“健脾益气生血法”对胃癌贫血患者细胞免疫功能的影响
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摘要
[目的]观察"益气健脾生血法"代表方——归脾汤对胃癌贫血患者血红蛋白、红细胞计数、红细胞压积和外周血T细胞亚群变化的影响,并探究其临床意义。[方法]采用随机、对照、前瞻性临床研究方法,收集60例确诊为胃癌伴轻中度贫血的患者,分为试验组(基础营养支持联合归脾汤、力蜚能胶囊和叶酸片治疗)和对照组(基础营养支持联合力蜚能胶囊、叶酸片治疗)。28 d为1个疗程,治疗前后使用血液分析仪和流式细胞仪检测血红蛋白、红细胞计数、红细胞压积和外周血T细胞亚群水平变化,并进行2组间比较。[结果]与治疗前比较,2组胃癌贫血患者治疗后的血红蛋白、红细胞计数和红细胞压积均明显升高(P<0.05),且试验组升高水平较对照组更明显(P<0.05)。与治疗前比较,试验组治疗后的CD8 T细胞水平明显降低(P<0.05),CD3、CD4 T细胞水平、CD4/CD8比值、Th1、Tc1细胞水平以及Th1/Th2、Tc1/Tc2比值均明显升高(P<0.05),而对照组上述细胞水平变化均不大(P>0.05)。[结论]胃癌贫血患者细胞免疫功能低下,应用归脾汤辅助西医治疗可有效地纠正贫血,改善机体细胞免疫抑制状态,从而对胃癌综合治疗措施的实施产生积极作用。
[Objective] To observe the representative prescription of "onifying spleen to nourish Qi and to produce blood"— Guipi soup's effect on the changes of hemoglobin, erythrocyte count, hematocrit and peripheral blood T cell subsets in patients with anemia of gastric cancer, and to discuss its clinical significance. [Methods]Using randomized, controlled and prospective clinical research method, 60 cases that diagnosised as gastric cancer with mild or moderate anemia were selected and then divided randomly into two groups: Experimental group(which was treated with Guipi soup and conventional therapy) and Control group(which was treated with conventional therapy). 28 days as a course of treatment, hemoglobin, red blood cell count, hematocrit and peripheral blood T cell were detected by hematology analyzer and flow cytometry before and after treatment, and the results were compared between the two groups.[Results]Compared with which before treatment, the level of hemoglobin, red blood cell count and hematocrit in two groups were all elevated greatly(P<0.05), while such index in Experimental group were more higher than Control group(P<0.05). Compared with which before treatment, the level of CD8 T cell in Experimental group reduced markedly(P<0.05), the levels of CD3, CD4, Th1, Tc1, and the ratios of CD4/CD8, Th1/Th2, Tc1/Tc2 rase significantly(P<0.05), while such index in Control group had no obvious change(P>0.05).[Conclusion]The cellular immune function of anemia patients with gastric cancer is low, application of guipi soup at the base of western medicine treatment can effectively rectify anemia, improve the cellular immunosuppression state, therefore to have a positive effect on the implementation of comprehensive treatment measures for gastric cancer.
[Objective] To observe the representative prescription of "onifying spleen to nourish Qi and to produce blood"— Guipi soup's effect on the changes of hemoglobin, erythrocyte count, hematocrit and peripheral blood T cell subsets in patients with anemia of gastric cancer, and to discuss its clinical significance. [Methods]Using randomized, controlled and prospective clinical research method, 60 cases that diagnosised as gastric cancer with mild or moderate anemia were selected and then divided randomly into two groups: Experimental group(which was treated with Guipi soup and conventional therapy) and Control group(which was treated with conventional therapy). 28 days as a course of treatment, hemoglobin, red blood cell count, hematocrit and peripheral blood T cell were detected by hematology analyzer and flow cytometry before and after treatment, and the results were compared between the two groups.[Results]Compared with which before treatment, the level of hemoglobin, red blood cell count and hematocrit in two groups were all elevated greatly(P<0.05), while such index in Experimental group were more higher than Control group(P<0.05). Compared with which before treatment, the level of CD8 T cell in Experimental group reduced markedly(P<0.05), the levels of CD3, CD4, Th1, Tc1, and the ratios of CD4/CD8, Th1/Th2, Tc1/Tc2 rase significantly(P<0.05), while such index in Control group had no obvious change(P>0.05).[Conclusion]The cellular immune function of anemia patients with gastric cancer is low, application of guipi soup at the base of western medicine treatment can effectively rectify anemia, improve the cellular immunosuppression state, therefore to have a positive effect on the implementation of comprehensive treatment measures for gastric cancer.
引文
[1] 杨华强,张荣环,李红,等.老年消化系肿瘤贫血患者血红蛋白和红细胞体积及细胞免疫的临床意义[J].世界华人消化杂志,2014,22(36):5737-5741.
[2] 黄梅淑.外周血T淋巴细胞及其相关细胞因子检测在胃部疾病发生、进展中的价值初探[J].石家庄:河北医科大学,2012.
[3] 侯婧瑛,向仍运,陈淑芬,等.Foxp3～+ Tregs和PD1在胃癌组织中的表达及其临床病理意义[J].中国病理生理杂志,2015,31(10):1744-1749.
[4] 魏玮,高勇,王理伟,等.细胞免疫状况与肿瘤相关性贫血患者生活质量的关系[J].肿瘤,2010,30:406-409.
[5] 陈杨,王艳荣,张权,等.晚期胃癌患者其肿瘤相关性贫血与预后的关系[J].解放军医学院学报,2015,36(4):351-354.
[6] 张之南,沈悌.血液病诊断及疗效标准.3版.北京:科学出版社,2007:1,17-18.
