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Article(id=1322927104580531173, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.11.014, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340000528, onlineDateStr=2026-10-30, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340000528, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340000528, creator=13701087609, updateTime=1793340000528, updator=13701087609, issue=Issue{id=1322926985957221241, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='11', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339972247, creator='13701087609', updateTime=1793340743335, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930220201804556, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930220201804557, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=60, endPage=63, ext={EN=ArticleExt(id=1322927104865743846, articleId=1322927104580531173, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Modified Baitouwen Decoction（加味白头翁汤）on Autophagy Protein in Patients with Liver Cancer After Operation, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the effect of Modified Baitouwen Decoction（加味白头翁汤）on the level of autophagy protein in patients with liver cancer after surgery.

Method

Ninety-two patients with liver cancer admitted to the Department of Hepatobiliary and pancreatic Surgery of Shanxi Cancer Hospital were included as the study objects，and were selected from March 2022 to September 2024. They were divided into two groups by random number table method. Forty-six patients in the control group received surgical treatment，and 46 patients in the observation group received combined treatment with Modified Baitouwen Decoction on the basis of the control group. The therapeutic effect，TCM symptom scores，liver function indexes，tumor markers and related autophagy protein level were compared between the two groups.

Results

The objective remission rate and disease control rate in the observation group were 43.48%（20/46）and 93.48%（43/46），respectively，which were higher than 31.91%（15/46）and 73.91%（34/46）in the control group（P<0.05）. After treatment，the TCM symptom scores of the observation group were lower than those of the control group（P<0.05）. After treatment，the levels of alanine aminotransferase（ALT），aspartate aminotransferase（AST）and total bilirubin（TBIL）in the observation group were lower than those in the control group，and the level of albumin（ALB）was higher than that in the control group，with significant difference between two groups（P<0.05）. After treatment，the levels of alpha fetoprotein isoform3（AFP-L3），Golgi apparatus protein 73（GP73），alpha fetoprotein（AFP）and gamma glutamyltransferase（γ-GT）in the observation group were lower than those in the control group，and the positive rates of microtubule associated protein 1 light chain 3（LC3），Beclin-1 and mammalian target protein of rapamycin（mTOR）were lower than those in the control group，with significant differences between the two groups（P<0.05）.

Conclusion

Modified Baitouwen Decoction has a clear therapeutic effect on patients with liver cancer after surgery，which can alleviate the relevant symptoms of patients，protect liver function，reduce the levels of tumor markers，regulate the levels of LC3，Beclin-1 and mTOR，inhibit the proliferation of cancer cells and delay the development of disease，and has high application value.

, authors=Zhenhua WANG, Yipeng REN, Yuchao MA, Li ZHANG, Rong WANG, Lixia LIU, authorsList=Zhenhua WANG, Yipeng REN, Yuchao MA, Li ZHANG, Rong WANG, Lixia LIU, authorCompany=null, correspAuthors=Lixia LIU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322927107453629423, articleId=1322927104580531173, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=加味白头翁汤对肝癌患者术后相关自噬蛋白水平的影响效应研究, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

分析加味白头翁汤对肝癌患者术后相关自噬蛋白水平的影响。

方法

纳入山西省肿瘤医院肝胆胰外科收治的92例肝癌患者为研究对象，随机数字表法分为两组，对照组46例例采用外科手术治疗，观察组46在对照组基础上采用加味白头翁汤联合治疗，对比两组治疗效果、中医症状积分、肝功能指标、肿瘤标志物、相关自噬蛋白水平变化情况等。

结果

观察组客观缓解率为43.48%（20/46），疾病控制率为93.48%（43/46），高于对照组的31.91%（15/46）、73.91%（34/46），组间比较差异有统计学意义（P<0.05）；治疗后观察组中医症状积分低于对照组（P<0.05）；治疗后观察组丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）低于对照组，ALB高于对照组，组间比较差异有统计学意义（P<0.05）；治疗后观察组甲胎蛋白异质体3（AFP-L3）、高尔基体蛋白73（GP73）、甲胎蛋白（AFP）、γ-谷氨酰转移酶（γ-GT）水平低于对照组，微管相关蛋白1轻链3（LC3）、贝可丁1（Beclin-1）、哺乳动物雷帕霉素靶蛋白（mTOR）阳性率低于对照组，组间比较差异有统计学意义（P<0.05）。

结论

肝癌患者术后应用加味白头翁汤疗效明确，可缓解患者相关症状，对肝脏功能起到保护作用，降低肿瘤标志物水平，调节LC3、Beclin-1、mTOR水平，抑制癌细胞增殖，延缓病情发展，有较高应用价值。

, authors=王振华, 任一鹏, 麻宇超, 张莉, 王蓉, 刘丽霞, authorsList=王振华, 任一鹏, 麻宇超, 张莉, 王蓉, 刘丽霞, authorCompany=null, correspAuthors=刘丽霞, authorNote=

