启隔散联合免疫治疗对食管癌术后炎性微环境、骨骼肌消耗及循环肿瘤细胞的影响

Effect of Combination Use of Qige San and Immunologic Therapy on Inflammatory Microenvironments,Skeletal Muscle Consumption and Circulating Tumor Cells After Esophagectomy

目的:观察启隔散联合免疫治疗对食管癌术后炎性微环境、骨骼肌消耗及循环肿瘤细胞影响。方法:选取102例食管癌患者,期间共脱落14例,最后完成疗程并有完整记录88例,按随机数字表法分为治疗组及常规组各44例。常规组给予食管癌根治术及化疗,治疗组在常规组基础上给予启隔散联合免疫治疗。比较2组临床疗效及疾病控制率,比较2组手术前后中医证候评分、高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)、超敏C-反应蛋白(hs-CRP)、周血循环肿瘤细胞(CTC)、鳞状细胞癌抗原(SCC-Ag)、癌胚抗原(CEA)、LMP2 mRNA、TAP、骨骼肌指数(SMI)的变化,比较2组不良反应发生率及2年复发率。结果:治疗组疾病控制率高于常规组,差异有统计学意义(P<0.05)。2组总有效率比较,差异无统计学意义(P>0.05)。术后,2组吞咽哽噎、泛吐痰涎、胸膈痞满中医证候评分均较治疗前下降(P<0.05),治疗组吞咽梗噎、泛吐痰涎、胸膈痞满中医证候评分均低于常规组(P<0.05)。术后7 d,2组HMGB1、IL-6、IFN-γ、hs-CRP水平均较术前升高(P<0.05),治疗组HMGB1、IL-6、IFN-γ、hs-CRP水平均低于常规组(P<0.05)。术后7 d,2组CTC含量均较术前升高(P<0.05),治疗组CTC含量低于常规组(P<0.05)。术后,2组SCC-Ag、CEA、TAP水平均较术前下降(P<0.05),LMP2 mRNA水平均较术前上升(P<0.05);治疗组SCC-Ag、CEA、TAP水平均低于常规组(P<0.05),LMP2 mRNA水平高于常规组(P<0.05)。术后,2组SMI指标值均较治疗前下降(P<0.05),治疗组SMI指标值高于常规组(P<0.05)。治疗组不良反应发生率、复发率均低于常规组,差异均有统计学意义(P<0.05)。结论:启隔散联合免疫治疗对食管癌术后效果较好,可改善术后炎性微环境,减少骨骼肌消耗及循环肿瘤细胞,改善病情,提升疾病控制率,降低复发率,安全性高。

Objective:To observe the effect of the combination use of Qige San and immunologic therapy on inflammatory microenvironments,skeletal muscle consumption and circulating tumor cells after esophagectomy.Methods:A total of 102 patients with esophageal cancer were selected,and 14 cases were culled.Finally in total 88 cases completed all courses of treatment and had complete records,and they were divided into the treatment group and the routine group according to the random number table method,with 44 cases in each group.The routine group was given radical resection of esophageal cancer and chemotherapy,and the treatment group was additionally treated with Qige San combined with immunologic therapy based on the treatment of the routine group.The clinical effects and disease control rate,and the changes of traditional Chinese medicine syndrome scores,high mobility group box-1 protein(HMGB1),interleukin-6(IL-6),interferon-γ(IFN-γ),hypersensitive C-reactive protein(hs�CRP),circulating tumor cell(CTC),squamous cell carcinoma antigen(SCC-Ag),carcinoembryonic antigen(CEA),LMP2 mRNA,TAP and skeletal muscle index(SMI)before and after treatment,the incidence of adverse reactions and recurrence rates within two years were respectively compared between the two groups.Results:The disease control rate in the treatment group was higher than that in the routine group,the difference being significant(P<0.05).There was no significant difference being found in the comparison of total effective rate between the two groups(P>0.05).After treatment,the traditional Chinese medicine syndrome scores of choking when swallowing,excessive excretion of phlegm and drool,and abdominal distention and fullness in the two groups were reduced when compared with those before treatment(P<0.05),and the above scores in the treatment group were lower than those in the routine group(P<0.05).Seven days after surgery,the levels of HMGB1,IL-6,IFN-γand hs-CRP in both groups were up�regulated when compared with those before treatment(P<0.05),and the above four levels in the treatment group were lower than those in the routine group(P<0.05).Seven days after surgery,the CCT content in both groups was elevated when compared with that before treatment(P<0.05),and the CCT content in the treatment group was lower than that in the routine group(P<0.05).After surgery,the levels of SCC-Ag,CEA and TAP in both groups were down-regulated when compared with those before treatment(P<0.05),and the LMP2 mRNA levels were increased when compared with those before treatment(P<0.05);the levels of SCC-Ag,CEA and TAP in the treatment group were lower than those in the routine group(P<0.05),and the LMP2 mRNA level was higher than that in the routine group(P<0.05).After surgery,the SMI in the two groups was decreased when compared with that before treatment(P<0.05),and the SMI in the treatment group was higher than that in the routine group(P<0.05).The incidence of adverse reactions and recurrence rate in the treatment group were lower than those in the routine group.There was significance being found in the comparison of recurrence rate between the two groups(P<0.05).Conclusion:The combination use of Qige San and immunologic therapy has a great curative effect on patients after receiving surgery of esophageal cancer,which can enhance the postoperative inflammatory microenvironments,reduce skeletal muscle consumption and circulating tumor cells,improve the condition and the disease control rate,and reduce the recurrence rate with great safety.