从类癌相关激素探讨疏肝健脾法论治类癌综合征

余芙欢　苏雯婷　袁冰　祁志荣　谭煌英

摘要 类癌综合征（CS）是功能性神经内分泌肿瘤的并发症，肿瘤分泌类癌相关激素如5-羟色胺、缓激肽、组胺等是并发CS的主要原因，在调节类癌相关激素基础上缓解腹泻、腹痛、皮肤潮红、支气管痉挛、心脏瓣膜病变等症状是治疗CS的关键。以类癌相关激素为切入点，回顾近年的研究，结合临床观察发现，疏肝健脾法有调节类癌相关激素、改善CS类似症状的作用。运用疏肝健脾法治疗CS有整体性、多靶点的治疗特色与优势，今后深入开展有关疏肝健脾法有效缓解CS作用的临床及基础研究，对于CS临床疗效的提高具有重要的意义。

关键词 类癌综合征;功能性神经内分泌肿瘤;类癌相关激素;5-羟色胺;疏肝健脾

Discussion on Soothing Liver and Strengthening Spleen Method in the Treatment of Carcinoid Syndrome Based on Carcinoid Related Hormones

YU Fuhuan1，2，SU Wenting1，2，YUAN Bing1，2，QI Zhirong2，TAN Huangying2

（1 Beijing University of Chinese Medicine，Beijing 100029，China; 2 Department of Integrative Oncology，China-Japan Friendship Hospital，Beijing 100029，China）

Abstract Carcinoid syndrome（CS） is a complication of functional neuroendocrine tumors.Tumors secreting carcinoid-related hormones such as serotonin，bradykinin，histamine，etc.are the main causes of complications of CS.On the basis of regulating carcinoid-related hormones，it can relieve symptoms such as diarrhea，abdominal pain，skin flushing，bronchospasm，heart valve disease，etc.And it is the key to treating CS.This paper takes carcinoid-related hormones as the starting point，reviews recent studies，combined with clinical observations，and found that the method of soothing the liver and strengthening the spleen has the effect of regulating carcinoid-related hormones and improving CS-like symptoms.The use of the method of soothing the liver and strengthening the spleen to treat CS has holistic，multi-targeted therapeutic characteristics and advantages.In the future，clinical and basic research on the method of soothing the liver and strengthening the spleen to play its overall and effective alleviation of CS should be carried out in order to improve the clinical efficacy of CS.It is of great significance to improve the clinical efficacy of CS

Keywords Carcinoid syndrome; Functional neuroendocrine tumor; Carcinoid-related hormones; 5-hydroxytryptamine; Soothing liver and strengthening spleen

中图分类号：R242;R73文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.12.025

神经内分泌肿瘤（Neuroendocrine Tumor，NET）是一组较其他恶性肿瘤发病率低[1]、恶性度低、生存期长的罕见肿瘤，发生在全身任何存在神经内分泌细胞的部位，可依据有无激素相关症状分为功能性肿瘤和无功能性肿瘤二类，类癌综合征（Carcinoid Syndrome，CS）是功能性NET的主要并发症，肿瘤分泌类癌相关激素如5-羟色胺（5-Hydroxytryptamine，5-HT）、缓激肽、組胺等是引起CS的主要原因。CS患者除肿瘤负担外，还伴有腹泻、腹痛、皮肤潮红、支气管痉挛、心脏瓣膜病变等复杂综合征，严重影响患者的生命质量，加重患者家庭和社会的负担[2-3]。目前已有各类抑制类癌相关激素分泌的药物如生长抑素类似物（Somatostatin Analogs，SSAs）、特罗司他乙酯，但存在作用靶点局限，对晚期患者疗效差，长期使用疗效降低及临床总体疗效待提高等问题[4]。……