王振华（1985-），男，山西太原人，主治医师，硕士，研究方向：肝胆胰肿瘤相关研究。

, correspAuthorsNote=
刘丽霞（1984-），女，河北石家庄人，副主任医师，硕士，研究方向：中西医结合肿瘤。E-mail：。
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王振华（1985-），男，山西太原人，主治医师，硕士，研究方向：肝胆胰肿瘤相关研究。

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王振华（1985-），男，山西太原人，主治医师，硕士，研究方向：肝胆胰肿瘤相关研究。

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language=CN, orderNo=5, keyword=中西医结合疗法)], refs=[Reference(id=1322927116257472549, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2024, volume=40, issue=10, pageStart=1884, pageEnd=1892, url=null, language=null, rfNumber=［1］, rfOrder=0, authorNames=苏茜茜, 韩亮, 罗文昭, journalName=中国药理学通报, refType=null, unstructuredReference=苏茜茜，韩亮，罗文昭，等. 基于PTEN/PI3K/AKT信号通路探讨旋覆花汤联合索拉非尼对肝癌荷瘤小鼠的抗肿瘤作用［J］. 中国药理学通报，2024，40（10）：1884-1892., articleTitle=基于PTEN/PI3K/AKT信号通路探讨旋覆花汤联合索拉非尼对肝癌荷瘤小鼠的抗肿瘤作用, refAbstract=null), Reference(id=1322927116370718758, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2024, volume=33, issue=11, pageStart=1155, pageEnd=1163, url=null, language=null, rfNumber=［2］, rfOrder=1, authorNames=孔亮, 曹慧敏, 郭睿博, journalName=中国新药杂志, refType=null, unstructuredReference=孔亮，曹慧敏，郭睿博，等. 苓桂术甘汤联合基质金属蛋白酶响应型多柔比星逐级靶向脂质体抗原发性肝癌作用研究［J］. 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authorNames=吕智豪, 刘华熙, 莫德龙, journalName=沈阳药科大学学报, refType=null, unstructuredReference=吕智豪，刘华熙，莫德龙. 基于网络药理学结合实验验证分析白头翁汤治疗结直肠癌的作用机制［J］. 沈阳药科大学学报，2024，41（12）：1562-1574., articleTitle=基于网络药理学结合实验验证分析白头翁汤治疗结直肠癌的作用机制, refAbstract=null), Reference(id=1322927118509813819, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2022, volume=62, issue=7, pageStart=39, pageEnd=42, url=null, language=null, rfNumber=［23］, rfOrder=22, authorNames=尹玉婷, 黄炜, XI Yan, journalName=山东医药, refType=null, unstructuredReference=尹玉婷，黄炜，XI Yan. 白头翁皂苷A对肝癌细胞增殖、迁移、侵袭和放疗敏感性的影响及机制［J］. 山东医药，2022，62（7）：39-42., articleTitle=白头翁皂苷A对肝癌细胞增殖、迁移、侵袭和放疗敏感性的影响及机制, refAbstract=null), Reference(id=1322927118593699900, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2024, volume=46, issue=9, pageStart=1296, pageEnd=1300, url=null, language=null, rfNumber=［24］, rfOrder=23, 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language=null, rfNumber=［26］, rfOrder=25, authorNames=马成勇, 张宝云, 邓蓓蕾, journalName=中国实验方剂学杂志, refType=null, unstructuredReference=马成勇，张宝云，邓蓓蕾，等. 从CSF1R/STING/TBK1信号调控肿瘤相关巨噬细胞（TAMs）表型极化探究加味白头翁汤治疗结直肠癌的效应机制［J］. 中国实验方剂学杂志，2023，29（17）：96-108., articleTitle=从CSF1R/STING/TBK1信号调控肿瘤相关巨噬细胞（TAMs）表型极化探究加味白头翁汤治疗结直肠癌的效应机制, refAbstract=null), Reference(id=1322927118933438527, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2022, volume=42, issue=18, pageStart=1868, pageEnd=1875, url=null, language=null, rfNumber=［27］, rfOrder=26, authorNames=范泽萍, 陈兰英, 刘鹏, journalName=中国医院药学杂志, refType=null, unstructuredReference=范泽萍，陈兰英，刘鹏，等. 白头翁皂苷A3通过M2型巨噬细胞提高人结肠癌SW480细胞对5-FU的化疗敏感性［J］. 中国医院药学杂志，2022，42（18）：1868-1875., articleTitle=白头翁皂苷A3通过M2型巨噬细胞提高人结肠癌SW480细胞对5-FU的化疗敏感性, refAbstract=null), Reference(id=1322927118996353088, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2024, volume=31, issue=10, pageStart=186, pageEnd=190, url=null, language=null, rfNumber=［28］, rfOrder=27, authorNames=秦肆辉, 王媛, 李慧, journalName=中国中医药信息杂志, refType=null, unstructuredReference=秦肆辉，王媛，李慧，等. 白头翁汤及其加减方治疗溃疡性结肠炎研究进展［J］. 中国中医药信息杂志，2024，31（10）：186-190., articleTitle=白头翁汤及其加减方治疗溃疡性结肠炎研究进展, refAbstract=null), Reference(id=1322927120653103169, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2023, volume=44, issue=9, pageStart=1216, pageEnd=1219, url=null, language=null, rfNumber=［29］, rfOrder=28, authorNames=周林, 肖康, 夏建辉, journalName=陕西中医, refType=null, unstructuredReference=周林，肖康，夏建辉. 八珍汤加减辅助治疗原发性肝癌疗效及对患者外周血Th17/Treg平衡和不良反应的影响［J］. 陕西中医，2023，44（9）：1216-1219., articleTitle=八珍汤加减辅助治疗原发性肝癌疗效及对患者外周血Th17/Treg平衡和不良反应的影响, refAbstract=null), Reference(id=1322927120812486722, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, doi=null, pmid=null, pmcid=null, year=2023, volume=45, issue=8, pageStart=1208, pageEnd=1210，1214, url=null, language=null, rfNumber=［30］, rfOrder=29, authorNames=张凇铭, 史晓雯, 张伟, journalName=河北医药, refType=null, unstructuredReference=张凇铭，史晓雯，张伟，等. 自拟培元解毒通络汤治疗原发性肝癌TACE术后栓塞综合征的效果［J］. 河北医药，2023，45（8）：1208-1210，1214., articleTitle=自拟培元解毒通络汤治疗原发性肝癌TACE术后栓塞综合征的效果, refAbstract=null)], funds=[Fund(id=1322927114554585124, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, awardId=2018YFC0807204, language=CN, fundingSource=国家重点研发计划项目(2018YFC0807204), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322927107764007920, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, xref=null, ext=[AuthorCompanyExt(id=1322927107856282609, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, companyId=1322927107764007920, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Shanxi Cancer Hospital，Taiyuan 030013，Shanxi，China), AuthorCompanyExt(id=1322927107864671218, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, companyId=1322927107764007920, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=山西省肿瘤医院，山西 太原 030013)])], figs=[ArticleFig(id=1322927113510203418, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数完全缓解部分缓解稳定进展客观缓解疾病控制
观察组460（0）20（43.48）23（50.0）3（6.52）20（43.48）43（93.48）
对照组460（0）15（31.91）19（42.55）12（25.53）15（31.91）34（73.91）
χ2值6.256 47.658 8
P值0.000 00.000 0
), ArticleFig(id=1322927113623449627, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=CN, label=表1, caption=

