从肿瘤免疫编辑假说探讨肿瘤“正虚邪实”及其治疗
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摘要
肿瘤免疫编辑假说描述了免疫系统在肿瘤发生发展过程中所发挥的双重作用,并分为免疫清除、免疫平衡以及免疫逃逸三个序贯的阶段。中医学认为正虚邪实是肿瘤最重要的基本病机,并以此指导扶正培本及以毒攻毒治法的临床运用。应用肿瘤免疫编辑假说,将正气与免疫功能、病邪及癌毒与肿瘤细胞联系起来,将肿瘤"正虚邪实"病机拓展为"全身不一定虚,局部虚实夹杂",以此病机所指导的治法由"扶正培本及以毒攻毒"拓展为"匡扶病灶中的正气及靶向以毒攻毒"。尝试对"正虚邪实"及其治法进行拓展,可为肿瘤免疫治疗领域中充分发挥中医药多靶点、多层次、多因素的网络调节作用提供借鉴。
The cancer immunoediting hypothesis describes the dual role played by the immune system in tumor development and is divided into 3 sequential stages,i.e.immune clearance,immune balance,and immune escape.Traditional Chinese medicine believes that deficient vital qi and excess pathogenic qi is the most important basic pathogenesis of cancer,and it is used to guide the clinical application of supporting the healthy energy and combating poison with poison.Applying the cancer immunoediting hypothesis,the vital qi is linked with the immune function,the disease evil as well as cancer toxin with the tumor cells,and the pathogenesis deficient vital qi and excess pathogenic qi of the tumor is extended to"the whole body is not necessarily deficiency,but the local with intermingled deficiency and excess".The treatment method guided by this pathogenesis is expanded from "supporting the healthy energy and combating poison with poison"to"supporting the vital qi in the disease area,and targeted combating poison with poison".It is tried to expand the "deficient vital qi and excess pathogenic qi"and its treatment method,which can provide a reference for the multi-target,multi-level and multi-factor network regulation of Chinese medicine in the field of tumor immunotherapy.
The cancer immunoediting hypothesis describes the dual role played by the immune system in tumor development and is divided into 3 sequential stages,i.e.immune clearance,immune balance,and immune escape.Traditional Chinese medicine believes that deficient vital qi and excess pathogenic qi is the most important basic pathogenesis of cancer,and it is used to guide the clinical application of supporting the healthy energy and combating poison with poison.Applying the cancer immunoediting hypothesis,the vital qi is linked with the immune function,the disease evil as well as cancer toxin with the tumor cells,and the pathogenesis deficient vital qi and excess pathogenic qi of the tumor is extended to"the whole body is not necessarily deficiency,but the local with intermingled deficiency and excess".The treatment method guided by this pathogenesis is expanded from "supporting the healthy energy and combating poison with poison"to"supporting the vital qi in the disease area,and targeted combating poison with poison".It is tried to expand the "deficient vital qi and excess pathogenic qi"and its treatment method,which can provide a reference for the multi-target,multi-level and multi-factor network regulation of Chinese medicine in the field of tumor immunotherapy.
引文
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[24]郭晓冬,魏品康,陈洁,等.化痰散结方对肿瘤间质纤维母细胞活化相关蛋白表达的影响[J].宁夏医科大学学报,2015,37(7):759-763.
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[26]凌昌全.“癌毒”是恶性肿瘤之根本[J].中西医结合学报,2008,6(2):111-114.
[2]EHRLICH P. Ueber den jetzigen stand der Karzinomforschung[J]. Ned Tijdschr Geneeskd,1909,5(part 1):273-290.
[3]BURNET M. Cancer:a biological approach. I. The processes of control. II. The significance of somatic mutation[J]. Br Med J,1957,1(5022):779-786.
[4]SHANKARAN V,IKEDA H,BRUCE AT,et al. IFNγand lymphocytes prevent primary tumour development and shape tumour immunogenicity[J]. Nature,2001,410(6832):1107-1111.
