Research Center for Traditional Chinese Medicine Complexity System, Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
Department of Liver and Spleen and Stomach Diseases, Henan Province Hospital of Traditional Chinese Medicine/the Second Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450002 Henan, China.
J Tradit Chin Med. 2021 Feb;41(1):157-166. doi: 10.19852/j.cnki.jtcm.2021.01.018.
To investigate the therapeutic effect of the Jianpi Liqi Fang ( ，JPLQF) combined with transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) and spleen deficiency syndrome (SDS) and identify a potential indicator of efficacy.
Ninety-nine patients with HCC who were diagnosed with SDS, non-spleen deficiency syndrome (NSDS), or no syndrome (NS) were treated with JPLQF combined with TACE for three periods. Therapeutic efficacy was compared among the groups. Plasma proteins were screened using label-free discovery analysis and verified via enzyme-linked immunosorbent assay (ELISA). Furthermore, receiver operating characteristic (ROC) curves were analyzed to evaluate therapeutic indicators.
After treatment, the Karnofsky Performance Status was significantly improved in the SDS group and significantly better than that in the NS group. The Traditional Chinese Medicine (TCM) syndrome scores were lower in the SDS group after treatment and lower than those in the NSDS group. However, alanine aminotransferase, carbohydrate antigen 19-9, alpha-fetoprotein, and carcinoembryonic antigen levels and white blood cell and platelet counts did not differ among the groups. Serum aspartate aminotransferase levels in the SDS group were significantly lower after treatment than before treatment, and total bilirubin levels were significantly lower in the SDS group than in the NSDS group. Label-free analysis identified 24 differentially expressed proteins (DEPs) between the SDS and NS groups, including 17 and 7 upregulated and downregulated proteins, respectively. Fibulin-5 (FBLN5) displayed the largest difference in expression between the groups. ELISA confirmed that FBLN5 levels were significantly lower in the NSDS and NS groups than in the SDS group. Following treatment with JPLQF and TACE, FBLN5 expression was upregulated only in the SDS group. Furthermore, ROC curve analysis indicated that FBLN5 may serve as a potential indicator of the efficacy of JPLQF combined with TACE in patients with HCC and SDS.
JPLQF combined with TACE improved quality of life, clinical TCM symptoms, and liver function in patients with HCC and SDS. FBLN5 expression was significantly altered by treatment with JPLQF and TACE in patients with HCC and SDS.
探讨健脾理气方联合经导管动脉化疗栓塞术（TACE）治疗肝癌脾虚证患者的疗效，并寻找可能的疗效预测指标。
99 例肝癌脾虚证患者采用健脾理气方联合 TACE 治疗 3 个周期，比较各组疗效。采用无标记定量发现分析筛选血浆蛋白，酶联免疫吸附法（ELISA）验证，并分析受试者工作特征（ROC）曲线评价疗效预测指标。
治疗后，脾虚组 Karnofsky 评分明显提高，且明显优于非脾虚组；治疗后脾虚组中医证候评分降低，且低于非脾虚湿阻组；但各组丙氨酸氨基转移酶、糖链抗原 19-9、甲胎蛋白、癌胚抗原水平及白细胞、血小板计数比较差异均无统计学意义；脾虚组治疗后天门冬氨酸氨基转移酶水平明显低于治疗前，总胆红素水平明显低于非脾虚湿阻组。脾虚组与非脾虚组比较，差异有统计学意义的蛋白有 24 个，其中上调蛋白 17 个，下调蛋白 7 个，差异最大的蛋白为纤维连接蛋白 5（fibulin-5，FBLN5）。ELISA 验证结果显示，非脾虚湿阻组和非脾虚组 FBLN5 水平均明显低于脾虚组。健脾理气方联合 TACE 治疗后，FBLN5 仅在脾虚组表达上调。ROC 曲线分析表明，FBLN5 可能是健脾理气方联合 TACE 治疗肝癌脾虚证患者疗效的潜在预测指标。
健脾理气方联合 TACE 可提高肝癌脾虚证患者的生活质量和临床中医症状及肝功能，FBLN5 可能是健脾理气方联合 TACE 治疗肝癌脾虚证患者的疗效预测指标。