两组肝癌患者近期治疗效果比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数完全缓解部分缓解稳定进展客观缓解疾病控制
观察组460（0）20（43.48）23（50.0）3（6.52）20（43.48）43（93.48）
对照组460（0）15（31.91）19（42.55）12（25.53）15（31.91）34（73.91）
χ2值6.256 47.658 8
P值0.000 00.000 0
), ArticleFig(id=1322927113745084444, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后t值P值
观察组4622.11±1.029.15±0.14*19.245 40.000 0
对照组4621.12±1.0416.05±0.17*11.482 40.000 0
t值0.708 09.717 1
P值0.480 60.000 0
), ArticleFig(id=1322927113870913565, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=CN, label=表2, caption=

两组肝癌患者中医症状积分情况比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后t值P值
观察组4622.11±1.029.15±0.14*19.245 40.000 0
对照组4621.12±1.0416.05±0.17*11.482 40.000 0
t值0.708 09.717 1
P值0.480 60.000 0
), ArticleFig(id=1322927113946411038, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数ALT/（U/L）AST/（U/L）TBIL/（μmmol/L）ALB/（g/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
观察组46129.63±9.7249.25±5.72*286.25±6.7272.62±7.84*63.85±18.8221.82±9.72*26.25±5.7239.52±2.11*
对照组46128.48±9.8675.25±6.72*287.52±7.45115.58±8.72*63.72±19.7229.85±10.75*26.24±5.7331.25±2.13*
t值0.148 29.474 40.297 211.262 50.341 28.482 60.185 311.284 3
P值0.248 30.000 00.182 60.000 00.276 20.000 00.248 20.000 0
), ArticleFig(id=1322927114026102815, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=CN, label=表3, caption=

