摘要
目的探讨术前新辅助化疗结合解毒化瘀汤对乳腺癌患者机体免疫、血清肿瘤标志物、转移浸润相关指标的干预作用。方法选取2020年3月至2023年1月济源市第二人民医院收治的80例乳腺癌患者纳入研究,按随机数表法分为对照组和观察组各40例。对照组患者采用新辅助化疗(21 d为一个疗程,治疗2个疗程,第2疗程结束后20 d进行手术治疗),观察组患者在此基础上联合解毒化瘀汤治疗(于化疗第1 d开始服用,服用至术前1周)。疗程结束后,比较两组患者的临床疗效、治疗前及治疗后(口服药物疗程结束后)的中医证候积分、血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原153(CA153)]、T淋巴细胞亚群(CD3^(^(+))、CD4^(+)、CD4^(+)/CD8^(+))、血管内皮生长因子(VEGF)等相关指标,并比较两组患者术时肿瘤组织中p27、CD44v6蛋白表达情况。结果观察组患者的治疗总有效率为77.50%,略高于对照组的62.50%,但差异无统计学意义(P>0.05);治疗后,观察组患者的乳房胀痛、乏力疲惫、失眠、疼痛等证候评分分别为(1.69±0.47)分、(1.35±0.36)分、(1.05±0.34)分、(0.83±0.26)分,明显低于对照组的(2.39±0.58)分、(1.97±0.43)分、(1.67±0.42)分、(1.19±0.25)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的血清CA125、CEA、CA153水平分别为(45.85±8.96)U/mL、(5.10±1.10)ng/mL、(37.12±6.33)U/mL,明显低于对照组的(65.24±11.32)U/mL、(9.87±2.13)ng/mL、(56.32±9.47)U/mL,差异均有统计学意义(P<0.05);治疗后,观察组患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平分别为(69.96±5.69)%、(46.35±4.10)%、2.02±0.45,明显高于对照组的(56.25±4.01)%、(35.00±5.64)%、1.32±0.36,差异均有统计学意义(P<0.05);治疗后,观察组患者的血清VEGF-A、VEGF-C、VEGF-D、VEGFR-1水平分别为(932.54±132.29)pg/mL、(1320.25±312.96)pg/mL、(913.25±231.25)pg/mL、(101.20±8.12)pg/mL,明显低于对照组的(1232.15±246.85)pg/mL、(1836.69±400.32)pg/mL、(1485.42±314.65)pg/mL、(112.32±10.69)pg/mL,差异均有统计学意义(P<0.05);术后,观察组患者的p27蛋白阳性表达率为77.50%,明显高于对照组的55.00%,CD44v6蛋白阳性表达率为25.00%,明显低于对照组的52.50%,差异均有统计学意义(P<0.05)。结论术前解毒化瘀汤辅助新辅助化疗能降低乳腺癌患者血清肿瘤标志物水平,调控肿瘤细胞转移浸润相关基因表达,改善患者机体免疫功能。
Objective To explore the intervention effect of Jiedu Huayu Decoction combined with neoadjuvant chemotherapy on body immunity,serum tumor markers,metastasis and invasion-related indicators of breast cancer patients before operation.Methods Eighty patients with breast cancer admitted to the Second People's Hospital of Jiyuan from March 2020 to January 2023 were selected and included in the study.They were randomly divided into a control group and an observation group,each with 40 cases.Patients in the control group received neoadjuvant chemotherapy,21 days as one course,for 2 courses of treatment,and surgery was performed 20 days after the second course of treatment.Patients in the observation group received Jiedu Huayu Decoction combined with neoadjuvant chemotherapy(Jiedu Huayu Decoction was taken from the first day of chemotherapy until one week before surgery).At the end of the treatment period,the clinical efficacy,TCM syndrome scores before and after treatment(after the end of the oral drug treatment period),serum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),carbohydrate antigen 153(CA153)],T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),vascular endothelial growth factor(VEGF),and other relevant indicators were compared between the two groups.The expression of p27 and CD44v6 proteins in tumor tissues during surgery was also compared between the two groups.Results The total effective rate of treatment in the observation group was 77.50%,slightly higher than 62.50%in the control group(P>0.05).After treatment,the symptom scores of breast distension,fatigue and exhaustion,insomnia,and pain in the observation group were(1.69±0.47)points,(1.35±0.36)points,(1.05±0.34)points,and(0.83±0.26)points,respectively,which were significantly lower than(2.39±0.58)points,(1.97±0.43)points,(1.67±0.42)points,and(1.19±0.25)points in the control group,respectively(P<0.05).After treatment,the serum CA125,CEA,and CA153 levels in the observation group were(45.85±8.96)U/mL,(5.10±1.10)ng/mL,and(37.12±6.33)U/mL,respectively,which were significantly lower than(65.24±11.32)U/mL,(9.87±2.13)ng/mL,and(56.32±9.47)U/mL in the control group(P<0.05).After treatment,the CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)levels in the observation group were(69.96±5.69)%,(46.35±4.10)%,and 2.02±0.45,respectively,which were significantly higher than(56.25±4.01)%,(35.00±5.64)%,and 1.32±0.36 in the control group(P<0.05).After treatment,the levels of serum VEGF-A,VEGF-C,VEGF-D,and VEGFR-1 in the observation group were(932.54±132.29)pg/mL,(1320.25±312.96)pg/mL,(913.25±231.25)pg/mL,and(101.20±8.12)pg/mL,respectively,which were significantly lower than(1232.15±246.85)pg/mL,(1836.69±400.32)pg/mL,(1485.42±314.65)pg/mL,and(112.32±10.69)pg/mL in the control group,respectively(P<0.05).After surgery,the positive expression rate of p27 protein in the observation group was 77.50%,which was significantly higher than 55.00%in the control group,and the positive expression rate of CD44v6 protein was 25.00%,which was significantly lower than 52.50%in the control group,with statistically significant differences(P<0.05).Conclusion Preoperative Jiedu Huayu Decoction combined with neoadjuvant chemotherapy can reduce the level of serum tumor markers in patients with breast cancer,regulate the expression of tumor cell metastasis and invasion related genes,and improve the immune function of patients.
作者
王三学
张斌
陈晓博
李彩霞
WANG San-xue;ZHANG Bin;CHEN Xiao-bo;LI Cai-xia(Outpatient Department,the Second People's Hospital of Jiyuan,Jiyuan 459000,Henan,CHINA;Department of Surgery,Jiyuan People's Hospital,Jiyuan 459000,Henan,CHINA)
出处
《海南医学》
CAS
2023年第24期3523-3528,共6页
Hainan Medical Journal
基金
2020年河南省医学科技攻关计划联合共建项目(编号:LHGJ20205076)。