[7] 黄旭宏,宋玉国,刘春雷,等.胃癌与T淋巴细胞亚群关系的研究进展[J].世界华人消化杂志,2016,24(15):2331-2335.
[8] 秦斌,张筱茵.胃癌分子免疫学研究进展[J].世界华人消化杂志,2009,17(2):115-119.
[9] Ubukata H,Motohashi G,Tabuchi T,et al.Evaluations of interferon-/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognosticindicators in gastric cancer patients[J].J Surg Oncol,2010,102(7):742-747.
[10] 刘彤华.肿瘤相关性贫血相关因素分析[J].中国实验诊断学,2013,23(17):1688-1690.
[11] Prá D,Franke SI,Henriques JA,.Iron and genome stability:an update[J].Mutat Res,2012,733(1-2):92-99.
[12] 葛军娜,于健春,康维明.10218例消化系恶性肿瘤贫血情况调查[J].中华胃肠外科杂志,2011,14(5):340-342.
[13] 阮润生,徐克成.肿瘤免疫治疗的新策略[J].中华肿瘤杂志,2011,33(12):943-946.
[14] Martinsson A,Andersson C,Andell P,Koul S,Engstr?m G,Smith JG.Anemia inthe general population:prevalence,clinical correlates and prognostic impact[J].Eur J Epidemiol,2014,29(7):489-498.
[15] 宋春燕,王翠英,沈凤梅.归脾汤治疗肿瘤相关性贫血临床研究[J].中医学报,2013,28(3):320-321.
[16] 旷欲胜,邱根全,刘佚,等.脾虚证大鼠侧脑室注射孤啡肽对细胞免疫功能的影响[J].西安交通大学学报(医学版),2007,48(6):658-661.
[17] 雷萍,韩晓伟,侯殿东,陈殿学,关洪全.灰树花多糖对脾虚小鼠T细胞亚群和Th1/Th2亚群的影响[J].中国中医药信息杂志,2013(7):27-29.
[18] 张燕军,崔大江,雷宝霞.归脾汤加味治疗化疗诱发的难治性骨髓抑制32例临床观察[J].现代肿瘤医学,2011(8):1644-1646.
[19] 李卫河,姚卫华,王清华,花勤亮.归脾汤对食管癌放化疗毒副作用的疗效观察[J].中国中医药信息杂志,2000,7(6):68-69.
[2] 黄梅淑.外周血T淋巴细胞及其相关细胞因子检测在胃部疾病发生、进展中的价值初探[J].石家庄:河北医科大学,2012.
[3] 侯婧瑛,向仍运,陈淑芬,等.Foxp3～+ Tregs和PD1在胃癌组织中的表达及其临床病理意义[J].中国病理生理杂志,2015,31(10):1744-1749.
[4] 魏玮,高勇,王理伟,等.细胞免疫状况与肿瘤相关性贫血患者生活质量的关系[J].肿瘤,2010,30:406-409.
[5] 陈杨,王艳荣,张权,等.晚期胃癌患者其肿瘤相关性贫血与预后的关系[J].解放军医学院学报,2015,36(4):351-354.
[6] 张之南,沈悌.血液病诊断及疗效标准.3版.北京:科学出版社,2007:1,17-18.
[7] 黄旭宏,宋玉国,刘春雷,等.胃癌与T淋巴细胞亚群关系的研究进展[J].世界华人消化杂志,2016,24(15):2331-2335.
[8] 秦斌,张筱茵.胃癌分子免疫学研究进展[J].世界华人消化杂志,2009,17(2):115-119.
[9] Ubukata H,Motohashi G,Tabuchi T,et al.Evaluations of interferon-/interleukin-4 ratio and neutrophil/lymphocyte ratio as prognosticindicators in gastric cancer patients[J].J Surg Oncol,2010,102(7):742-747.
[10] 刘彤华.肿瘤相关性贫血相关因素分析[J].中国实验诊断学,2013,23(17):1688-1690.
[11] Prá D,Franke SI,Henriques JA,.Iron and genome stability:an update[J].Mutat Res,2012,733(1-2):92-99.
[12] 葛军娜,于健春,康维明.10218例消化系恶性肿瘤贫血情况调查[J].中华胃肠外科杂志,2011,14(5):340-342.
[13] 阮润生,徐克成.肿瘤免疫治疗的新策略[J].中华肿瘤杂志,2011,33(12):943-946.
[14] Martinsson A,Andersson C,Andell P,Koul S,Engstr?m G,Smith JG.Anemia inthe general population:prevalence,clinical correlates and prognostic impact[J].Eur J Epidemiol,2014,29(7):489-498.
[15] 宋春燕,王翠英,沈凤梅.归脾汤治疗肿瘤相关性贫血临床研究[J].中医学报,2013,28(3):320-321.
[16] 旷欲胜,邱根全,刘佚,等.脾虚证大鼠侧脑室注射孤啡肽对细胞免疫功能的影响[J].西安交通大学学报(医学版),2007,48(6):658-661.
[17] 雷萍,韩晓伟,侯殿东,陈殿学,关洪全.灰树花多糖对脾虚小鼠T细胞亚群和Th1/Th2亚群的影响[J].中国中医药信息杂志,2013(7):27-29.
[18] 张燕军,崔大江,雷宝霞.归脾汤加味治疗化疗诱发的难治性骨髓抑制32例临床观察[J].现代肿瘤医学,2011(8):1644-1646.
[19] 李卫河,姚卫华,王清华,花勤亮.归脾汤对食管癌放化疗毒副作用的疗效观察[J].中国中医药信息杂志,2000,7(6):68-69.