复方苦参注射液联合同期放化疗治疗局部晚期鼻咽癌的疗效及其对患者免疫功能的影响

摘要

Objective To observe the clinical efficacy of compound sophorae flavescentis injection combined with synchronous chemotherapy and radiotherapy on patients with locally advanced nasopharyngeal carcinoma and its in-fluence on immune function. Methods A total of 82 patients with locally advanced nasopharyngeal carcinoma, who ad-mitted to outpatient of the Second Affiliated Hospital of Xi'an Jiaotong University from June 2012 to June 2015, were se-lected and randomly divided into the treatment group (n=42) and the control group (n=40) according to the random num-ber table method. Chemotherapy of cisplatin combined with intensity modulated radiation therapy (IMRT) was given ev-ery three weeks for the two groups, and the treatment group was treated with compound sophorae injection (20 mL, intra-venous infusion, one time/one day for 14 days and withdrawal 7 days as one cycle, continuous treatment for 3 cycles) additionally. Then the various cellular immune parameters (including the levels of CD3+, CD4+, CD8+T cells, ratio of CD4+/CD8+) of the two groups one day before therapy and one week after therapy were observed and compared, and the degree of bone marrow depression and short-term (3 months) effect were also compared. Results These therapies were all finished in the patients of the two groups. The level of CD4+ in the treatment group patients was significantly in-creased with (42.93±10.78)%vs (36.00±10.21)%, and the level of CD8+was significantly decreased with (24.42±9.79)%vs (29.73 ± 8.25)%. The ratio of CD4+/CD8+was significantly increased with (2.10 ± 1.32) vs (1.38 ± 0.83), so the level of cellular immune function after treatment in the treatment group was superior to that before treatment, the differences were statistically significant (all P<0.05). The increment of CD4+value and CD4+/CD8+ratio in the treatment group pa-tients were higher than those in the control group, (6.65±1.34)%vs (-5.09±1.38)%, (0.56±0.15) vs (-0.57±0.16), and the reduction of CD8+value in the treatment group was significantly higher than those of the control group, (-3.86±1.51)%vs (7.03 ± 1.54)%. The cellular immune function of the treatment group after the treatment was superior to the control group after treatment, and the difference was statistically significant (all P<0.05). The degree of bone marrow depression of the treatment group was significantly lower than that of the control group (P<0.05). There was no significant differ-ence between the two groups in the short-term efficacy (P>0.05). Conclusion Although the compound sophorae flaves-centis injection cannot improve the short-term curative effect of synchronous chemotherapy and radiotherapy in the treat-ment of locally advanced nasopharyngeal carcinoma, it can effectively activate the cellular immune function and allevi-ate the damage to the bone marrow in synchronous chemotherapy and radiotherapy in the treatment of locally advanced nasopharyngeal carcinoma, which is worthy of clinical application.%目的：观察复方苦参注射液联合同期放化疗治疗局部晚期鼻咽癌的疗效及其对患者免疫功能的影响。方法将2012年6月至2015年6月在西安交通大学第二附属医院肿瘤科门诊诊治的82例局部晚期鼻咽癌患者按照随机数法分为观察组42例和对照组40例，对照组采用顺铂3周化疗方案联合同期调强放射治疗(IMRT)，观察组在对照组治疗的基础上加用复方苦参注射液20 mL静脉滴注，1次/d，连续14 d，停药7 d为一个周期，连续治疗3个周期。治疗前1 d及结束后1周观察并比较两组患者各项细胞免疫指标(CD3+、CD4+、CD8+及CD4+/CD8+)的变化情况；两组患者治疗过程中骨髓抑制最高等级反应程度；治疗结束后3个月时两组治疗的近期效果。结果所有的患者均完成放疗计划。观察组患者治疗后的CD4+水平较治疗前升高[(42.93±10.78)%vs (36.00±10.21)%]，CD8+降低[(24.42±9.79)%vs (29.73±8.25)%)，CD4+/CD8+比值升高(2.10±1.32 vs 1.38±0.83)，观察组治疗后的细胞免疫功能水平优于其治疗前水平，差异均有统计学意义(P<0.05)；观察组患者治疗后的CD4+、CD4+/CD8+增加量高于对照组[(6.65±1.34)% vs (-5.09±1.38)%、(0.56±0.15) vs (-0.57±0.16)]，CD8+降低量高于对照组(-3.86±1.51)% vs (7.03±1.54)%，观察组治疗结束后细胞免疫功能水平优于对照组治疗后水平，差异均有统计学意义(P<0.05)；观察组骨髓抑制程度低于对照组，差异有统计学意义(P<0.05)；两组患者的近期疗效比较差异无统计学意义(P>0.05)。结论复方苦参注射液虽未能提高局部晚期鼻咽癌同期放化疗近期疗效，但能有效激活患者的细胞免疫功能，减轻局部晚期鼻咽癌同期放化疗对骨髓的损伤，值得临床推广应用。