【摘要】 目的探讨大剂量化疗联合香菇多糖治疗难治性弥漫大B细胞淋巴瘤(DLBCL)的效果及对叉头框蛋白P1(FOXP1)和Livin表达的影响。方法选取2010年1月—2015年1月沧州市中西结合医院诊治的42例难治性DLBCL患者,按照治疗方法不同分成对照组与联合组,每组21例。两组均予利妥昔单抗静脉滴注,对照组予大剂量吉西他滨+地塞米松+顺铂(GDP)方案化疗,联合组在对照组基础上给予香菇多糖静脉滴注,随访至2016年9月15日。监测免疫功能以及FOXP1、Livin蛋白表达情况,比较临床效果、生存率以及不良反应。结果化疗后,对照组CD4+、CD4+/CD8+以及自然杀伤细胞(NK)均低于化疗前(P<0.01),CD8+高于化疗前(P<0.01);联合组CD4+、CD4+/CD8+以及NK均明显高于化疗前和对照组(P<0.05,P<0.01),CD8+低于化疗前和对照组(P<0.01)。联合组FOXP1蛋白表达积分和阳性率均低于对照组(P<0.05),Livin蛋白表达积分和阳性率均高于对照组(P<0.05)。联合组总有效率和生存率高于对照组(P<0.05),Ⅲ~Ⅳ度血红蛋白减少和消化道反应发生率低于对照组(P<0.01)。结论大剂量GDP联合香菇多糖能有效提高难治性DLBCL的临床疗效,安全性较好,可能与下调FOXP1、上调Livin蛋白表达有关。更多还原

【Abstract】 Objective To investigate efficacy of high-dose chemotherapy combined with Lentinan in treatment of patients with refractory diffused large B-cell lymphoma( DLBCL) and its effects on FOXP1 and Livin protein expressions.Methods A total of 42 patients with refractory DLBCL admitted during January 2010 and January 2015 were divided into control group and combined group( n = 21 for each group) according to different treatment methods. All patients were treated with Rituximab intravenously. Control group was treated with chemotherapy by high-dose Gemcitabine + Dexamethasone + Cisplatin( GDP),while combined group was added with Lentinan by intravenous infusion on the basis of treatment for control group,and then the follow-up was ended on September 15,2016. Immune function and FOXP1 and Livin protein expressions were detected,and clinical efficacy,survival rates and adverse reactions were compared in two groups. Results After chemotherapy,in control group,CD4 +,CD4 +/CD8 + and natural killer( NK) cell levels were significantly lower than those before chemotherapy( P < 0. 01),while CD8 + level was significantly higher than that before chemotherapy( P < 0. 01). In the combined group,CD4 +,CD4 +/CD8 + and NK cell levels were significantly higher than those before chemotherapy and in control group( P < 0. 05,P < 0. 01),while CD8 + level was significantly lower than that before chemotherapy and in control group( P < 0. 01). In combined group,values of expression integral and positive rate of FOXP1 protein were significantly lower than those in control group( P < 0. 05),while values of expression integral and positive rate of Livin protein were significantly higher than those in control group( P < 0. 05). In combined group,the total effective rate and survival rate were significantly higher( P < 0. 05),while incidence rates of grade Ⅲ-Ⅳ hemoglobin reduction and digestive tract reaction were significantly lower than those in control group( P <0. 01). Conclusion High-dose chemotherapy combined with Lentinan in treatment of patients with refractory diffused large B-cell lymphoma can effectively improve clinical efficacy with good safety,which may be related to down-regulation of FOXP1 and up-regulation of Livin.更多还原