刘霞　宋立业　宋琪

摘要目的：觀察复方斑蝥胶囊对胃癌患者的Th17/Treg比值及临床疗效和生命质量的影响。方法：选取2015年9月至2017年8月青岛市肿瘤医院收治的胃癌患者60例，根据随机数字表法随机分为对照组和观察组，每组30例。对照组接受FOLFOX4方案进行化疗，以14 d为1个治疗周期，共治疗4个周期，观察组在对照组治疗方法基础上加用复方斑蝥胶囊，075 g/次，2次/d。2组均以21 d为1个治疗周期，共治疗2个周期。治疗结束后比较2组患者血清肿瘤标志物癌胚抗原（CEA）、癌抗原（CA）199、CA242和CA724水平、生命质量评分（SF36）、不良反应、生存率以及外周血Th17细胞百分比、Treg细胞百分比以及Th17/Treg比值。结果：治疗后2组患者外周血CA199、CEA、CA724及CA242较治疗前下降，观察组下降的趋势较对照组明显（P<005）；2组治疗后躯体、角色、情绪、社会、总体生命质量评分均较治疗前升高，其中观察组优于对照组（P<005）；2组不良反应以骨髓抑制及消化道症状为主，2组骨髓抑制发生情况差异无统计学意义（P>005），观察组消化道症状发生率低于对照组（P<005）。2组患者治疗后外周血Th17细胞百分比、Treg细胞百分比及Th17/Treg下降，其中观察组下降的水平大于对照组，差异有统计学意义（P<005）。结论：胃癌机体存在的免疫逃逸现象，复方斑蝥胶囊可通过纠正Th17/Treg细胞失衡而提高胃癌疗效，改善患者生命质量。

关键词胃癌；复方斑蝥胶囊；Th17；Treg；生命质量；血清；肿瘤标志物；不良反应；生存率

Effects of Fufang Banmao Capsule on Th17 / Treg Cell Imbalance in Gastric Cancer and Quality of Life

Liu Xia，Song Liye，Song Qi

（First Department of Internal Medicine，Qingdao Cancer Hospital，Qingdao 266042，China）

AbstractObjective：To observe the clinical effects of compound cantharides Capsule on Th17 / Treg cell imbalance in gastric cancer and quality of life.Methods：A total of 60 cases of gastric cancer selected in Qingdao Cancer Hospital from September 2015 to August 2017 were observed and divided into control group and observation group，with 30 cases in each group.The control group received chemotherapy with FOLFOX4 regimen，and 14 d as a treatment course for 4 cycles.The observation group was additionally treated with Fufang Banmao Capsules，075 g / time，2 times / day.The 2 groups were treated with 21 d as a treatment cycle for 2 cycles.After treatment，serum tumor markers CEA，CA199，CA242 and CA724 levels，quality of life score（SF36），toxic and side effects，survival rate，percentage of Th17 cells in peripheral blood，percentage of Treg cells and Th17 / Treg ratio in 2 groups were compared.Results：1）Peripheral blood CA199，CEA，CA724 and CA242 decreased after treatment in 2 groups.Compared with control group，the observation group decreased significantly（P<005）； 2）Body，role，emotional，social and overall quality of life scores in 2 groups were higher than that before treatment.The observation group was better than control group（P<005）； 3）The major adverse reactions of 2 groups were myelosuppression and gastrointestinal symptoms.Occurrence difference of bone marrow suppression in 2 groups had no statistical differences（P>005）.The incidence rate of gastrointestinal symptoms in observation group was lower than that of the control group（P<005）.4）Peripheral blood Th17 cells than，the percentage of Treg cells and Th17 / Treg decreased in 2 groups.The observation group decreased more significantly than control group（P<005）.The differences were statistically significant（P<005）.Conclusion：There is a significant immune escape phenomenon in gastric cancer.Fufang Banmao capsules can improve the curative effects of gastric cancer by correcting the imbalance of Th17 / Treg cells and quality of life of patients.

Key WordsGastric cancer； Fufang Banmao Capsule； Th17； Treg； Quality of life； Serum； Tumor markers； Toxic and side effects； Survival rate

中图分类号：R2895；R735文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.08.018

胃癌是临床常见的消化道恶性肿瘤，化疗仍是主要治疗手段，但其引起的不良反应严重限制患者依从性[1]。中医药与化疗药物在治疗癌症方面有协同效应多有报道，胃癌患者气虚无力行血，血脉不畅生瘀，痰瘀胶着日久而成瘤，在中医“久病多瘀”理论指导下我们认为益气活血化瘀应是治疗胃癌的关键[23]。复方斑蝥胶囊有益气活血、化瘀通络的功效，主要含有斑蝥、刺五加、半枝莲、黄芪、女贞子、山茱萸、人参等，临床有诸多其效治疗恶性肿瘤的报道，但其作用机制目前尚无定论[4]。

幽门螺旋杆菌（Hp）的感染被视为胃癌的主要致癌因素，多数Hp感染可被机体免疫系统清除，其中CD4抗原阳性的T淋巴细胞（CD4+T细胞）在免疫应答中占据核心位置。……