大剂量化疗联合香菇多糖治疗难治性弥漫大B细胞淋巴瘤的效果及FOXP1与Livin蛋白的表达

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.

Efficacy of High-dose Chemotherapy Combined with Lentinan in Treatment of Patients with Refractory Diffused Large B-cell Lymphoma and Its Effects on FOXP1 and Livin Protein Expressions

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 ex pression 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 ⅢI-ⅣW 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.