反应率(20.41%,10/49)比较,差异无统计学意义(P>0.05)。结论 清肺化痰汤联合安罗替尼治疗痰热阻肺证中晚期小细胞肺癌化疗患者可降低肿瘤特异因子的表达,改善机体免疫,提高疾病控制率。

Objective To observe the effect of Qingfei Huatan Decoction(清肺化痰汤)combined with arotinib on tumor specific factors and immune function in patients with middle and advanced lung cancer with phlegm heat obstruction syndrome.Methods Ninety-eight patients with middle and advanced lung cancer treated with etoposide+cisplatin/carboplatin in the hospital from June 2019 to September 2021(phlegm-heat obstructing lung syndrome)were randomly divided into two groups,49 cases in each group.The arotinib group was treated with etoposide+cisplatin/carboplatin combined with arotinib,and the traditional Chinese medicine group was treated with Qingfei Huatan Decoction on the basis of arotinib group.Tumor specific factors,immune function indexes,Karnofsky score,TCM symptom score,curative effect and adverse reactions were compared between the two groups.Results Compared with those before treatment,the levels of keratin 19 fragment antigen 21-1(CYFRA21-1),carcinoembryonic antigen(CEA),neuron specific enolase(NSE)and carbohydrate antigen 125(CA125)in traditional Chinese medicine group and arotinib group decreased(P<0.05).After treatment,the tumor specific factors in traditional Chinese medicine group were lower than those in arotinib group(P<0.05)Compared with those before treatment,the levels of CD_(3)^(+),CD_(4)^(+) and CD_(4)^(+)/CD_(8)^(+) in the traditional Chinese medicine group increased and CD_(8)^(+) decreased(P<0.05).There was no significant difference in the indexes of immune function in the arotinib group compared with those before treatment(P>0.05).The indexes of immune function in the traditional Chinese medicine group were significantly improved compared with that in the arotinib group after treatment(P<0.05)Compared with those before treatment,the Karnofsky score in the traditional Chinese medicine group increased and the TCM syndrome score decreased(P<0.05),and the TCM syndrome score in the arotinib group decreased.There was no significant difference between the Karnofsky score and those before treatment(P>0.05).After treatment,the Karnofsky score in the traditional Chinese medicine group was higher than that in the arotinib group,and the TCM syndrome score was lower than that in the arotinib group(P<0.05).The disease control rate(DCR)of the traditional Chinese medicine group was 79.59%(39/49),which was significantly higher than that of the arotinib group(61.22%,30/49).The objective remission rate(ORP)and adverse reaction rate of the traditional Chinese medicine group were 53.06%(26/49)and 12.24%(6/49),respectively.There was no significant difference compared with the ORP(36.73%,18/49)and adverse reaction rate(20.41%,10/49)of the arotinib group(P>0.05).Conclusion Qingfei Huatan Decoction combined with arotinib can reduce the expressions of tumor specific factors,improve body immunity and disease control rate in the treatment of middle and advanced lung cancer patients with phlegm-heat obstructing lung syndrome.