[5]DUNN GP,BRUCE AT,IKEDA H,et al. Cancer immunoediting:from immunosurveillance to tumor escape[J].Nature Immun,2002,3(11):991-998.
[6]MATSER YAH,TERPSTRA ML,NADALIN S,et al.Transmission of breast cancer by a single multiorgan donor to 4 transplant recipients[J]. Am J Transplant,2018,18(7):1810-1814.
[7]KAUFFMAN HM,MCBRIDE MA,CHERIKH WS,et al.Transplant tumor registry:donor related malignancies[J].Transplantation,2002,74(3):358-362.
[8]MACKIE RM,REID R. Fatal melanoma transferred in a donated kidney 16 years after melanoma surgery[J]. N Engl J Med,2003,348(6):567-568.
[9]FERREIRA GF,DE OLIVEIRA RA,JORGE LB,et al.Urothelial carcinoma transmission via kidney transplantation[J]. Nephrol Dial Transplant,2010,25(2):641-643.
[10]蔡善荣,郑树,张苏展.不同年龄组大肠癌预后多因素分析的比较[J].中华肿瘤杂志,2005,27(8):483-485.
[11]陈军,徐祗顺,张怡,等.年龄因素与成人肾恶性肿瘤临床发病特点的关系[J].中华泌尿外科杂志,2006,27(2):93-96.
[12]CHO SJ,YOON JH,HWANG SS,et al. Do young hepatocellular carcinoma patients with relatively good liver function have poorer outcomes than elderly patients?[J].J Gastroen Hepat,2007,22(8):1226-1231.
[13]GAUCI ML,LANOY E,CHAMPIAT S,et al. Longterm survival in patients responding to anti-Pd-1/Pd-L1therapy and disease outcome upon treatment discontinuation[J]. Clin Cancer Res,2018. doi:10. 1158/1078-0432. CCR-18-0793.
[14]COHEN JV,FLAHERTY K. Response to immune checkpoint antibodies:Not all responses are created equal[J].Clin Cancer Res,2018. doi:10. 1158/1078-0432. CCR-18-3296.
[15]IWAI Y,HAMANISHI J,CHAMOTO K,et al. Cancer immunotherapies targeting the PD-1 signaling pathway[J]. J Biomed Sci,2017,24(1):26.
[16]SANMAMED MF,CHEN LP. A paradigm shift in cancer immunotherapy:from enhancement to normalization[J].Cell,2018,175(2):313-326.
[17]唐武军,王笑民.郁仁存治疗肿瘤“内虚学说”初探[J].北京中医药,2011,30(3):186-188.
[18]李琦玮,于明薇,王笑民.癌毒理论研究现状[J].中医杂志,2015,56(4):347-350.
[19]杨永,杨霖,于明薇,等.癌毒阴阳辨[J].中医杂志,2016,57(17):1522-1523.
[20]薛爱珍,邓旻,史亦谦.中药多糖促诱生细胞因子的研究进展[J].浙江中西医结合杂志,2007,17(1):64-66.
[21]田野,李周,高昊,等.国内已上市辅助肿瘤治疗中成药研究进展[J].药学研究,2018,37(1):35-40.
[22]王晓雪,周则卫.中药以毒攻毒抗肿瘤作用研究进展[J].医药导报,2008,27(11):1364-1366.
[23]铁明慧,张颖.活血化瘀促进肿瘤血管正常化的机制探讨[J].华西医学,2014,29(12):2379-2381.
[24]郭晓冬,魏品康,陈洁,等.化痰散结方对肿瘤间质纤维母细胞活化相关蛋白表达的影响[J].宁夏医科大学学报,2015,37(7):759-763.
[25]陈腾飞,刘清泉.浅述中医“正气”理论[J].环球中医药,2016,9(11):1332-1335.
[26]凌昌全.“癌毒”是恶性肿瘤之根本[J].中西医结合学报,2008,6(2):111-114.
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