复方苦参注射液对直肠癌放疗患者外周血sIL-2R和IL-8水平影响的研究

目的观察复方苦参注射液对直肠癌放疗患者外周血白介素-8（IL-8）、可溶性白介素2受体（sIL-2R）的动态变化，探讨其相互关系及临床意义。方法收集宜春市人民医院自2006年9月至2011年9月期间进展期直肠癌患者84例，随机分为两组，治疗组为复方苦参注射液联合体外三维适形放疗，对照组为三维适形放疗，两组放疗均给予计划靶区总剂量30Gy，分10次照射，每周5次，每次300cGy。治疗组放疗同时加用复方苦参注射液20ml＋生理盐水250ml，每日1次，连续15天为1个疗程。观察两组临床疗效、放疗近期不良反应以及生活质量的改善；双抗体夹心ELISA法检测两组放疗前、后直肠癌患者血清sIL-2R和IL-8水平变化。同时，取健康人群42例，均为宜春市人民医院体检中心经健康体检合格的正常人，作为健康对照组。结果（1）疗效比较：按照WHO实体瘤疗效评价标准，治疗组有效率为47．6％、对照组有效率21．4％，两组经，检验，P〈0．05，差异有统计学意义，治疗组优于对照组。（2）生活质量：以KPS评分评价改善、稳定、进展三个等级，得出治疗组改善16例，稳定17例，进展9例，对照组改善12例，稳定14例，进展16例，且治疗组和对照组经秩和检验，P〈0．05，差异有统计学意义，治疗组优于对照组。（3）sIL-2R、IL-8的检测：84例直肠癌患者在治疗前与42例健康人外周血sIL-2R、IL-8水平经t检验，均显示P〈0．05，差异有统计学意义；84例直肠癌患者放疗前与放疗后外周血sIL-2R、IL-8水平经t检验，P〈0．05，差异有统计学意义；治疗组放疗后1天与14天外周血sIL-2R、IL-8水平与对照组比较，经方差分析，P〈0．05，差异有统计学意义；但是治疗组和对照组各自组内以t检验比较放疗后1天、14天的外周血sIL-2R、IL-8水平，P〉0．05，差异无统计学意义。（4）不良反应：I度反应治疗组和对照组分别为5（11．9％），11（26．2％），经χ^2检验，P〈0．05，两者差异有统计学意义；治疗组和对照组治疗期间放射性直肠炎分别为4（9．52％）、12（28．6％），经χ^2检验，P〈0．05，两者差异有统计学意义。结论直肠癌患者可能存在外周血sIL-2R和IL-8水平升高。复方苦参注射液可能有降低直肠癌患者外周血sIL-2R和IL-8水平的作用，同时减少放疗毒副反应，提高患者生存质量。

Study on the effect of Compound matrine on the level of sIL-2R and IL-8 in peripheral blood cells of patients with rectal cancer to radiation

Objective To evaluate the level of sIL-2R and IL-8 in peripheral blood cells of patients with rectal cancer which compound matrine injection combined with radiation on rectal carcinoma. To explore the correlation of sIL-2R and IL-8 to patients with rectal cancer and clinical role. Methods To collect 84 patients diagnosed with rectal carcinoma at The People＇s Hospital of Yichun city in Jiangxi province from Steptemper 2006 to Steptemper 2011, we randomly divided into two groups： therapeutic group and control group. The patients in therapeutic group were treated with compound matrine and intensity modulated radiation therapy（IMRT） （30 Gy/10 f/2 W）,while the patients in control group were treated with IMRT. Compared two groups to the clinical effects and the levels of IL-8 and sIL-2R tested by ELISA in the pre-radiation and post-radiation. In addition, 42 normal people were singled out from physical examination center in the People＇s Hospital of Yichun city, which were considered as healthy controls. Results （ 1 ） Comparative effectiveness： The clinical effect and survival quality in therapeutic group better （47.6%） than those in control group（21.4% ） by chi-square test according to the criteria for assessing a solid tumors of WHO. （2） Life quality： All patients were divided into improvement, stability and progress three ranks in accordance with KPS. It have 16 improvement, 17 stability and 9 progress patients in therapeutic group; But, control group have 12 improvement, 14 stability and 16 progress patients. The Life quality in therapeutic group better than those in control group by rank sum test. （3） sIL-2R,IL-8 examination： Serum levels of sIL-2R and IL-8 were higher in rectal cancer patients before treatments than those in the healthy groups by student test. However, sIL-2R and IL-8 serum levels were found significantly lower in 84 rectal cancer patients after radiotherapy; The level of sIL-2R and IL-8 in therapeutic group was lower at the postradiation first day or 14th day compare to control group. However, no significant difference between post therapeutic on the first day and 14th day in both experimental groups by student test. （4） Adverse reactions ：The side effects of hematotoxicity （ 11.9% ） and radiation proctitos （9.52%） were fewer in therapeutic group while the hematotoxicity （26.2%） and radiation proctitos （28.6%） were higher in control group by chi-square test. Conclusion SIL-2R and IL-8 levels increase in serum of rectal carcinoma patients. Compound matrine can decrease the side effects of IMRT and significantly inhibit sIL-2R and IL-8 in peripheral blood on the radiation process, and can improve survival quality patients with rectal cancer.