| Objective:In this study,we evaluated the efficacy and safety of the combination of Banxia Xiexin Decoction with chemotherapy in the treatment of postoperative gastric cancer patients through clinical observation.Secondly,by constructing a tumor-bearing nude rat model of gastric cancer,we observed the effects of combining Banxia Xiexin Decoction with chemotherapy on the intestinal flora of tumor-bearing nude rats with gastric cancer,and analyzed the possible mechanism of action of Banxia Xiexin Decoction as an adjunct to chemotherapy for gastric cancer from the perspective of intestinal microecology.Methods:1.Clinical researchPatients with stage Ⅱ and Ⅲ gastric cancer who met the inclusion criteria in the inpatient treatment at Yangzhou Hospital of Traditional Chinese Medicine,Gaoyou Hospital of Traditional Chinese Medicine and Yizheng Hospital of Traditional Chinese Medicine from September 2020 to January 2022 were selected and randomly divided into a combination group and a control group,with 50 cases in each group.The control group was treated with chemotherapy alone,while the combination group was treated with Banxia Xiexin Decoction orally during chemotherapy for 6 cycles.The 1-year recurrence rate of patients in the two groups were followed up and recorded,and the physical symptom score,quality of life score,and occurrence of toxic side effects of the patients were recorded before and after treatment.Statistical analysis was carried out using SPSS 26.0 software.2.Animal experimental researchA nude mouse gastric cancer HGC27 subcutaneous transplantation tumor model was constructed,and interventions were grouped according to healthy group,model group,chemotherapy group and combination group.The healthy and the model groups were given 0.9%NaCl intraperitoneally+0.9%NaCl gavage,the chemotherapy group were given 5-FU(20mg/kg)intraperitoneally+0.9%NaCl gavage,and the combined group were given Banxia Xiexin Decoction(8g/kg)gavage+5-FU(20mg/kg)intraperitoneally.The cecal contents of nude mice were collected after 10 days of continuous intervention and the structural composition and abundance of intestinal flora were analyzed by 16S rRNA sequencing technology.Results:1.Clinical research(1)One-year recurrence rate:After 6 cycles of treatment were completed until the end of the follow-up time,the one-year recurrence and metastasis rates of the combined group and the control group were 31.3%and 38.3%,respectively.The one-year recurrence and metastasis rate of the combined group was lower than that of the control group,but the difference was not statistically significant(P=0.471).(2)Physical symptom score:Before treatment,there was no statistically significant difference in the physical symptom score between the two groups(P>0.05).After 6 cycles of treatment,the physical symptom score of the combined group decreased more significantly than that of the control group,and the difference was statistically significant(P<0.05).(3)Quality of life score:Before treatment,there was no statistically significant difference in quality of life score between the two groups(P>0.05).After six cycles of treatment,the combination group showed significant improvements in cognitive function,emotional function,physical function,social function,symptom domain,overall health domain,insomnia,loss of appetite,and constipation compared to the control group,and the differences were statistically significant(P<0.05).(4)Occurrence of toxic side effects:The incidence of leukopenia,anemia,throm bocytopenia,and gastrointestinal reactions in the combination group was lower than t hat in the control group,and the differences were statistically significant(P<0.05).2.Animal experimental research(1)Compared with the chemotherapy group,the combination group of nude mice showed improvement in mental activity,diet,and fecal characteristics.There was no significant difference in the body weight among all nude mice before modeling(P>0.05).After treatment,the body weight of the combination group was higher than that of the chemotherapy group,and the difference was statistically significant(P<0.05).The tumor mass of the combination group was significantly lower than that of the model group,and the difference was statistically significant(P<0.05).The tumor inhibition rates of the chemotherapy group and the combination group were 28.97%and 41.12%,respectively.(2)AS Vs statistics and analysis of intestinal flora:Valid tag data volumes ranged from 41954-59806 across 12 samples.Some bacterial colonies were shared between groups,while each group had unique ones.(3)Alpha diversity analysis:Sequencing depth and coverage were adequate across all samples,with high species richness and even distribution.There was no significant difference in gut microbiota diversity between the combined group and chemotherapy group(P>0.05).(4)Beta diversity analysis:The gut microbiota structure of all four groups of nude mice differed somewhat from that of the healthy group.(5)Community structure distribution statistics:The dominant species composition of the gut microbiota at the phylum,class,order,family,and genus levels was similar among groups,but there were significant differences in relative abundance levels within each group.(6)Comparison of differential species:At the phylum and genus levels,the relative abundance of Proteobacteria in the model group was significantly increased compared to the healthy group(P<0.05).In the combined group,the relative abundances of Bacteroidota and Odoribacter were significantly higher than those in the chemotherapy group,while the relative abundances of Campilobacterota and Helicobacter were significantly lower in the chemotherapy group(P<0.05).Conclusion:(1)Banxia Xiexin Decoction combined with chemotherapy can improve the physical symptoms of patients with stage Ⅱ and Ⅲ gastric cancer after surgery,improve their quality of life,and reduce the incidence of bone marrow suppression and gastrointestinal reactions caused by chemotherapy.(2)Banxia Xiexin Decoction combined with chemotherapy can effectively delay the growth of subcutaneous transplanted tumors in nude mice with gastric cancer,and improve adverse reactions such as depression,poor appetite,diarrhea,and weight loss caused by chemotherapy.(3)Banxia Xiexin Decoction may play an adjuvant role in gastric cancer chemotherapy by reducing the relative abundances of Campilobacterota and Helicobacter,and increasing those of Bacteroidota and Odoribacter in the gut microbiota of nude mice. |
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