槐耳颗粒在鼻咽癌放化疗患者中的应用效果

2020-08-31 11:32:23 中国当代医药 2020年20期

张才友 曾春生 王小毛 罗会俊 李金伟 吴伟 林松焕

[摘要]目的 探討槐耳颗粒在鼻咽癌放化疗患者中的应用效果。方法 选取2014年1月~2016年1月我院初治的同期放化疗鼻咽癌患者60例作为研究对象,采用简单随机化法将其分为对照组和观察组,每组各30例。对照组患者给予常规同期放化疗,观察组患者在同期放化疗基础上联合槐耳颗粒,治疗完成后1个月,比较分析两组患者治疗前后T细胞亚群表达变化、临床疗效及生存质量。结果 两组患者的临床治疗总有效率比较,差异无统计学意义(P>0.05);治疗后,两组患者的CD3+、CD4+、CD4+/CD8+细胞表达水平均高于治疗前,且观察组患者的CD3+、CD4+、CD4+/CD8+细胞表达水平高于对照组,差异有统计学意义(P<0.05);治疗后,两组患者的CD8+细胞表达水平均低于治疗前,观察组患者的CD8+细胞表达水平低于对照组,差异有统计学差异(P<0.05);同期放化疗后,观察组患者的躯体功能评分高于对照组,且疲劳、恶心/呕吐及疼痛评分低于对照组,差异均有统计学意义(P<0.05)。结论 槐耳颗粒能有效提高鼻咽癌同期放化疗后的免疫功能,还能改善患者的生存质量,临床应用价值较高。

[关键词]鼻咽癌;槐耳颗粒;同期放化疗;免疫功能;生存质量

[中图分类号] R739.6          [文献标识码] A          [文章编号] 1674-4721(2020)7(b)-0099-04

Application effect of Huai′er Granules in radiochemotherapy for patients with nasopharyngeal carcinoma

ZHANG Cai-you1   ZENG Chun-sheng1   WANG Xiao-mao1   LUO Hui-jun1   LI Jin-wei2   WU Wei2   LIN Song-huan2

1. Central Pharmacy, Ganzhou Cancer Hospital, Jiangxi Province, Ganzhou   341000, China; 2. Department of Radiotherapy, Ganzhou Cancer Hospital, Jiangxi Province, Ganzhou   341000, China

[Abstract] Objective To explore the effect of Huai′er Granules in radiochemotherapy for patients with nasopharyngeal carcinoma. Methods A total of 60 patients with nasopharyngeal carcinoma who underwent concurrent radiotherapy and chemotherapy from January 2014 to January 2016 were selected as the research objects. The selected patients were divided into the control group and the observation group by simple randomization, 40 cases in each group. The control group was treated with concurrent chemoradiotherapy, and the observation group was treated with concurrent chemoradiotherapy combined with Huai′er Granules. One month after the treatment was completed, the changes in T cell expression, clinical efficacy, and quality of life of patients of the two groups before and after treatment were analyzed. Results The total effective rate of clinical treatment of patients between the two groups was not statistically significant (P>0.05). After treatment, the expression levels of CD3+, CD4+, CD4+/CD8+ cells in two groups were higher than before treatment, and the expression levels of CD3+, CD4+, CD4+/CD8+ cells in the observation group were higher than those in control group, the differences were statistically significant (P<0.05). After treatment, the expression level of CD8+ cells in two groups were lower than those before treatment, and the expression level of CD8+ cells in the observation group was lower than that in control group (P<0.05). After radiochemotherapy, the physical function score of the observation group was higher than that in the control group, and the meanwhile, the fatigue, nausea/vomiting and pain scores in observation group were lower than those in control group, the differences were statistically significant (P<0.05). Conclusion Huai′er Granule can effectively improve the immune function of nasopharyngeal carcinoma after radiotherapy and chemotherapy at the same time, and can also improve the quality of life of patients. It is worthy of further clinical research.

槐耳是我国民间常用的补中益气药物,对提高肿瘤患者低下的免疫力具有显著作用,可诱导人体产生α、γ干扰素,诱导T淋巴细胞分裂、繁殖、成熟、分化,调整抑制性与辅助性T淋巴细胞的比例,产生某些细胞激活因子,如白细胞介素-2,使NK细胞活性增强,是具有明显协同作用的免疫调节剂[6]。槐耳颗粒还可作为抗肿瘤常用的辅助药物,临床可配合手术和放、化疗等治疗手段,在肿瘤的治疗过程中有明显的抑制作用,增强机体免疫功能,提高恶性肿瘤放化疗后患者的生存质量[7]。

肿瘤的形成及发展过程中,CD4+/CD8+T淋巴细胞比例降低导致机体免疫功能低下,并协同促进肿瘤的进一步恶化进展。槐耳具有显著促进T淋巴细胞增殖的作用,能提高恶性肿瘤患者T细胞亚群百分比及CD4+/CD8+T淋巴细胞比值[9-10]。槐耳联合其他药物用于治疗肿瘤取得了较好的临床效果。以西罗莫司为基础,联合槐耳颗粒、胸腺肽α1的三联抗肿瘤疗法可抑制Treg细胞的表达和增殖,通过抑制细胞间的相互作用,促进肝移植复发模型大鼠的T淋巴细胞数量升高,提高CD4+/CD8+比值[11-12]。患者术后服用槐耳颗粒,同样能提高T淋巴细胞亚群百分比,增大CD4+/CD8+细胞比值[13-14]。因此,槐耳颗粒能通过升高T淋巴细胞以达到提高机体抗肿瘤的免疫功能,从而改善患者预后[15]。在本研究中,两组鼻咽癌患者治疗后的总有效率比较,差异无统计学意义(P>0.05);同期放化疗前两组患者的CD3+、CD4+、CD8+、CD4+/CD8+细胞表达水平比较,差异无统计学意义(P>0.05);行同期放化疗后,两组患者的CD3+、CD4+、CD4+/CD8+细胞表达水平均高于治疗前,CD8+细胞表达水平低于治疗前,差异有统计学意义(P<0.05)。提示患者机体免疫功能下降与肿瘤的发生和发展关系密切,针对鼻咽癌同期放化疗联合槐耳颗粒治疗后可减轻肿瘤负荷,促进免疫功能抑制得到缓解;同期放化疗联合槐耳颗粒治疗后观察组患者的CD3+、CD4+、CD4+/CD8+细胞表达水平高于对照组,CD8+细胞表达水平低于对照组,差异有统计学意义(P<0.05),提示其能进一步提高鼻咽癌患者治疗的免疫功能。本研究结果还显示,同期放化疗联合槐耳颗粒治疗的鼻咽癌患者功能子量表中的躯体功能得分高于常规放化疗的对照组患者(P<0.05),而症状子量表中的疲劳、恶心/呕吐和疼痛得分低于对照组(P<0.05),提示槐耳颗粒对患者机体状态的保护作用及其提高生存质量有重要意义。

综上所述,槐耳颗粒虽不能显著提高鼻咽癌患者放化疗的临床疗效,但能有效提高鼻咽癌同期放化疗后的免疫功能,改善患者的生存质量,临床应用价值较高。

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(收稿日期:2019-12-05)