| Hepatocellular Carcinoma (HCC), called hepatama for short, is one of an incurable malignant tumor in world. Because of its hiding morbidity, the opportunity for operating therapy is often missing. Transcather arterial chemoembolization (TACE), also called hepatic arterial chemoembolization (HACE), is considered a secure, effective and repeatable first selecting conventional therapy for the inoperable hepatama. Its curative effect is significant in the near future. TACE can deflate the tumor, relieve the symptom and kill the tumor cells. It can control the growth of the tumor in a short time and prolong the live time of the patients. Because a large quantity of chemo medicine comes into body, the liver tissue will be ischemic and hypoxia and the allomeric function of organism is damaged severely. Improving the immunological function of the hepatama patients after TACE, cutting down the recurrence rate of the tumor and prolonging the live time have been the key point of the therapeutic efficacy.The traditional Chinese medicine is the natural medicine. It can improve the immunity of the organism and it can coordinate and influence each other with immune system, endocrine system and nervous system. They maintain the stabilization and balance of the life mechanism, help to resist tumor growth and decrease the side effect of the interventional therapy in common.The patients with hepatoma often have immunological function abnormality. The expression of immune suppressive factors increases and the expression of immune enhancive factors decreases. The study suggested that the change of TNF-αand IL-2 in the blood of patients with HCC had close correlation to HCC. IL-2 is an important cell immune enhancive factor and it has significant effects to resist tumor. sIL-2R is an immune suppressive factor. It can combine to the IL-2 in blood circulation and hold up the effects of IL-2. TNF-αhas many biological function and has intimate cell toxic action to many tumor cells and normal cells. It can also mediate inflammation and immune reaction.Vascular endothelial growth factor is an important vascular growth factor. It has strong effects on proliferation of vascular endothelial cell, hydrolization of basal lamina, cell immigration and vascular construction. It also has high specificness. HCC is a typical tumor with vascularity. It grows quickly and the vascular infiltration among the liver is easily to happen. The therapeutic effect is below the mark. There is study showed that the expression of VEGF was significantly in hepatoma cells and it has close relation to the growth and metastasis of HCC. Cyclooxygenase-2 is an important rate-limiting enzyme in the biosynthesis process of prostaglandin and it has essential effects in the genesis, development and metastasis of lots of tumors. There is study showed that the expression of COX-2 was high in hepatoma and the expressive level of VEGF and COX-2 in the peripheral blood had important value in judging the metastasis and recurrence of hepatoma. It also had significance in guiding clinical therapy and improving prognosis.ObjectiveIn this study, the traditional Chinese medicine had been given to the HCC patients after TACE. The change of CD3+, CD4+, CD4+/CD8+, NK cell and alpha-fetoprotein (AFP) in blood were detected after the therapy with QingGanHuaYu orally taking liquid in HCC patients after TACE. The content of VEGF and COX-2 in peripheral blood was also examined and the composite index of the patients was observed. Through the above research, the influence of traditional Chinese medicine on the immune function, the potentiality of tumor metastasis and living quality was discussed. This study revealed the effects of QingGanHuaYu orally taking liquid on the suppression of the proliferation of hepatoma cells and the decreasing of the expression of VEGF. This study illuminated the contribution of QingGanHuaYu orally taking liquid to the therapy of HCC from both immunology and HCC metastasis sides. It can improve the immunity, lessen side effects and inhibit tumor metastasis and so on. This study also discussed the effects of traditional Chinese medicine and its targets and provided experimental basis to the clinical study of the traditional Chinese medicine.Methods1 Patients selection: The patients with HCC was randomly selected from the forth hospital of Hebei Medical University from 2006.2 to 2007.2. Among the patients, there were 38 males and 22 females and the age of the patients was from 48-65 and the average age was 56.3±7.7. All the patients were consistent with the following diagnostic code: (1) the result of histology examination was HCC; (2) imaging examination identifies the position; (3) AFP>200μg/L. According to Chinese liver cancer cooperation meeting staging standard, stage I were 8 cases, stage II were 42 cases and stage III were 10 cases.2 Experimental grouping: Divide the patients randomly into experimental group and control group:The experimental group is TACE with traditional Chinese medicine therapy. Among the 30 cases of PHC patients, there were 20 males and 10 females. The average age was 55.5±8.7. The patients in stage I were 5 cases, stage II 19 cases and stage III 6 cases.The control group is merely TACE group. Among the 30 cases of PHC patients, there were 18 males and 12 females. The average age was 56.9±7.9. The patients in stage I were 3 cases, stage II 23 cases and stage III 4 cases.3 Specimen collecting: Blood sample 5ml was collected 1 day before and 28 days after the intervention in the morning on an empty stomach. The blood was stuff into non-anticoagulation and anticoagulation tubes respectively. The centrifugalization was carried out at 4oC in 2500r/min for 10min. The serum and blood plasma was divided and preserved at -30oC.4 The examination of T cell subgroup: The CD3+, CD4+, CD4+/CD8+ and NK cell activity in peripheral blood were examined through flow cytometry with the antibody labeled by triad colour fluorescent before and after the therapy in the two patients groups. 