参芪解毒汤辅助治疗晚期非小细胞肺癌的疗效

卢言琪 孟启明 陈玉英

摘要 目的：探讨参芪解毒汤联合GP方案对晚期非小细胞肺癌（Nonsmall-cell Lung Cancer，NSCLC）患者血清巨噬细胞抑制因子-1（MIC-1）、基质金属蛋白酶-9（MMP-9）及免疫功能的影响。方法：选取2019年3月至2019年12月深圳市宝安纯中医治疗医院收治的晚期NSCLC患者84例作为研究对象，采用随机数字表法分为对照组和观察组，每组42例。对照组予以GP方案化疗，在此基础上观察组予以参芪解毒汤治疗。比较2组临床疗效、治疗期间不良反应发生情况及治疗前后中医证候积分、血清MIC-1和MMP-9水平、免疫功能指标（CD3+、CD4+、CD8+、CD4+/CD8+）。结果：观察组有效率（47.62%）和疾病控制率（83.33%）显著高于对照组（26.19%、64.29%）（P<0.05）。治疗后观察组中医证候积分（11.38±2.76）显著低于对照组（14.71±2.48）（P<0.05）。治疗后观察组血清MIC-1（584.28±82.16）pg/mL和MMP-9（170.63±115.27）ng/L水平均顯著低于对照组[（832.13±90.84）pg/mL，（228.59±121.38）ng/L]（P<0.05）。治疗后观察组CD3+（64.72±6.83）%、CD4+（35.76±4.23）%及CD4+/CD8+（1.62±0.41）%均显著高于对照组[（50.35±3.46）%，（29.28±3.41）%，1.02±0.11）%]，CD8+（22.17±3.26）%显著低于对照组（28.23±2.16）%（P<0.05）。观察组白细胞计数减少、血小板计数减少、贫血及胃肠道反应的发生率（16.67%、4.76%、9.52%、19.05%）显著低于对照组（35.71%、19.05%、26.19%、40.48%）（P<0.05）。结论：参芪解毒汤联合GP方案能够降低晚期NSCLC患者MMP-9、MIC-1表达水平，较单一使用GP方案而言能够提高治疗效果，降低中医证候积分，改善患者免疫功能，降低不良反应发生率。且疗效高于单纯的化疗，值得临床推广应用。

关键词 参芪解毒汤;GP方案;非小细胞肺癌;巨噬细胞抑制因子-1;基质金属蛋白酶-9;免疫功能;中医证候;不良反应

Abstract Objective：To investigate the effects of Shenqi Jiedu Decoction with GP regimen on serum macrophage inhibitory factor 1（mic-1），matrix metalloproteinase-9（mmp9）and immune function in patients with advanced non-small cell lung cancer（NSCLS）.Methods：A total of 84 patients with advanced NSCLC admitted to Bao′an Authentic Traditional Chinese Medicine Therapy Hospital from March 2019 to December 2019 were selected as research objects and were divided into a control group and an observation group by random digital table method，with 42 cases in each group.The control group received GP regimen chemotherapy.On this basis，the observation group was treated with Shenqi Jiedu Decoction.The clinical efficacy and adverse reactions/ side effects during treatment were compared between 2 groups.Traditional Chinese medicine（TCM）syndrome score，the level of serum MIC-1 and MMP-9，immune function index（CD3+，CD4+，CD8+，CD4+/ CD8+）were also compared between the 2 groups before and after treatment.Results：The effective rate（47.62%）and disease control rate（83.33%）in the observation group were significantly higher than those in the control group（26.19%，64.29%）（P<0.05）.The TCM syndrome score（11.38±2.76）in the post-treatment observation group was significantly lower than that in the control group（14.71±2.48）（P<0.05）.After treatment，the level of serum MIC-1（584.28±82.16）pg/mL and MMP-9（170.63±115.27）ng/Lin the observation group were significantly lower than those in the control group[（832.13±90.84）pg/mL，（228.59±121.38）ng/L]（P<0.05）.After treatment，CD3+（64.72±6.83）%，CD4+（35.76±4.23）%and CD4+/CD8+（1.62±0.41）%in the observation group were significantly higher than those in the control group[（50.35±3.46）%，（29.28±3.41）%，1.02±0.11）%]while CD8+（22.17±3.26）%was significantly lower than the control group（28.23±2.16）%（P<0.05）.The incidence of leukopenia，thrombocytopenia，anemia and gastrointestinal reactions in the observation group（16.67%，4.76%，9.52%，19.05%）was significantly lower than that in the control group（35.71%，19.05%，26.19%，40.48%）（P<0.05）.Conclusion：Shenqi Jiedu Decoction combined with GP regimen can reduce the expression of mmp-9 and mic-1 in advanced NSCLC patients.Compared with the single use of GP regimen，it can improve the curative effect，reduce the score of TCM syndrome，improve the immune function of patients，and reduce the incidence of adverse reactions.Plus the higher effect than that of chemotherapy alone，this therapy is worthy of clinical application.

Keywords Shenqi Jiedu Decoction; GP regimen; Non-small cell lung cancer; Macrophage inhibitor factor 1; Matrix metalloproteinase-9; Immune function; TCM syndromes; Adverse reactions

中图分类号：R246.5;R2-031;R730.58;R979.1文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.07.017

肺癌按病理分型一般分为非小细胞肺癌（Non-small Cell Lung Cancer，NSCLC）和小细胞肺癌（Small Cell Lung Cancer，SCLC），其中前者占比80%[1]。NSCLC起病隱匿且病情进展极快，患者就诊时癌症已进展至中晚期。有研究报道，仅采用手术及术后放化疗并不能显著提高NSCLCⅢ期以上患者的5年生存率[2]。随着表皮生长因子受体-酪氨酸激酶抑制剂（EGFR-TKI）的问世，不仅使得部分患者的疗效提高，患者的生存期也得到了明显的延长，但对于已经出现淋巴转移及肺外转移的患者而言，其5年生存率仍处于较低水平。

目前研究显示，NSCLC的浸润、转移是一个多阶段、多步骤、多种成分参与的序贯连续过程，此过程中肿瘤细胞对正常细胞外基质及基底膜的降解是转移的关键所在，可检测到基质金属蛋白酶（Matrix Metalloproteinases，MMPs）表达水平的明显升高[3]。……