扶正化痰祛瘀法联合化疗治疗中晚期肺腺癌的临床和实验研究

发布时间：2018-06-27 09:24

本文选题：扶正化痰祛瘀法 + 肺腺癌　；参考：《南京中医药大学》2017年硕士论文

【摘要】：研究目的:运用扶正化痰祛瘀方联合化疗治疗中晚期肺腺癌患者,分析扶正化痰祛瘀法对中晚期肺腺癌患者近期疗效、生存质量及化疗毒副反应的影响;观察扶正化痰祛瘀方对A549肺癌BALB/c裸鼠皮下移植瘤生长的影响,并探讨此法可能的抗肿瘤作用机制。研究方法:1.将42例经细胞学或病理学确诊为中晚期的肺腺癌患者,随机分为试验组(扶正化痰祛瘀方+化疗组)21例和对照组(单纯化疗组)21例,通过2个周期的治疗,观察两组近期客观有效率、肺癌相关肿瘤标志、中医症候和KPS评分的变化,并观察两组化疗期间毒副反应的发生状况。2.培养A549肺癌细胞,建立裸鼠皮下移植瘤模型,将其分成生理盐水组、中药组(扶正化痰祛瘀方)、顺铂组、中药(扶正化痰祛瘀方)+顺铂组,观察给药期间裸鼠日常活动、精神状态及肿瘤生长变化,计算瘤体体积、瘤重抑制率;用免疫组化法测定四组瘤体中bcl-2、bax和突变型p53基因的表达情况。研究结果:1.治疗2个周期后,试验组在咳痰、痰血、胸痛及乏力四个症状上有显著改善,与对照组相比,差异有统计学意义(P0.05);两组相比,试验组在化疗毒副反应如骨髓抑制、恶心呕吐的发生率上明显减少,差异有统计学意义(P0.05)。2.中药+顺铂组裸鼠皮下移植瘤体积及瘤重明显小于生理盐水组,差异有显著统计学意义(P0.01),同时亦小于中药组和化疗组,差异有统计学差异(P0.05);中药+顺铂组bcl-2、突变型p53基因表达阳性面积光密度值(IOD)明显低于生理盐水组,差异具有显著统计学意义(P0.01),同时亦低于中药组及顺铂组(P0.05);中药+顺铂组bax基因表达IOD值高于生理盐水组,差异有显著统计学意义(P0.01),同时亦高于中药组和顺铂组(P0.05)。研究结论:扶正化痰祛瘀法在提高患者生存质量、减轻化疗带来的骨髓抑制和恶心呕吐方面有确切疗效,与化疗联用疗效更优;扶正化痰祛瘀法联合化疗能明显抑制肺癌皮下移植瘤生长,其作用机制可能与下调bcl-2基因、突变型p53基因,上调bax基因,从而加速肿瘤细胞凋亡有关。
[Abstract]:Objective: to study the effect of Fuzheng Huatan Quyu recipe combined with chemotherapy in the treatment of middle and late stage lung adenocarcinoma, and to analyze the effect of Fuzheng Huatan Quyu method on the short-term curative effect, quality of life and side effects of chemotherapy in patients with middle and late stage lung adenocarcinoma. To observe the effect of Fuzheng Huatan Quyu recipe on the growth of A549 lung cancer BALB / C nude mice subcutaneously transplanted tumor and to explore the possible anti-tumor mechanism of this method. Research method: 1. 42 cases of lung adenocarcinoma diagnosed by cytology or pathology were randomly divided into two groups: the experimental group (21 cases) and the control group (21 cases). Observe the short-term objective effective rate, lung cancer related tumor markers, TCM symptoms and KPS score changes, and observe the occurrence of adverse reactions during the two groups of chemotherapy. 2. A549 lung cancer cells were cultured and subcutaneously transplanted tumor models were established in nude mice. They were divided into normal saline group, traditional Chinese medicine group (Fuzheng Huatan Quyu recipe), cisplatin group and traditional Chinese medicine (Fuzheng Huatan Quyu recipe) cisplatin group. The daily activities of nude mice during administration were observed. Mental state and tumor growth, tumor volume and tumor weight inhibition rate were calculated, and the expression of bcl-2mbax and mutant p53 gene were detected by immunohistochemical method. The result of the study was: 1. After 2 cycles of treatment, the four symptoms of expectoration, phlegm and blood, chest pain and fatigue in the experimental group were significantly improved, compared with the control group, the difference was statistically significant (P0.05). The incidence of nausea and vomiting was significantly reduced, the difference was statistically significant (P0.05). The volume and weight of subcutaneous transplanted tumor in Cisplatin group were significantly smaller than those in normal saline group (P0.01), but also smaller than those in traditional Chinese medicine group and chemotherapy group. The positive area optical density (IOD) of mutant p53 gene expression in Cisplatin group was significantly lower than that in normal saline group. The difference was statistically significant (P0.01), but also lower than the traditional Chinese medicine group and cisplatin group (P0.05); the bax gene expression in the Cisplatin group was higher than that in the saline group (P0.01), but also higher than the traditional Chinese medicine group and cisplatin group (P0.05). Conclusion: the method of tonifying and removing phlegm and removing blood stasis is effective in improving the quality of life of patients and alleviating the bone marrow depression and nausea and vomiting caused by chemotherapy, and the combination of chemotherapy and chemotherapy is more effective. The combination of Fuzheng phlegm dispelling blood stasis method and chemotherapy can obviously inhibit the growth of lung cancer subcutaneously transplanted tumor, its mechanism may be related to down-regulation of bcl-2 gene, mutant p53 gene, upregulation of bax gene, thus accelerating the apoptosis of tumor cells.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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