四君子汤加减对乳腺癌术后化疗患者肠道菌群及细胞免疫功能的影响

Effect of modified Sijunzi Decoction on gut microbiota and cellular immune function in patients with breast cancer undergoing postoperative chemotherapy

目的分析四君子汤加减对乳腺癌术后化疗效果以及患者肠道菌群、细胞免疫功能的影响。方法选取2021年1月至2023年1月我院收治的150例乳腺癌患者,均符合手术指征,且接受术后化疗。采用简单随机抽签分组的方法,规定抽取奇数的为单纯化疗组(n=70),偶数的为中药联合组(n=80)。单纯化疗组:术后2周开始化疗,选择CEF(环磷酰胺^(+)表阿霉素^(+)氟尿嘧啶)方案化疗:第1 d环磷酰胺600mg/m^(2)^(+)第1 d表阿霉素60 mg/m^(2)^(+)第1、8 d氟尿嘧啶500 mg/m^(2),静脉滴注,21 d为1个化疗周期间隔,共治疗6个周期。中药联合组:在上述化疗基础上服用四君子汤汤剂,1剂/d,疗程同单纯化疗组。评估两组患者中医证候疗效,检测化疗前后肠道菌群与免疫细胞的变化,观察毒副作用。结果中药联合组脾气虚证证候疗效优于单纯化疗组(Z=2.394,P=0.017)。化疗后,中药联合组的双歧杆菌和乳杆菌数量增加且多于单纯化疗组(P<0.001),肠杆菌和肠球菌数量减少且低于单纯化疗组(P<0.001),CD3^(+)T细胞、CD4^(+)T细胞、CD4^(+)/CD8^(+)T细胞水平高于单纯化疗组(P<0.001)。中药联合组的胃肠反应发生率低于单纯化疗组(χ^(2)=5.133,P=0.023)。结论四君子汤加减对乳腺癌术后化疗效果有提升作用,可改善患者术后中医脾气虚证相关证候,调节肠道菌群及细胞免疫功能,毒副作用小。

Objective To observe the effect of modified Sijunzi Decoction in postoperative chemotherapy of breast cancer and the influence on gut microbiota and cellular immune function of patients.Methods One hundred and fifty patients with breast cancer admitted to our hospital from January 2021 to January 2023 were selected,all of whom met the surgical indications and received postoperative chemotherapy,and were randomly divided into chemotherapy alone group(n=70)and traditional Chinese medicine(TCM)combination group(n=80).For the chemotherapy group,the chemotherapy was started 2 weeks after operation with CEF regimen(Cyclophosphamide 600 mg/m^(2)on the first day,Epirubicin 60 mg/m^(2)on the first day,and Fluorouracil 500 mg/m^(2)on the first and eighth days,intravenous drip,with 21 days as a chemotherapy cycle)for a total of 6 cycles.For the TCM combination group,modified Sijunzi Decoction was administered on the basis of the above chemotherapy regimen,one dose per day,and the course of treatment was the same as that of the chemotherapy group.The curative effect on TCM syndromes in both groups was evaluated,the changes of intestinal flora and immune cells before and after chemotherapy were detected,and the toxic and side effects were observed.Results The curative effect on spleen Qi deficiency syndrome in the TCM combination group was better than that in the chemotherapy group(Z=2.394,P=0.017).After chemotherapy,the counts of bifidobacteria and lactobacilli in the TCM combination group increased and were higher than those in the chemotherapy group(P<0.001),while those of enterobacteria and enterococci decreased and were less than in the chemotherapy group(P<0.001);the levels of CD3^(+)T cells,CD4^(+)T cells and CD4^(+)/CD8^(+)T cell were higher than in the chemotherapy group,and the differences were statistically significant(P<0.001).The incidence of gastrointestinal reactions in the TCM combination group was lower than that in the chemotherapy group(χ^(2)=5.133,P=0.023).Conclusion Modified Sijunzi Decoction can promote the effect of postoperative chemotherapy for breast cancer,improve the related syndromes of spleen-Qi deficiency syndrome in patients after operation,and regulate intestinal flora and cellular immune function,with few toxic and side effects.