两组肝癌患者肝功能指标变化情况比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数ALT/（U/L）AST/（U/L）TBIL/（μmmol/L）ALB/（g/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
观察组46129.63±9.7249.25±5.72*286.25±6.7272.62±7.84*63.85±18.8221.82±9.72*26.25±5.7239.52±2.11*
对照组46128.48±9.8675.25±6.72*287.52±7.45115.58±8.72*63.72±19.7229.85±10.75*26.24±5.7331.25±2.13*
t值0.148 29.474 40.297 211.262 50.341 28.482 60.185 311.284 3
P值0.248 30.000 00.182 60.000 00.276 20.000 00.248 20.000 0
), ArticleFig(id=1322927114143543328, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数AFP-L3/（ng/L）GP73/（μg/L）AFP/（μg/L）γ-GT/（U/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
观察组461 582.59±56.85912.25±59.9590.25±23.4845.21±9.48302.58±25.94162.57±27.8296.25±29.7535.14±9.75
对照组461 583.45±59.78141.25±68.4891.54±24.7266.58±11.47303.44±26.71243.25±52.4896.48±30.4759.47±12.17
t值0.247 813.589 70.194 211.057 70.358 719.586 20.172 616.752 4
P值0.189 70.000 00.248 80.000 00.247 90.000 00.348 20.000 0
), ArticleFig(id=1322927114223235105, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=CN, label=表4, caption=

两组肝癌患者肿瘤标志物水平比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数AFP-L3/（ng/L）GP73/（μg/L）AFP/（μg/L）γ-GT/（U/L）
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
观察组461 582.59±56.85912.25±59.9590.25±23.4845.21±9.48302.58±25.94162.57±27.8296.25±29.7535.14±9.75
对照组461 583.45±59.78141.25±68.4891.54±24.7266.58±11.47303.44±26.71243.25±52.4896.48±30.4759.47±12.17
t值0.247 813.589 70.194 211.057 70.358 719.586 20.172 616.752 4
P值0.189 70.000 00.248 80.000 00.247 90.000 00.348 20.000 0
), ArticleFig(id=1322927114298732578, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数BeclinlLC3mTOR
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4639（84.78）23（50.00）*38（82.61）21（45.65）*41（89.13）20（43.48）*
对照组4640（86.96）33（71.74）*39（84.78）32（69.57）*42（91.30）31（67.39）*
t值0.248 58.845 20.246 212.189 40.249 69.457 5
P值0.145 20.000 00.348 90.000 00.348 90.000 0
), ArticleFig(id=1322927114395201571, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322927104580531173, language=CN, label=表5, caption=

两组肝癌患者相关自噬蛋白阳性率表达比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数BeclinlLC3mTOR
治疗前治疗后治疗前治疗后治疗前治疗后
观察组4639（84.78）23（50.00）*38（82.61）21（45.65）*41（89.13）20（43.48）*
对照组4640（86.96）33（71.74）*39（84.78）32（69.57）*42（91.30）31（67.39）*
t值0.248 58.845 20.246 212.189 40.249 69.457 5
P值0.145 20.000 00.348 90.000 00.348 90.000 0
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加味白头翁汤对肝癌患者术后相关自噬蛋白水平的影响效应研究
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王振华 , 任一鹏 , 麻宇超 , 张莉 , 王蓉 , 刘丽霞
中华中医药学刊 | 国家项目点击 2025,43(11): 60-63
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中华中医药学刊 |国家项目点击 2025 , 43 (11) : 60 -63
加味白头翁汤对肝癌患者术后相关自噬蛋白水平的影响效应研究
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王振华（1985-），男，山西太原人，主治医师，硕士，研究方向：肝胆胰肿瘤相关研究。

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王振华（1985-），男，山西太原人，主治医师，硕士，研究方向：肝胆胰肿瘤相关研究。

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王振华, 任一鹏, 麻宇超, 张莉, 王蓉, 刘丽霞
作者信息
  • 山西省肿瘤医院，山西 太原 030013
通讯作者:
刘丽霞（1984-），女，河北石家庄人，副主任医师，硕士，研究方向：中西医结合肿瘤。E-mail：。
作者简介:

王振华（1985-），男，山西太原人，主治医师，硕士，研究方向：肝胆胰肿瘤相关研究。

Effect of Modified Baitouwen Decoction（加味白头翁汤）on Autophagy Protein in Patients with Liver Cancer After Operation
Zhenhua WANG, Yipeng REN, Yuchao MA, Li ZHANG, Rong WANG, Lixia LIU
Affiliations
  • Shanxi Cancer Hospital，Taiyuan 030013，Shanxi，China
出版时间: 2025-11-10 doi: 10.13193/j.issn.1673-7717.2025.11.014
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摘要
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目的

分析加味白头翁汤对肝癌患者术后相关自噬蛋白水平的影响。

方法

纳入山西省肿瘤医院肝胆胰外科收治的92例肝癌患者为研究对象，随机数字表法分为两组，对照组46例例采用外科手术治疗，观察组46在对照组基础上采用加味白头翁汤联合治疗，对比两组治疗效果、中医症状积分、肝功能指标、肿瘤标志物、相关自噬蛋白水平变化情况等。

