消痰散结方对BRAF基因突变型甲状腺癌术后远期疗效的影响

Effect of Xiaotan Sanjie Prescription on Long-term Therapeutic Effect of BRAF Gene Mutant Thyroid Carcinoma after Operation

目的:研究消痰散结方对BRAF基因突变型甲状腺癌术后远期疗效的影响。方法:收集2008年1月至2011年1月本院行甲状腺全切除+中央区淋巴结清扫术治疗的患者资料,随访至2016年6月,共286例。根据术后病理组织的DNA检测的结果,分为试验组(BRAF基因突变) 175例和对照组(BRAF基因正常) 111例。术后在西医治疗基础上2组均给予消痰散结方30 m L·次-1、3次·d-1,术后第1年服药6个月,第2年起每年至少服药3个月。结果:根据卡氏评分,消痰散结方可显著提高试验组患者短期及远期的体力及全身状况(短期:P=0. 039 <0. 05;长期:P=0. 007 <0. 01);明显降低试验组术后131I放射治疗前TSH刺激状态下及远期TSH抑制状态下的甲状腺球蛋白(thyroglobulin,Tg)水平(刺激状态下Tg水平:P=0. 038 <0. 05;抑制状态下Tg水平:P=0. 013 <0. 05);显著降低试验组远期甲状腺癌术后的复发率(P=0. 026 <0. 05)。结论:消痰散结方可显著改善BRAF基因突变型患者甲状腺癌术后的长期预后,根据文献报道其作用机制可能是抑制BRAFV600E突变介导的MAPK通路。

Objective: To study the effect of Xiaotan Sanjie Prescription on long-term therapeutic effect of BRAF gene mutant thyroid carcinoma after operation. Methods: Data of 286 patients who underwent total thyroidectomy plus central lymph node dissection from January 2008 to January 2011 were collected and followed up until June 2016. According to the results of DNA detection in pathological tissues after operation,175 cases were divided into experimental group( BRAF gene mutation) and 111 cases were divided into control group( BRAF gene normal). After operation,on the basis of western medicine treatment,both groups were given Xiaotan Sanjie Prescription 30 m L times,3 times each day. After operation,they took medicine for 6 months in the first year and at least 3 months every year from the second year. Results: According to Karnofsky score,Xiaotan Sanjie Prescription can significantly improve the short-term and long-term physical strength and general condition of the experimental group.( short-term: P = 0. 039 <0. 05;long-term: P = 0. 007 < 0. 01). The level of thyroglobulin( Tg) was significantly decreased in the experimental group before and after131 I radiotherapy under TSH stimulation and long-term TSH suppression.( stimulated-thyroglobulin level: P = 0. 038 <0. 05;suppressed-thyroglobulin level: P = 0. 013 < 0. 05). The recurrence rate of long-term thyroid cancer in the experimental group was significantly reduced( P = 0. 026 < 0. 05). Conclusions: Xiaotan Sanjie Prescription can significantly improve the longterm prognosis of thyroid cancer patients with BRAF gene mutation. According to the literature,its mechanism may be to inhibit the MAPK pathway mediated by BRAFV600 E mutation.