西黄丸联合TC化疗方案对气滞血瘀型卵巢癌患者的疗效及TLR4/NF-κB/HIF-1α信号通路的影响

Efficacy of Xihuang Pills combined with the TC chemotherapy regimen in patients with qi stagnation and blood stasis-type ovarian cancer and its effects on the TLR4/NF-κB/HIF-1α signaling pathway

摘要:

目的 探讨西黄丸联合TC化疗方案对气滞血瘀型卵巢癌患者的疗效。方法 选取2021年1月—2024年12月在江南大学附属医院接受治疗的96例气滞血瘀型卵巢癌患者，通过随机数字表法将其分为对照组和观察组，各48例。所有患者均接受肿瘤细胞减灭术，对照组术后接受TC化疗，观察组在对照组的基础上服用西黄丸，21 d为1个疗程，两组均治疗6个疗程。比较两组临床疗效，以及治疗前后血清中Toll样受体4（TLR4）、核因子κB（NF-κB）、缺氧诱导因子-1α（HIF-1α）水平，并检测T淋巴细胞水平、肿瘤标志物水平［血清糖类抗原（CA）125、CA19-9、人附睾蛋白（HE）4］、炎症因子水平、凝血功能，评估中医证候积分和生活质量评分。结果 观察组总有效率（ORR）高于对照组（P <0.05）。观察组治疗后TLR4、NF-κB和HIF-1α蛋白相对表达量均低于对照组（P <0.05）。同组内，治疗后TLR4、NF-κB和HIF-1α蛋白相对表达量均低于治疗前（P <0.05）。观察组治疗后CD3⁺、CD4⁺高于对照组，CD8⁺低于对照组（P <0.05）。同组内，治疗后CD3⁺、CD4⁺均低于治疗前，CD8⁺高于治疗前（P <0.05）。观察组治疗后CA19-9、HE4、CA125水平均低于对照组（P <0.05）。同组内，治疗后CA19-9、HE4、CA125水平均低于治疗前（P <0.05）。观察组治疗后白细胞介素-6（IL-6）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）水平均低于对照组（P <0.05）。同一组内，治疗后IL-6、PT、APTT、FIB水平均低于治疗前（P <0.05）。观察组治疗后中医证候积分低于对照组，QLQ-C30评分高于对照组（P <0.05）。同一组内，治疗后中医证候积分低于治疗前，QLQ-C30评分高于治疗前（P <0.05）。结论 术后化疗联合西黄丸相较于单纯化疗，能通过调控TLR4/NF-κB/HIF-1α通路提升疗效，改善患者免疫状态与生活质量。

Abstract:

Objective To explore the efficacy of Xihuang Pills combined with TC chemotherapy regimen in patients with qi stagnation and blood stasis type ovarian cancer.Methods A total of 96 patients diagnosed with ovarian cancer of the qi stagnation and blood stasis type, who were treated at our hospital between January 2021 and December 2024, were enrolled in this study. Using a random number table, they were assigned to either a control group or an observation group, with 48 participants in each. All patients underwent cytoreductive surgery. Postoperatively, the control group received TC chemotherapy, whereas the observation group was administered Xihuang Pills in addition to the same chemotherapy regimen. A treatment course lasted for 21 days, and both groups received treatment for 6 courses. The clinical efficacy of the two groups was compared. Before and after treatment, the serum levels of TLR4, NF-κB and HIF-1α were detected; the levels of T lymphocytes, tumor markers [serum carbohydrate antigen (CA) 125, CA19-9, human epididymis protein (HE) 4] and inflammatory factors were measured; the coagulation function was examined; the TCM syndrome score and quality of life score were evaluated.Results The objective response rate (ORR) in the observation group was higher than that in the control group (P < 0.05). After treatment, the levels of TLR4, NF-κB and HIF-1α in the observation group were lower than those in the control group (P < 0.05). Within each group, the levels of TLR4, NF-κB and HIF-1α after treatment were lower than those before treatment (P < 0.05). After treatment, the levels of CD3⁺ and CD4⁺ in the observation group were higher, while the level of CD8⁺ was lower compared with the control group (P < 0.05). Within each group, CD3⁺ and CD4⁺ levels were lower and CD8⁺ levels were higher after treatment than before treatment (P < 0.05). After treatment, the levels of CA19-9, HE4 and CA125 in the observation group were lower than those in the control group (P < 0.05). Within each group, the levels of CA19-9, HE4 and CA125 after treatment were reduced relative to pre-treatment levels (P < 0.05). Post-treatment levels of IL-6, PT, APTT and FIB in the observation group were significantly lower than those in the control group (P < 0.05). Within each group, the levels of IL-6, PT, APTT and FIB after treatment were all lower than those before treatment (P < 0.05). After treatment, the traditional Chinese medicine (TCM) syndrome score of the observation group was lower, whereas the EORTC QLQ-C30 score was higher than that of the control group (P < 0.05). Within each group, the TCM syndrome score decreased and the EORTC QLQ-C30 score increased after treatment compared with baseline (P < 0.05).Conclusion Compared with chemotherapy alone, postoperative chemotherapy combined with Xihuang Pills can improve clinical efficacy and enhance the immune function and quality of life of patients with qi stagnation and blood stasis type ovarian cancer by regulating the TLR4/NF-κB/HIF-1α pathway.