结果

观察组客观缓解率为43.48%（20/46），疾病控制率为93.48%（43/46），高于对照组的31.91%（15/46）、73.91%（34/46），组间比较差异有统计学意义（P<0.05）；治疗后观察组中医症状积分低于对照组（P<0.05）；治疗后观察组丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）低于对照组，ALB高于对照组，组间比较差异有统计学意义（P<0.05）；治疗后观察组甲胎蛋白异质体3（AFP-L3）、高尔基体蛋白73（GP73）、甲胎蛋白（AFP）、γ-谷氨酰转移酶（γ-GT）水平低于对照组，微管相关蛋白1轻链3（LC3）、贝可丁1（Beclin-1）、哺乳动物雷帕霉素靶蛋白（mTOR）阳性率低于对照组，组间比较差异有统计学意义（P<0.05）。

结论

肝癌患者术后应用加味白头翁汤疗效明确，可缓解患者相关症状，对肝脏功能起到保护作用，降低肿瘤标志物水平，调节LC3、Beclin-1、mTOR水平，抑制癌细胞增殖，延缓病情发展，有较高应用价值。

肝癌  /  白头翁汤  /  肝功能  /  相关自噬蛋白  /  中西医结合疗法
Objective

To analyze the effect of Modified Baitouwen Decoction（加味白头翁汤）on the level of autophagy protein in patients with liver cancer after surgery.

Method

Ninety-two patients with liver cancer admitted to the Department of Hepatobiliary and pancreatic Surgery of Shanxi Cancer Hospital were included as the study objects，and were selected from March 2022 to September 2024. They were divided into two groups by random number table method. Forty-six patients in the control group received surgical treatment，and 46 patients in the observation group received combined treatment with Modified Baitouwen Decoction on the basis of the control group. The therapeutic effect，TCM symptom scores，liver function indexes，tumor markers and related autophagy protein level were compared between the two groups.

Results

The objective remission rate and disease control rate in the observation group were 43.48%（20/46）and 93.48%（43/46），respectively，which were higher than 31.91%（15/46）and 73.91%（34/46）in the control group（P<0.05）. After treatment，the TCM symptom scores of the observation group were lower than those of the control group（P<0.05）. After treatment，the levels of alanine aminotransferase（ALT），aspartate aminotransferase（AST）and total bilirubin（TBIL）in the observation group were lower than those in the control group，and the level of albumin（ALB）was higher than that in the control group，with significant difference between two groups（P<0.05）. After treatment，the levels of alpha fetoprotein isoform3（AFP-L3），Golgi apparatus protein 73（GP73），alpha fetoprotein（AFP）and gamma glutamyltransferase（γ-GT）in the observation group were lower than those in the control group，and the positive rates of microtubule associated protein 1 light chain 3（LC3），Beclin-1 and mammalian target protein of rapamycin（mTOR）were lower than those in the control group，with significant differences between the two groups（P<0.05）.

Conclusion

Modified Baitouwen Decoction has a clear therapeutic effect on patients with liver cancer after surgery，which can alleviate the relevant symptoms of patients，protect liver function，reduce the levels of tumor markers，regulate the levels of LC3，Beclin-1 and mTOR，inhibit the proliferation of cancer cells and delay the development of disease，and has high application value.