5 The examination of cytokine in serum: The serum level of TNF-αand IL-2 of the patients were detected by double antibody sandwich enzyme linked immunosorbent assay (ELISA) method.6 The VEGF level in peripheral blood of the two patients group was examined through ELISA method.7 The expression of COX-2 in gene level in blood karyocyte was detected by RT-PCR method in the two patients group before and after therapy.8 The examine of AFP in two patients group was performed.9 The detection of the tumor change and outside liver metastasis: the maximum level diameter and vertical diameter was determined by CT or multicolor ultrasonic examination by Doppler's method. Calculated the volume of the tumor and compared them before and after therapy. The outside metastasis to lung, bone, brain and absorbent gland was detected by CT or sternite.10 The therapeutic effect assessment of the two groups after therapy: The assessment and analysis were based on the solid tumor objective evaluation criterion enacted by WHO. The assessment standard was as follow: (1) complete remission means the tumor is absorbed completely; (2) partial remission means the tumor is absorbed partly; (3) no change means the tumor has no change; (4) pathogenetic condition advancement means the tumor increases.11 The evaluation of life quality of the two groups: The evaluation was based on the Karnosky performance status (KPS). Improving means after therapy the score increases beyond 10; descending means after therapy the score decreases beyond 10; stabilizing means the score changes in 10.12 Statistical analysis: the data processing was carried out by SPSS 13.0 software. Measurement data was expressed as X±S. The compare between groups was using T test. The enumeration data was compared by X2 test. Ranked data was compared by rank-sum test. P<0.05 means the difference has statistical significance. Results1 The comparison of T cell subgroup and NK cell between two groups:the examine values of CD3+, CD4+, CD4+/CD8+ and NK cell had no significant difference before the therapy. Compared with the simple TACE group, the TACE with QingGanHuaYu orally taking liquid group had low CD3+ value (P<0.05),CD4+ value (P<0.05) and the CD4+/CD8+ value also decreased (P<0.05).2 The comparison of TNF-αand IL-2 level in serum between prior and circa of the interventional therapy: compared with prior therapy, the TNF-αlevel decreased (P<0.05) and the IL-2 level (P<0.05) increased significantly after therapy.3 The comparison of TNF-αand IL-2 level in serum between the two groups: compared with the simple TACE group(13.56±1.55), the TNF-αlevel(10.85±1.67) decreased (P<0.05); and the IL-2 level (P<0.05) increased significantly in the TACE with QingGanHuaYu orally taking liquid group(32.83±3.03) compared with the simple group(28.05±2.95).4 After the interventional therapy, the VEGF level in serum and the expression of COX-2 in the blood karyocyte Compared with before the interventional therapy, the difference had statistical significance (P<0.05). The comparison of VEGF expression between the two groups: the VEGF level in TACE with QingGanHuaYu orally taking liquid group (207.49±93.22) was significant lower than that of simple TACE group (456.08±175.49) (P<0.05).5 The comparison of COX-2 in peripheral blood karyocyte between two groups: the value of COX-2 in TACE with QingGanHuaYu orally taking liquid group was 47.77%, significant lower than that of simple TACE group 55.69%. The difference had statistical significance (P<0.05).6 In the TACE with QingGanHuaYu orally taking liquid group, there were 6 patients had metastasis outside liver and the metastasis rate was 20%. In the simple TACE group, there were 14 patients had metastasis outside liver and the metastasis rate was 43.3%. The difference between the two group had statistical significance (P<0.05).7 In the TACE with QingGanHuaYu orally taking liquid group, there were 24 patients had partial remission and the effective rate was 80%. In the simple TACE group, there were 12 patients had partial remission and the effective rate was 40%. The difference between the two group had statistical significance (P<0.05).8 According to the KPS evaluation standard, there were 13 patients had life quality improvement and the improving rate was 43.3% in the TACE with QingGanHuaYu orally taking liquid group. There were 6 patients had life quality improvement and the improving rate was only 20% in the simple TACE group. The difference between the two group had statistical significance (P<0.05).Conclusion1 In the TACE with QingGanHuaYu orally taking liquid therapy group, the NK cell decreasing extent of NK cell is lower than that of simple TACE therapy group and the value of CD3+, CD4+, CD4+/CD8+ were higher than that of simple TACE therapy group. So, QingGanHuaYu orally taking liquid has protection to the cell immunity of the HCC patients after chemo.2 The expression of VEGF and COX-2 in peripheral blood degraded significantly in the TACE with QingGanHuaYu orally taking liquid therapy group. Using QingGanHuaYu orally taking liquid after TACE therapy can inhibit the angiogenesis in tumor.3 In the TACE with QingGanHuaYu orally taking liquid therapy group, the objective tumor curative effect and the relief rate of clinical symptom were better than the simple TACE group. The TACE therapy combined with QingGanHuaYu orally taking liquid can deflate the volume of the tumor and relieve the clinical symptom.4 When it comes to the comparison of the life quality, the patients accepted TACE with QingGanHuaYu orally taking liquid therapy were living better than those of accepting the simple TACE therapy. So, combined treatment of traditional Chinese medicine and western medicine toHCC can improve the patients'life quality significantly.5 In the TACE with QingGanHuaYu orally taking liquid therapy group, the value of AFP in peripheral blood descended largely. When compared with the simple TACE therapy group, the difference had statistical significance. The TACE therapy combined the QingGanHuaYu orally taking liquid therapy can degrade the level of AFP in peripheral blood of the patients with HCC.6 On the adverse effect of the TACE therapy such as liver function lesion, in the TACE with QingGanHuaYu orally taking liquid therapy group, it is less than that of the simple TACE therapy group. QingGanHuaYu orally taking liquid can reduce and lessen the side effects after the TACE therapy in the patients with HCC.
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