健脾养正方联合新辅助化疗对脾胃气虚证胃癌患者Treg代谢及生活质量影响  

Effect of Jianpi Yangzheng Decoction(健脾养正方)Combined with Neoadjuvant Chemotherapy on Treg Metabolism and Quality of Life in Patients with Gastric Cancer of Spleen and Stomach Qi Deficiency Syndrome

作　　者：张星星[1] 张粲粲 韩博 袁梦云 郑姗姗 吴坚[1] 谢晓东[1] ZHANG Xingxing;ZHANG Cancan;HAN Bo;YUAN Mengyun;ZHENG Shanshan;WU Jian;XIE Xiaodong(Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029,Jiangsu,China;Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu,China)

机构地区：[1]南京中医药大学附属医院,江苏省中医院,江苏南京210029 [2]南京中医药大学,江苏南京210023

出　　处：《辽宁中医药大学学报》2024年第12期5-10,F0003,共7页Journal of Liaoning University of Traditional Chinese Medicine

基　　金：江苏省中医药管理局课题(JD2022SZ06);南京中医药大学校级课题(SJCΧ22_0772)。

摘　　要：目的观察健脾养正方联合新辅助化疗对胃癌脾胃气虚证患者的疗效及安全性,并探讨其作用机制。方法选择2018年1月—2023年8月于江苏省中医院住院治疗的胃癌患者80例,患者随机分为对照组(40例)和治疗组(40例),对照组患者给予以奥沙利铂和替吉奥为主的SOX术前新辅助化疗方案,治疗组在新辅助化疗基础上配合健脾养正方治疗,疗程42 d。记录两组患者肿瘤退缩分级、治疗前后中医证候评分、中医证候总体疗效及卡氏功能状态评分(Karnofsky performance status scores,KPS评分)。观察两组患者治疗过程的血常规并判定安全性。免疫荧光检测肿瘤组织中CD8^(+)T细胞、调节性T细胞(Treg细胞)比例,Treg细胞上单羧酸转运蛋白1(monocarboxylate transporter 1,MCT1)、M2型丙酮酸激酶(pyruvate kinase M2,PKM2)的表达。结果治疗后,治疗组肿瘤退缩分级有效率更高(P<0.05);治疗组纳差、乏力、体质量下降的中医证候评分优于对照组(P<0.05);治疗组中医证候总评分和KPS评分较对照组明显改善(P<0.05);两组患者白细胞减少、血小板减少、贫血发生情况比较,差异无统计学意义(P>0.05)。治疗组肿瘤组织中CD8^(+)T细胞浸润高于对照组,Treg细胞比例低于对照组;Treg细胞上PKM2、MCT1蛋白表达低于对照组。结论健脾养正方可有效提高胃癌新辅助化疗的疗效,改善胃癌患者中医证候疗效和生活质量。机制可能与该方抑制MCT1和PKM2表达从而抑制Treg的乳酸代谢及糖酵解代谢活性,恢复肿瘤微环境中Treg与效应CD8^(+)T细胞之间的平衡有关。Objective To observe the efficacy and safety of Jianpi Yangzheng Decoction(健脾养正方)combined with neoadjuvant chemotherapy in patients with gastric cancer of spleen-stomach Qi deficiency syndrome,and to explore its mechanism of action.Methods From January 2018 to August 2023,80 patients with gastric cancer who were hospitalized in Jiangsu provincial hospital of traditional Chinese medicine were randomly divided into control group(40 cases)and treatment group(40 cases).The patients in the control group were given SOX preoperative neoadjuvant chemotherapy.The treatment group was treated with Jianpi Yangzheng Decoction on the basis of neoadjuvant chemotherapy for 42 days.Tumor regression grade(TRG)pathological assessment,traditional Chinese medicine(TCM)syndrome scores before and after treatment,TCM syndrome efficacy and Karnofsky performance status scores(KPS scores)the two groups of tumor patients were recorded.To observe the blood routine of the two groups of patients during treatment and determine safety.Immunofluorescence detection of the ratio of CD8^(+)T cells to Treg cells in tumor tissue,as well as the expression of monocarboxylate transporter 1(MCT1)on Treg cells and pyruvate kinase M2(PKM2).Results After treatment,the treatment group showed a higher rate of tumor regression grade effectiveness(P<0.05).The treatment group had better scores in terms of poor appetite,fatigue,and weight loss compared with the control group(P<0.05).The treatment group showed significant improvement in the total score of TCM syndrome and KPS scores compared with the control group(P<0.05).There was no statistically significant difference between the two groups in terms of leukopenia,thrombocytopenia,and anemia occurrence(P>0.05).The treatment group had higher infiltration of CD8^(+)T cells and a lower proportion of Treg cells in tumor tissue compared to the control group.The expression of PKM2 and MCT1 proteins on Treg cells was lower in the treatment group than in the control group.Conclusion Jianpi Yangzheng Decoction e

关 键 词：胃癌 新辅助化疗 健脾养正方 TREG 乳酸代谢 

分 类 号：R273[医药卫生—中西医结合]