参苓白术散对肿瘤恶病质患者TNF-α、TWEAK、Fn14表达的影响

Effect of Shenlingbaizhu powder on the expression of TNF-α，TWEAK and Fn14 in patients with tumor cachexia

摘要:

目的：观察参苓白术散对肿瘤恶病质患者血清肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、肿瘤坏死因子弱凋亡诱导剂（tumor necrosis factor-like weak inducer of apoptosis，TWEAK）、成纤维细胞生长诱导因子-14（fibroblast growth fac－tor-inducible 14，Fn14）表达的影响。方法：将64例诊断符合肿瘤恶病质，辨证属于脾气虚证患者，随机分为2组。对照组32例，予以复方氨基酸等营养支持治疗；治疗组32例，在营养支持治疗基础上加用参苓白术散汤剂，水煎服，每日1剂，分3次温服，共用4周。观察治疗前后中医临床证候、生存质量评定（Kanrofsky score，KPS）、TNF-α、TWEAK及其受体早期反应蛋白Fn14。结果：治疗组和对照组脾气虚证患者治疗后比较，中医证候总有效率分别为40.62%和15.62%，治疗组明显优于对照组（P<0.05）。在KPS评分改善率方面，治疗组优于对照组（P<0.05）。2组治疗后TNF-α、TWEAK、Fn14均降低，治疗组治疗前后差异有统计学意义（P<0.05），2组间比较，治疗后治疗组TNF-α、TWEAK、Fn14降低更为显著，差异均有统计学意义（P<0.05）。结论：参苓白术散与营养支持相联合，可改善肿瘤恶病质患者中医证候，提高患者体力状况，降低患者体内TNF-α、TWEAK、Fn14表达，提示参苓白术散可能通过该途径起到控制肿瘤恶病质发生的作用。

Abstract:

Objective：To observe the expression of TNF-α，TWEAK，Fn14 on the treat of tumor cachexia with Shenlingbaizhu powder. Methods：Sixty-four tumor cachexia patients were randomized into treatment group and control group，with thirty-two in each. The control group was given nutritional support and the treatment group was given Shenlingbaizhu powder in addition. The effect was evaluated after 4 weeks. The clinical symptoms，kanrofsky score（KPS），tumor necrosis factor-α（TNF-α），tumor necrosis factor-like weak inducer of apoptosis（TWEAK） and fibroblast growth factor-inducible 14（Fn14） were observed. Results：After treatment，the total effective rates of the Chinese medicine symptom in treatment group and control group were 40.62% and 15.62% respectively，with significant differences between groups（P<0.05）. After treatment，the KPS improvement rate was improved significantly in treatment group（P<0.05）. After treatment，the TNF-α，TWEAK and Fn14 were reduced significally in treatment group（P<0.05）. Conclusion：Shenlingbaizhu powder combined with nutritional support can improve life quality and KPS，decrease TNF-α，TWEAK，Fn14 expres－sion of the tumor cachexia patient. Shenlingbaizhu powder control cancer cachexia maybe due to its regulation of these cytokines.