乳腺癌患者龙贝逍遥散治疗后血清miR-145表达量变化及与血清肿瘤标志物的关系研究

Study on the Changes in Serum miR-145 Expression and Its Relationship with Serum Tumor Markers in Breast Cancer Patients After Treatment with Longbei Xiaoyao Powder

【目的】分析乳腺癌患者龙贝逍遥散治疗后血清微小RNA-145(miR-145)表达量变化及与血清肿瘤标志物的关系。【方法】选取北京航天总医院普外科2016年1月至2021年1月接诊的100例乳腺癌肝郁气滞型患者展开回顾性研究,根据治疗方法的不同将其分为对照组和观察组,每组各50例。对照组给予新辅助CAF化疗(C:环磷酰胺;A:多柔比星;F:氟尿嘧啶)治疗,观察组在对照组的基础上联合龙贝逍遥散治疗,每疗程为21 d,共治疗3个疗程。比较2组患者的疾病控制率、血清miR-145表达量、血清肿瘤标志物、不良反应总发生率。Pearson分析血清miR-145与血清肿瘤标志物的关系,比较观察组中有效组与无效组血清miR-145表达量、血清肿瘤标志物水平,绘制受试者工作曲线(ROC),计算曲线下面积(AUC),分析血清miR-145、肿瘤标志物对新辅助CAF化疗联合龙贝逍遥散临床疗效的预测价值。【结果】(1)治疗3个疗程后,观察组的疾病控制率为86.00%(43/50),明显高于对照组的54.00%(47/50),组间比较,差异有统计学意义(P<0.01)。(2)治疗后,2组患者的血清miR-145表达量均较治疗前明显升高(P<0.05),且观察组的升高幅度明显优于对照组(P<0.01)。(3)治疗后,2组患者的血清糖类抗原153(CA153)、糖类抗原125(CA125)、癌胚抗原(CEA)水平均较治疗前明显降低(P<0.05),且观察组的降低幅度均明显优于对照组(P<0.01)。(4)观察组的不良反应总发生率为20.00%(10/50),对照组为16.00%(8/50),组间比较,差异无统计学意义(P>0.05)。(5)Pearson分析,血清miR-145与血清CA153、CA125、CEA均呈负相关性(P<0.001),r值分别为-4.014、-3.986、-4.086。(6)有效组血清miR-145表达量高于无效组(P<0.01),血清CA153、CA125、CEA水平低于无效组(P<0.01)。(7)血清miR-145、肿瘤标志物联合检测预测新辅助CAF化疗联合龙贝逍遥散临床疗效的AUC是0.799(95%CI:0.716-0.963),灵敏度、特异度均高于单独检测(P<0.001)。【结论】龙贝逍遥散可提高对乳腺癌的疾病控制率,上调血清miR-145表达量,降低血清肿瘤标志物水平,且不增加不良反应,具有一定的安全性;乳腺癌患者血清miR-145与肿瘤标志物存在一定的相关性,联合检测可提高对治疗方案的预测效能,具有一定的参考价值。

Objective To observe the changes in serum microRNA-145(miR-145)expression and to explore its relationship with serum tumor markers in breast cancer patients after treatment with Longbei Xiaoyao Powder.Methods A retrospective study was conducted on 100 patients with breast cancer of the liver depression and qi stagnation type who were treated in the General Surgery Department of Beijing Aerospace General Hospital from January 2016 to January 2021.The patients were divided into the control group and the observation group according to the treatment methods,with 50 cases in each group.The control group was treated with neoadjuvant CAF chemotherapy(C:cyclophosphamide;A:doxorubicin;F:fluorouracil),and the observation group was treated with Longbei Xiaoyao Powder on the basis of treatment for the control group.Each course of treatment covered 21 days,and the two groups were treated for a total of 3 courses.Disease control rate,serum miR-145 expression,serum tumor markers,and total incidence of adverse reactions were compared between the two groups.Pearson’s analysis was used for the investigation of the relationship between serum miR-145 and serum tumor markers.The serum miR-145 expression and serum tumor marker levels were compared between the effective cases and ineffective cases of the observation group.The receiver operating characteristic curve(ROC)was plotted,and the area under the curve(AUC)was calculated to analyze the predictive value of serum miR-145 and tumor markers on the clinical efficacy of neoadjuvant CAF chemotherapy in combination with Longbei Xiaoyao Powder.Results(1)After 3 courses of treatment,the disease control rate of the observation group was 86.00%(43/50),which was significantly higher than that of the control group[54.00%(47/50)],and the difference was statistically significant(P<0.01).(2)After treatment,the serum miR-145 expression level in the two groups was significantly increased compared with that before treatment(P<0.05),and the degree of the increase in the observation group was significantly superior to that in the control group(P<0.01).(3)After treatment,the serum levels of glycan antigen 153(CA153),glycan antigen 125(CA125),and carcinoembryonic antigen(CEA)in the two groups were significantly decreased compared with those before treatment(P<0.05),and the degree of the decrease in the observation group was significantly superior to that in the control group(P<0.01).(4)The total incidence of adverse reactions in the observation group was 20.00%(10/50)and that in the control group was 16.00%(8/50),and the difference was not statistically significant between the groups(P>0.05).(5)Pearson analysis showed that serum miR-145 was negatively correlated with serum CA153,CA125,and CEA(P<0.001),with r value being-4.014,-3.986,and-4.086,respectively.(6)In the observation group,the expression of serum miR-145 in the effective cases was higher than that in the ineffective cases(P<0.01),and serum CA153,CA125,CEA levels were lower than those in the ineffective cases(P<0.01).(7)The AUC of the combined test of serum miR-145 and tumor markers for predicting the clinical efficacy of neoadjuvant CAF chemotherapy combined with Longbei Xiaoyao Powder was 0.799(95%CI:0.716-0.963),with higher sensitivity and specificity than that of the test of serum miR-145 or tumor markers alone(P<0.001).Conclusion Longbei Xiaoyao Powder for the treatment of breast cancer can improve the disease control rate,up-regulate the expression of serum miR-145,and reduce the level of serum tumor markers without increasing the incidence of adverse reactions.Serum miR-145 is correlated with tumor markers in breast cancer patients to some degree,and the combined test for both of them can improve the predictive efficacy for the therapeutic regimen,and the results exert certain reference value.