| Objective:The purpose of this clinical randomized controlled study was to investigate the effect of acupuncture on the quality of life,tumor related symptoms and the level of suppressive immune cells in patients with gastric cancer undergoing adjuvant chemotherapy.The results may provide a theoretical basis for acupuncture to improve the quality of life of patients with gastric cancer after adjuvant chemotherapy and the effect of acupuncture on the immune system.Method:In this study,the prospective randomized control method was used.The whole patients were divided into three groups:the high frequency group,the low frequency group and the control group.On the basis of the conventional western medicine treatment,the acupuncture group needled fixed points(bilateral Zusanli,bilateral Neiguan,bilateral public sun,Baihui,Yin Tang)and the back Shu points corresponding to the meridians of "deficiency syndrome".According to the heat sense test of meridians,the back Shu points was found.Double sides Zusanli and Neiguan were given electrical stimulation.The high frequency group received acupuncture treatment on the 1st,3rd,5th,8th,11th,15th and 18th day of the chemotherapy cycle.The low frequency group received acupuncture on the 1st,8th and 15th day of the chemotherapy cycle.The control group did not receive acupuncture treatment.Three groups were given XELOX regimen chemotherapy and antiemetic therapy according to NCCN clinical practice guidelines-antiemetic,a total of three courses.During the study,the scores of quality of life scale-gastric cancer(FACT-GA Chinese version v4.0),Edmonton Symptom Checklist(ESAS)were collected,the expression level of MDSCs(myelogenous inhibitory cell group)and Tregs in patients’ serum were detected before and after treatment.The influence of acupuncture on patients’quality of life,tumor related symptoms and immune cells were analyzed by using SPSS18.0 software for ANOVA and Kruskal-Wallis rank sum test etc.Result:1.37 patients were included in this study,including 11 in the high frequency group,12 in the low frequency group and 14 in the control group,with an average age of 53.41±11.09 years,24 in males(64.86%)and 13 in females(35.14%),13 in stage Ⅱ(35.14%),24 in stage Ⅲ(64.86%),34 in adenocarcinoma(91.89%),3 in other types(8.11%),and 19 in distal resection(51.35%),total gastrectomy was performed in 16 cases(43.24%),other operation in 2 cases(5.41%),neoadjuvant chemotherapy before operation in 5 cases(13.51%),no neoadjuvant chemotherapy in 32 cases(86.49%),ECOG score was 0 in 7 cases(18.92%),1 in 30 cases(81.08%).Through the above basic data statistical analysis,there was no significant difference among the three groups(P>0.05).2.Quality of life analysis:the FACT-GA scores of 33 patients at 10 observation points before and after treatment were analyzed,which were divided into eight dimensions,PWB,SWB,EWB,FWB,FACT-G,GA-domain,TOI,FACT-GA.The internal effect test of main body showed that the scores of PWB(physiological status),FACT-G(additional attention),TOI and FACT-GA at different time points were statistically significant(P<0.05),but there was no significant difference in SWB(social status),EWB(emotional status),FWB(functional status)and GA-domain scores(P>0.05).There was no interaction between the groups and time points(P>0.05).The inter subject effect test showed that there was no significant difference between the three groups(P>0.05).3.Analysis of tumor related symptoms:ESAS scores of 34 patients at 4 observation points before and after treatment were analyzed,the internal effect test of main body showed that the difference of ESAS scores at different time points were statistically significant(F=17.284,P<0.001),there were interaction between the groups and time points(F=2.396,P=0.034).The inter subject effect test showed that there was no significant difference in ESAS scores among the three groups(F=2.036,P=0.148).4.Immunosuppressive cell analysis:the changes of immunosuppressive cells in 32 patients before and after treatment were analyzed,the results showed that there was no significant difference in the level of total myeloid suppressor cells,myeloid suppressor cells,mononuclear myeloid suppressor cells and regulation of T cells between the three groups before and after treatment(P>0.05).There was no significant difference in D-value of total myeloid suppressor cell level and myeloid suppressor cell level before and after treatment between the three groups(P>0.05).There were significant differences in D-value of mononuclear myeloid suppressor cell level and regulation of T cell level before and after treatment between the three groups(P<0.05).The difference between the two groups before and after treatment was compared,the difference between the low-frequency group and the blank group in D-value of mononuclear myeloid suppressor cell level before and after treatment was statistically significant(P<0.05),the level of mononuclear myeloid suppressor cells in the blank group decreased significantly after treatment,which was better than that in the low frequency group.The difference between the low-frequency group and the blank group,the low-frequency group and the high-frequency group in D-value of regulation of T cell level before and after treatment was statistically significant(P<0.05).The difference between the other two groups was not statistically significant(P>0.05).Conclusion:(1)Compared with the blank group,the scores of various dimensions of life quality and symptom load(pain,fatigue,nausea,depression,anxiety,drowsiness,appetite,quality of life,shortness of breath)of patients with gastric cancer treated by acupuncture during the adjuvant chemotherapy showed that the acupuncture group,especially the low-frequency group,had a better trend than the control group,but the statistical analysis showed no significant difference.(2)Based on the analysis of small sample size in this study,compared with the control group,acupuncture has no significant superiority on the level of total myeloid suppressor cells,myeloid suppressor cells and mononuclear myeloid suppressor cells,but low frequency acupuncture could significantly reduce the level of Treg cells. |
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