liver cancer  /  Baitouweng Decoction（白头翁汤）  /  liver function  /  related autophagy protein  /  integrative therapy of traditional Chinese and western medicine
王振华, 任一鹏, 麻宇超, 张莉, 王蓉, 刘丽霞. 加味白头翁汤对肝癌患者术后相关自噬蛋白水平的影响效应研究. 中华中医药学刊, 2025 , 43 (11) : 60 -63 . DOI: 10.13193/j.issn.1673-7717.2025.11.014
Zhenhua WANG, Yipeng REN, Yuchao MA, Li ZHANG, Rong WANG, Lixia LIU. Effect of Modified Baitouwen Decoction（加味白头翁汤）on Autophagy Protein in Patients with Liver Cancer After Operation[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (11) : 60 -63 . DOI: 10.13193/j.issn.1673-7717.2025.11.014
正文
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肝癌为临床常见恶性肿瘤之一，为源于肝细胞或肝内胆管上皮细胞的恶性肿瘤。肝癌的发生与多种因素存在密切的联系，如病毒性肝炎、肝硬化、长期大量饮酒等[1]。近年来随着饮食、环境变化等，肝癌的发生率呈明显上升趋势，根据相关数据显示，肝癌的发病率为所有恶性肿瘤的第4位，而病死率则达到第2位[2]。目前对于肝癌患者而言，手术仍是首选，尤其对于早期肝癌患者而言，通过外科手术切除肿瘤组织，可减少肿瘤负荷及扩散风险。传统医学认为机体平衡失调是“癌毒”发生的重要原因，外因包括六淫邪毒，如湿热、疫毒等侵袭人体，内因则涉及七情怫郁、饮食损伤、宿有旧疾等[3-4]。白头翁汤出自《伤寒论·辨厥阴病脉证并治》，有清热解毒、益气养阴、行气疏肝的功效[5]。鉴于此，本次研究对肝癌患者术后应用加味白头翁汤治疗，获得较好效果。现报道如下。
1　临床资料
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1.1　一般资料
纳入山西省肿瘤医院肝胆胰外科2022年3月—2024年9月收治的92例肝癌患者为研究对象，随机数字表法分为两组。对照组46例，男25例，女21例；年龄41～73岁，平均（56.58±5.42）岁；肿瘤直径1.3～4.5 cm，平均（2.58±2.15）cm；临床分期Ⅰ期16例，Ⅱ期30例；Child-Pugh分级A级29例，B级17例。观察组46例，男27例，女19例；年龄42～75岁，平均（57.42±5.45）岁；肿瘤直径1.4～4.6 cm，平均（2.57±2.16）cm；临床分期Ⅰ期19例，Ⅱ期27例；Child-Pugh分级为A级31例，B级15例。两组上述相关临床数据资料比较差异无统计学意义（P>0.05），有良好可比性。患者对此次研究均知情且同意，同时研究也经伦理委员会审核通过。
1.2　纳入标准
1）西医诊断标准：①患者均符合《原发性肝癌诊疗指南》[6]中制定的相关诊断标准，且经影像学、病理组织检查等明确诊断，为早期肝癌；②肿瘤最大≤5 cm，均为肝内单发病灶，未发生肝外转移，且未对主要血管侵袭，经会诊可进行手术切除治疗；③肝功能Child-Pugh分级为A级或B级；④无明显肝肾功能及骨髓功能障碍等。2）中医诊断标准：①参照《中药新药临床研究指导原则》[7]中相关诊断标准，辨证为湿热蕴毒症，主症表现为痞块，胁部胀满灼痛；次症表现为神疲乏力、形体消瘦、面色晦黯、口苦口干、大便干结；舌红苔黄腻，脉滑数。具备上述主症及两项以上次症，结合舌脉即可明确诊断。
1.3　排除标准
①肝肾功能存在严重器质性疾病者；②无法进行外科手术治疗者；③存在淋巴结转移者；④合并其他恶性肿瘤者；⑤合并凝血功能障碍者；⑥临床资料不完善者；⑦合并精神疾病者，无法配合研究者。
2　方法
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2.1　治疗方法
2.1.1　对照组
予以外科手术治疗。患者取仰卧位，麻醉方式采用气管插管全身麻醉。麻醉后，在其右肋缘下方行约一12 cm长的切口。使用钝性器分离皮下组织与肌肉层，以便清晰地暴露肝脏。肝脏完全暴露后，对病灶组织进行切除，同时切除病灶周围约1 cm范围内的健康肝组织，以确保病灶的彻底清除。切除完成后，逐层缝合切口，以促进愈合。手术结束后，为预防感染，常规给予患者抗生素。
2.1.2　观察组
在对照组基础上予以加味白头翁汤治疗。方药组成如下：白头翁15 g，黄柏12 g，黄连6 g，秦皮12 g；若伴有腹水情况则加地耳草15 g，桂枝15 g，泽泻10 g；若瘀血明显者则加丹参30 g；若存在胃脘怕冷者则加砂仁6 g，豆蔻6 g。将上述中药以水煎煮至250 mL，1剂/d，分早晚服用。治疗1周。
2.2　观察指标及方法
2.2.1　治疗效果
