参苓白术散治疗脾虚湿困型晚期结直肠癌疗效及对肠道菌群、免疫功能、生活质量的影响  

Efficacy of Shen Ling Baizhu Powder on advanced colorectal cancer with syndrome of spleen deficiency and dampness encumbrance and its effects on intestinal flora,immune function and quality of life

作　　者：曹晨 张翔 顾芳红 潘龙赐 葛婷 刘吟宇 黄怡娴 刘志勇 CAO Chen;ZHANG Xiang;GU Fanghong;PAN Longci;GE Ting;LIU Yinyu;HUANG Yixian;LIU Zhiyong(Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China)

机构地区：[1]复旦大学附属中山医院青浦分院,上海201700

出　　处：《现代中西医结合杂志》2025年第2期190-196,共7页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：上海市卫生健康委员会中医药科研项目(2022QN004);上海市中医肿瘤特色专科项目(ZYTSZK2-17)。

摘　　要：目的探讨参苓白术散治疗脾虚湿困型晚期结直肠癌的疗效及对肠道菌群、免疫功能、生活质量的影响。方法采用随机数字表法,将2021年3月—2022年7月在复旦大学附属中山医院青浦分院住院的60例脾虚湿困型晚期结直肠癌患者分为参苓白术散联合组和XELOX组,每组30例。XELOX组采取XELOX化疗方案治疗,21 d为1个治疗周期,治疗4个周期。参苓白术散联合组在XELOX化疗方案基础上加用参苓白术散治疗12周。比较2组治疗前后肠道菌群丰度和Alpha多样性、肿瘤标志物和免疫功能指标[血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原724(CA724)水平和总B淋巴细胞CD19^(+)、NK细胞CD16^(+)CD56^(+)、辅助/诱导性T细胞CD3^(+)CD4^(+)、总T细胞CD3^(+)、抑制/细胞毒性T细胞CD3^(+)CD8^(+)细胞比例]、生活质量[根据KPS评分和生活质量量表(QOL)评定]及治疗后近期临床疗效、不良反应发生情况。结果治疗后,参苓白术散联合组患者乳酸杆菌属、双歧杆菌属丰度均明显高于治疗前及XELOX组(P均<0.05),肠球菌属和大肠杆菌属丰度均明显低于治疗前及XELOX组(P均<0.05);XELOX组患者乳酸杆菌属、双歧杆菌属丰度均明显低于治疗前(P均<0.05),肠球菌属和大肠杆菌属丰度均明显高于治疗前(P均<0.05)。治疗后,参苓白术散联合组患者observed_species指数明显低于治疗前(P<0.05),shannon指数明显高于治疗前(P<0.05);2组患者治疗后observed_species指数、chao指数、shannon指数、simpson指数比较差异均无统计学意义(P均>0.05)。治疗后,2组患者血清CEA、CA19-9和CA724水平均明显低于治疗前(P均<0.05),且参苓白术散联合组各指标水平均明显低于XELOX组(P均<0.05);治疗后,2组患者CD19^(+)、CD16^(+)CD56^(+)、CD3^(+)CD4^(+)、CD3^(+)、CD3^(+)CD8^(+)细胞比例和KPS评分、QOL评分均明显高于治疗前(P均<0.05),且参苓白术散联合组上述指标均明显高于XELOX组(P均<0.05)。参苓白Objective It is to explore the effect of Shen Ling Baizhu Powder(SLBP)on advanced colorectal cancer with syndrome of spleen deficiency and dampness encumbrance and its effects on intestinal flora,immune function and quality of life.Methods Sixty patients with advanced colorectal cancer of syndrome of spleen deficiency and dampness encumbrance hospitalized in Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from March 2021 to July 2022 were divided into SLBP combination group and XELOX group by a randomized numerical table method,with 30 cases in each group.The XELOX group was treated with XELOX chemotherapy,21 days as 1 treatment cycle,and 4 cycles were observed.The SLBP combination group was treated with SLBP for 12 weeks based on XELOX chemotherapy.The abundance and Alpha diversity of intestinal flora,levels of tumor markers and immune function indexes[serum carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 724(CA724)and proportions of total B-lymphocytes CD19^(+),NK-cells CD16^(+)CD56^(+),helper/inducer T-cells CD3^(+)CD4^(+),total T cell CD3^(+),and suppressor/cytotoxic T cell CD3^(+)CD8^(+)],quality of life[assessed by KPS score and Quality of Life Scale(QOL)]before and after treatment,and recent clinical efficacy and occurrence of adverse effects after treatment were compared between the two groups.Results After treatment,the abundances of Lactobacillus and Bifidobacterium in patients of the SLBP combination group were significantly higher than those before treatment and in the XELOX group(all P<0.05),while the abundances of Enterococcus and Escherichia coli were significantly lower than those before treatment and in the XELOX group(all P<0.05).After treatment,the observed species index in the SLBP combination group was significantly lower than that before treatment(P<0.05),and the Shannon index was significantly higher than that before treatment(P<0.05);there were no statistically significant differences in the observed species index,chao index,shannon i

关 键 词：晚期结直肠癌 参苓白术散 脾虚湿困型 免疫功能 肠道菌群 生活质量 

分 类 号：R735.3[医药卫生—肿瘤]