六君子湯對於非小細胞肺癌病人以化學治療後其免疫調控基因組表現及臨床預後之影響

林孟志
長庚大學
肺癌是目前世界上主要的死亡原因之一，而非小細胞肺癌佔了百分之八十。其中三分之二的病人在診斷之初即為無法開刀的末期肺癌。以Cisplatin為主的化療可使其一年存活率增加百分之十，平均存活增加兩個月。加入第二個化療藥物(如Gemcitabine)，可改善腫瘤的反應率及病人存活率。然而在過去二十年來在改善化療的效果方面少有進展，主要是因為化療藥物的毒性和抗藥性。最可能會威脅生命的毒性是嗜中性球的減少及免疫力的抑制，可能會造成敗血症。其他的毒性包括噁心、嘔吐、腹瀉、黏膜炎、神經病變等。已有報告指出，在化療之後，白血球的數目，吞嗜功能及活性都會降低。此外最近也有文獻報告癌症患者由於內在性免疫系統長期被活化．其順適性免疫系統的功能是被抑制的。另一方面，先天性或後天性的抗藥性是化療失敗的另一個原因。這可能是和基因的變異以及與其他藥物(如Cisplatin)主要經由Glutathione代謝途徑來代謝。如果能經由對藥物代謝的了解來預測和處理化療藥物的副作用將可改善病人的預後。　　根據研究，中藥結合化學治療能夠穩定和縮小非小細胞肺癌局部病灶、提高患者生活品質、延長患者存活期，與化療合用具有增效減毒的效果。而六君子湯以黨參、白朮、茯苓和甘草補脾益氣治療肺氣虛。現代研究證實四君子湯有增強機體免疫力的作用；半夏、陳皮合茯苓、甘草即成二陳湯除濕化痰，一補其氣之不足，一瀉其痰之有餘以宣肺，希望能達到提高患者生活品質、延長患者存活期，減少化療副作用的效果。六君子湯已被證實可以改善胃腸，免疫及肺功能。它可有效的治療慢性阻塞性的病人，也可改善末期肺癌患者的生活品質。
關鍵字：六君子湯；非小細胞肺癌；化學治療

Genomic expressions and outcomes in non small cell lung cancer patients treated with combinations of liu jun zi tang (六君子湯) and chemotherapy

Chang Gung University
Lung cancer is a major cause of mortality worldwide, with an estimated annual incidence of more than 1.2 million cases and mortality of more than 1.1 million cases. Non-small cell lung cancer（NSCLC） acconunts for at least 80% of all lung tumors and approximately two thirds of patients initially present with inoperable NSCLC. Cisplatin-based chemotherapy led to an absolute increase in 1-year survival of 10% and increased median survival by 2 months in these patients. Adding a second drug (Gemcitabine, Vinorelbine,Docetaxel, or Paclitaxel), improved tumor response and survival rate.Little progress towards improving the efficacy of chemothery has been made in the past 20 years, mostly because of drug-related toxity and drug resistance. The most life-threatening toxicity is leukopenia, occurring immediately after chemotherapy and frequently leading to sepsis. The other toxicities indude nausea, vomiting, anorexia, mucositis, alopecia, diarrhea, neuropathy, etc. It has been reported that both the number and function of leukocytes (phagocytosis, test of NBT reduction, and MPO activity) were decreased after chemotherapy. In addition, the adaptive immunity has been demonstrated to be suppressed in cancer patients due to chronic activation of the innate immune system. On the other hand, inherent and acquired drug resistance is a major cause of chemotherapy failue, which may be related to gene variations and interations with other dungs.
關鍵字：Non-small cell lung cancer, chemotherapy；liu jun zi tang(六君子湯)；microarray genomic expression