2024 年第 5 期 第 19 卷

益气活血解毒法促进卵巢癌由“冷”向“热”转化基于免疫-炎性微环境的理论探讨分析

Theoretical exploration and analysis of Yiqi Huoxue Jiedu method based on immune-inflammatory microenvironment on promoting the transformation of ovarian cancer from "cold" to "hot"

作者：梅荷婷1 卢雯平1 姜奕慈2 宋清雅1 常磊1

英文作者：Mei Heting1 Lu Wenping1 Jiang Yici2 Song Qingya1 Chang Lei1

单位：1中国中医科学院广安门医院肿瘤科，北京100053；2北京核工业医院中医科，北京100053

英文单位：1Department of Oncology Guang′anmen Hospital Chinese Academy of Chinese Medicine Sciences Beijing 100053 China; 2Department of Traditional Chinese Medicine Beijing Nuclear Industry Hospital Beijing 100053 China

关键词：卵巢癌；益气活血解毒法；冷肿瘤；免疫-炎性微环境；中医

英文关键词：Ovariancancer;YiqiHuoxueJiedumethod;Coldtumor;Immune-inflammatorymicroenvironment;TraditionalChinesemedicine

• 摘要：

• 卵巢癌是致死率高居首位的妇科恶性肿瘤，探索有效的治疗方法预防转移成为亟待解决的临床难题。免疫治疗是肿瘤治疗的新视野，然而卵巢癌由于普遍缺乏细胞毒性T细胞的浸润，并且浸润的T细胞并不能识别所有的肿瘤抗原，属于“冷肿瘤”范畴，对免疫治疗并不敏感。中医认为气虚血瘀毒浊是卵巢癌的关键病机，益气活血解毒法是重要治法，有必要在理论研究上进一步阐明。免疫抑制和慢性炎症构成肿瘤微环境两大核心特征，共同促进肿瘤发生、发展及转移。本文分析了免疫-炎性微环境与中医“阴阳”“毒邪”理论的高度契合性：阳化气不足，如同正性免疫细胞如细胞毒性T细胞不足；阴成形太过，一方面，如同过多的免疫抑制性细胞、因子、代谢产物浸润，另一方面，如同人体的因虚致毒，维持并放大了炎性微环境，炎症促进肿瘤进展，炎症反过来又可促进免疫抑制。从免疫-炎症的角度阐明该法的治疗思路：“温阳扶正，平衡阴阳”以激活正性免疫；“活血、化痰、散寒、清热”以驱散阴邪，解化毒滞，从而缓解免疫抑制，调控炎性微环境；“以毒攻毒”以抗炎治疗，完善了该法转化“冷”“热”免疫原性的理论基础，为进一步物质研究提供理论依据。

• Ovarian cancer is a gynecological malignant tumor with the highest mortality rate. Exploring effective treatment methods to prevent metastasis has become an urgent clinical problem to be solved. Immunotherapy is a new field of cancer treatment. However, ovarian cancer is not sensitive to immunotherapy because of the lack of infiltration of cytotoxic T cells and the inability of infiltrated T cells to recognize all tumor antigens. It belongs to the category of "cold tumor" and is not sensitive to immunotherapy. Traditional Chinese medicine believes that qi deficiency, blood stasis and toxic turbidity are the key pathogenesis of ovarian cancer, and the Yiqi Huoxue Jiedu method is an important treatment, which needs to be further clarified on the basis of theoretical research. Immunosuppression and chronic inflammation constitute the two core characteristics of the tumor microenvironment, which jointly promote the occurrence, development and metastasis of tumors. In this paper, the immune-inflammatory microenvironment is highly consistent with the theory of "Yin and Yang" and "poison-pathogenic factors" of traditional Chinese medicine. The deficiency of Yang transforming qi is like the deficiency of positive immune cells such as cytotoxic T cells. On the one hand, it is like infiltration of too many immunosuppressive cells, factors, and metabolites. On the other hand, it is like poison caused by deficiency in the human body, which maintains and amplifies the inflammatory microenvironment. Inflammation promotes tumor progression, and inflammation in turn promotes immunosuppression. The therapeutic idea of this method is clarified from the perspective of immune inflammation: "warming Yang, strengthening positive, balancing Yin and Yang" to activate positive immunity. "Activating blood circulation, dissipating phlegm, dispersing cold and clearing heat" can disperse Yin and pathogenic factors, detoxify toxic stagnation, thereby alleviating immunosuppression and regulating inflammatory microenvironment. The anti-inflammatory treatment by "Fighting poison with poison" improves the theoretical basis for the transformation of "cold" and "hot" immunogenicity by this method, and provides theoretical basis for further material research.