依据WHO实体瘤疗效评价标准对近期疗效进行评价：经CT复查，患者的目标肿瘤病灶基本消失，则为完全缓解，若CT复查显示治疗后肿瘤直径缩小超过30%，则为部分缓解，若CT复查显示治疗后肿瘤直径缩小情况没有达到部分缓解水平，肿瘤直径增加也没有超过20%，则为稳定，若CT复查显示治疗后肿瘤直径超过20%，则为进展。观察两组客观缓解率（完全缓解＋部分缓解/例数）和疾病控制率（完全缓解＋部分缓解＋稳定/例数）情况。
2.2.2　中医症状积分
参照《中药新药临床研究指导原则》对主要症状、次要症状依据无、轻、中、重分别赋予0、2、4、6分，总分30分，分值越高表示患者病情越严重。
2.2.3　肝功能指标
抽取两组空腹肘静脉血3 mL，离心速度为3000 r/min，离心时间设置5 min，获得血清后。采用贝克曼全自动生化分析仪AU680型号检测丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、血清总胆红素（TBIL）、血清白蛋白（ALB），观察其变化情况。
2.2.4　肿瘤标志物水平
治疗前及治疗后1周后采集患者空腹外周静脉血3 mL，离心速度为3000 r/min，离心时间设置10 min，获得血清后，采用日本Olympus7060型全自动分析仪检测血清甲胎蛋白异质体3（AFP-L3）、高尔基体蛋白73（GP73）、甲胎蛋白（AFP）、γ-谷氨酰转移酶（γ-GT），观察其水平变化情况。
2.2.5　相关自噬蛋白阳性率
采用SP免疫组织化学技术，操作过程中严格遵循说明书指导。首先对石蜡切片进行脱蜡处理。脱蜡处理之后，使用胰酶进行抗原修复，滴加过氧化酶阻断液以封闭切片，约10 min后10%的非免疫动物血清对切片进行孵育，时间为40 min。在孵育完成后，分别滴加Beclinl抗体、LC3抗体以及mTOR抗体，并将切片放置在4℃的环境中过夜。然后使用鼠抗兔二抗对切片进行孵育，孵育时间为20 min，然后使用DAB显色剂进行显色反应。在染色结果的判定上，贝可丁1（Beclinl）、微管相关蛋白1轻链3（LC3）和哺乳动物雷帕霉素靶蛋白（mTOR）的阳性表达主要体现在细胞膜和/或细胞质染色为淡黄色、棕黄色或棕褐色。通过结合染色强度和阳性细胞的百分率来进行判定。染色强度的评分标准如下：无着色为0分，淡黄色为1分，棕黄色为2分，而褐色则为3分。阳性细胞百分比的评分标准为：阳性细胞数小于5%的计为0分，5%～25%的计为1分，26% ～50%的计为2分，超过50%的计为3分。将染色强度的分数与阳性细胞百分比的分数相乘，得到的总分如果大于或等于4分，则判定为免疫组织化学阳性（＋）；如果总分小于4分，则判定为阴性（-）。
2.3　统计学方法
将采集数据采用SPSS 25.0处理分析，数据资料均符合正态分布，治疗效果用［例（%）］表示，采用χ2检验；中医症状积分、肿瘤标志物、肝功能等指标用（）表示，用t检验。P<0.05为差异有统计学意义。
3　结果
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3.1　近期治疗效果比较
观察组客观缓解率为43.48%，疾病控制率为93.48%，高于对照组的31.91%、73.91%，组间比较差异有统计学意义（P<0.05）。见表1。
3.2　中医症状积分情况比较
治疗前两组中医症状积分比较差异无统计学意义（P>0.05）；治疗后两组症状积分均有所降低（P<0.05），且相较于对照组，观察组降低更为明显（P<0.05）。见表2。
3.3　肝功能指标变化情况比较
治疗前两组ALT、AST、TBIL、ALB比较差异无统计学意义（P>0.05）；治疗后两组上述ALT、AST、TBIL指标水平均有降低，ALB提高，且较于对照组，观察组改善更为显著（P<0.05）。见表3。
3.4　肿瘤标志物水平比较
治疗前两组AFP-L3、GP73、AFP、γ-GT比较差异无统计学意义（P>0.05）；治疗后两组上述指标均有所降低（P<0.05），且相较于对照组，观察组降低更为明显，组间差异有统计学意义（P<0.05）。见表4。
3.5　相关自噬蛋白阳性率表达比较
两组治疗前Beclinl、LC3、mTOR阳性率比较差异无统计学意义；治疗后两组上述3项阳性率均有所降低，且相较于对照组，观察组降低更为明显，组间比较差异有统计学意义（P<0.05）。见表5。
4　讨论
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肝癌为临床常见、高发恶性肿瘤之一，在我国肿瘤相关死亡原因中仅次于肺癌。肝癌的发病率在全球范围内也呈上升趋势，严重威胁着人类的生命健康。其病因复杂，可能与遗传、环境、生活方式等多种因素有关[8]。目前临床针对肝癌仍以手术治疗为主，术后如何尽快促进患者恢复，延缓病情发展，减轻肝脏损伤，提高患者日常生活质量已成为临床研究的重点。肝癌在祖国医学中归属于“积聚”“癥瘕”“肝积”等范畴，其病因在于情志不畅致肝气郁结，导致脏腑气血虚亏[9]。其病机是由于脾脏功能失调、水湿运化不利，痰湿互结，形成病理产物，日积月累，最终导致气、血、湿、热及瘀毒相互交织，形成复杂的病理状态，发为本病[10-11]。同时，患者在手术、药物的作用下会进一步耗损气血，使得原本虚亏的体质更加虚弱，加剧病情的发展。因此对于肝癌术后患者应予以清热解毒、益气养阴、解毒散瘀疗法进行治疗。
