目的 探讨香菇多糖联合FOLFOX4化疗方案对中晚期胃癌患者免疫功能和生活质量的影响.方法 选取2010年1月至2014年6月滨州市中心医院肿瘤科收治的中晚期胃癌患者120例,采用随机数字表法分为对照组和观察组,各60例.对照组给予FOLFOX化疗方案治疗,奥沙利铂与亚叶酸钙静脉滴注,1次/周,5氟尿嘧啶静脉推注,1次/周,治疗3周为1个疗程.观察组在对照组基础上加用香菇多糖静脉滴注,2次/周,治疗3周为1个疗程.比较2组近期疗效、免疫功能、生活质量及毒副反应发生情况.结果 观察组近期治疗有效率为63.3％ (38/60);对照组为55.0％ (33/60),二者差异无统计学意义(P＞0.05).对照组治疗前后CD3+T细胞分别为(38±6)％、(31±7)％;CD4+T细胞分别为(25±7)％、(19±6)％;CD4 +/CD8+比值分别为(1.21±0.29)、(0.80±0.35),治疗后明显低于治疗前(P＜0.05).观察组治疗前后CD3+T细胞分别为(38±7)％、(44±6)％;CD4+T细胞分别为(25±7)％、(30±5)％;CD4+/CD8+比值分别为(1.20±0.31)、(1.41±0.21),治疗后较治疗前均明显升高,并且均明显高于对照组治疗后水平(P＜0.05).观察组和对照组治疗后躯体功能、机体疼痛、总健康、活力、社会功能、情绪角色及心理卫生评分低于治疗前[观察组:(59±10)分比(65±11)分,(52±10)分比(68±13)分,(59±8)分比(66±8)分,(57±11)分比(65±13)分,(54±15)分比(61±20)分,(57±11)分比(67±13)分,(60±12)分比(63±14)分;对照组:(53±12)分比(64±11)分,(52±11)分比(67±12)分,(53±8)分比(65±7)分,(51±11)分比(65±12)分,(53±14)分比(60±17)分,(50±12)分比(67±12)分,(51±13)分比(63±14)分],且治疗后观察组躯体功能、总健康、活力、社会功能、情绪角色及心理卫生评分均明显高于对照组,差异有统计学意义(P＜0.05),但躯体角色和机体疼痛评分,组间比较差异无统计学意义(P＞0.05).治疗过程中,观察组Ⅰ～Ⅱ度中性粒细胞减少症及骨髓抑制发生率明显低于对照组[20.0％(12/60)比46.0％(28/60),18.3％(11/60)比43.3％ (26/60)] (P ＜0.05),胃肠道反应、肝功能损害发生率2组比较差异无统计学意义(P＞0.05).结论 香菇多糖联合FOLFOX4化疗方案治疗中晚期胃癌疗效确切,能够明显提高患者的免疫功能和生活质量,并降低毒副反应.%Objective To investigate the influences of lentinan combined with FOLFOX4 regimen on the immune function and life quality in patients with medium and advanced gastric cancer.Methods Totally 120 patients with medium and advanced gastric cancer from January 2010 to June 2014 were enrolled and divided into control group (60 cases) treated with FOLFOX4 regimen (oxaliplatin and calcium folinate,intravenous drip,once/week;5-fluorouracil,intravenous injection,once/week),and observation group treated with lentinan (intravenous drip,twice/week) combined with FOLFOX4 regimen.After 3 weeks of treatment,the short-term curative efficacy,immune function,life quality and adverse reactions were observed and compared between the two groups.Results The short-term effective rate showed no significant difference between observation group and control group [63.3％ (38/60) vs 55.0％ (33/60)] (P ＞ 0.05).Compared with pretreatment,the percentage of CD3+ and CD4+ T lymphocyte subsets and the ratio of CD4+/CD8+ after treatment were significantly reduced in control group [(31 ±7)％ vs (38 ±6)％,(19 ±6)％ vs (25 ±7)％,(0.80 ±0.35) vs (1.21 ±0.29)],were significantly increased in observation group [(44 ±6)％ vs (38 ±7)％,(30 ±5)％ vs (25 ±7)％,and (1.41 ±0.21) vs (1.20 ±0.31)],higher than those in control group (all P＜0.05);As to the life quality,the scores of somatic function,bodily pain,general health status,vitality,social function,role emotional and mental health after treatment in observation group and control group were statistically higher than before treatment [observation group:(59 ± 10)scores vs (65 ± ll)scores,(52 ± 10) scores vs (68 ± 13) scores,(59 ± 8) scores vs (66 ± 8) scores,(57 ± 11) scores vs (65 ± 13) scores,(54 ± 15) scores vs (61 ± 20) scores,(57 ± 11) scores vs (67 ± 13) scores,(60 ± 12) scores vs (63 ± 14) scores;control group:(53 ± 12) scores vs (64 ± 11) scores,(52 ± 11) scores vs (67 ± 12) scores,(53 ± 8) scores vs (65 ± 7) scores,(51 ± 11) scores vs (65 ± 12) scores,(53 ± 14) scores vs (60 ± 17) scores,(50 ± 12) scores vs (67 ± 12) scores,(51 ± 13) scores vs (63 ± 14) scores],and the scores of somatic function,general health status,vitality,social function,role emotional and mental health after treatment in observation group were higher than control group,while the role physical and bodily pain showed no significantly differences compared with control group (P ＞0.05).During the treatment,the occurrence of Ⅰ-Ⅱ degree neutropenia and myelosuppression in observation group were 20.0％ (12/60) and 18.3％ (11/60),which were both statistically lower than those in control group [46.0％ (28/60) and 43.3％ (26/60)] (P ＜0.05);the occurrence of gastrointestinal reaction and liver function damage showed no statistical differences between the two groups (P ＞ 0.05).Conclusion Lentinan combined with FOLFOX4 regimen is effective in treating medium and advanced gastric cancer,which could significantly improve the immune function and life quality,with lower occurrence of toxic side effects compared with single FOLFOX regimen.
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