本次研究对肝癌患者术后应用加味白头翁汤治疗，结果发现治疗后观察组症状积分、血清肿瘤标志物水平降低、肝功能好于对照组（P<0.05）。可见术后应用加味白头翁汤治疗能缓解患者症状，促进肝功能恢复，降低血清肿瘤标志物水平，抑制肿瘤生长、增殖作用。这是由于白头翁汤是《伤寒杂病论》中的经典方剂，属于一种清热剂，具备清热泻火、凉血解毒以及滋阴降火的功效[12]。当人体受到外感热邪的侵袭，或者本身体质偏阳热，长期累积在体内，火热之邪会消耗人体的气和阴液，导致血液中的津液被过度灼烧，从而使得血液变得黏稠，流动不畅，形成瘀血；同时，火热之邪还能够将体液转化为痰液，热邪、痰液和瘀血相互结合，形成所谓的热毒，而热毒一旦在人体的经络和脏腑中阻塞，就可能引发肿瘤的形成[13-14]。因此，热毒的蕴结被认为是恶性肿瘤发生和发展的一个关键因素。因此，清热剂在预防和治疗恶性肿瘤方面扮演着一个不可替代的角色。白头翁汤，由白头翁、黄柏、黄连、秦皮四味药物组成，《医方集解·泻火之剂》：“此足阳明、少阴、厥阴药也”。白头翁苦寒能入阳明血分，而凉血止痢；秦皮苦寒性涩，能凉肝益肾而固下焦；黄连凉心清肝，黄柏泻火补水，并能燥湿止痢而厚肠，取寒能胜热，苦能坚肾，涩能断下也[15-16]。方中白头翁作为君药，具有清热解毒、凉血止痢的功效；臣以黄连之苦寒，清热解毒，燥湿厚肠；黄柏泻下焦湿热，共奏燥湿止痢之效。秦皮苦寒性涩，收敛作用强。四药并用，共奏清热泻火、凉血解毒的功效[17]。
自噬作为真核细胞的一种程序性细胞死亡方式，涉及体内多余蛋白质、细胞器及其他亚细胞成分的分解代谢过程[18]。该过程不仅限于清除受损细胞器、抑制细胞过度生长，还能启动细胞程序性死亡，从而在一定程度上抑制肿瘤细胞的增殖。此外，研究显示，在饥饿、缺氧等病理生理状态下，自噬可能通过激活特定机制增强肿瘤细胞的耐受性，进而促进肿瘤的发生和发展[19-20]。在肝癌细胞中，自噬相关蛋白如LC3、Beclin-1和mTOR被发现参与自噬过程的调控[21]。LC3作为自噬过程中的关键蛋白，主要负责自噬小体的形成，其表达水平通常与肿瘤细胞的生存和耐药性密切相关。在肝癌背景下，LC3可能通过促进肝癌细胞的自噬活动，帮助其逃避药物诱导的细胞死亡[22-23]。Beclin-1作为自噬的核心调节因子，其下调与肝癌的恶性进展有直接联系。Beclin-1的表达水平能显著影响肝癌细胞的存活和扩展。因此，通过调节Beclin-1的表达，有可能实现对肝癌生长的抑制。而mTOR作为自噬的负调节因子，能通过PI3K/Akt信号通路抑制自噬[24]。在肝癌细胞中，mTOR通常表现出过度激活状态，这抑制了自噬功能，从而促进了肿瘤细胞的生存和增殖[25]。本次研究发现，观察组治疗后Beclinl、LC3、mTOR阳性率均低于对照组（P<0.05）。可见该种治疗方式能降低LC3、Beclin-1、mTOR水平，抑制癌细胞增殖。这是由于白头翁汤中黄连、黄柏和白头翁的有效成分如小檗碱可以通过抑制mTOR通路来激活自噬[26-27]。在肝癌中，抑制mTOR可以促进自噬的启动，减少肝癌细胞的增殖[28]。而黄柏碱等药物能够通过直接或间接作用于mTOR，抑制其活性，从而诱导自噬，抑制肝癌的增殖[29]。黄连、黄柏和秦皮等成分可能通过调节Beclin-1和LC3的表达来激活自噬，这有助于肝癌细胞的凋亡和癌症控制[30]。特别是在黄连中含有的活性成分小檗碱已被证明可以促进Beclin-1的上调，从而激活自噬，从而达到抑制癌细胞增殖，延缓病情发展，促进患者术后尽快恢复的目的。
综上所述，肝癌患者术后应用加味白头翁汤联合治疗效果明确，可缓解患者相关症状，对肝脏功能起到保护作用，降低肿瘤标志物水平，调节LC3、Beclin-1、mTOR水平，抑制癌细胞增殖，延缓病情发展，有较高应用价值。
基金
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  • 国家重点研发计划项目(2018YFC0807204)
文献
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2025年第43卷第11期
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doi: 10.13193/j.issn.1673-7717.2025.11.014
  • 首发时间：2026-10-30
  • 出版时间：2025-11-10
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基金
国家重点研发计划项目(2018YFC0807204)
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    山西省肿瘤医院，山西 太原 030013

通讯作者:

刘丽霞（1984-），女，河北石家庄人，副主任医师，硕士，研究方向：中西医结合肿瘤。E-mail：。
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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