中文摘要：

目的探讨P53表达对预测非小细胞肺癌（NSCLC）化疗耐药性的意义及采用中药养肺解毒方对其的干预治疗。方法选择Ⅲ、Ⅳ期NSCLC患者96例，经纤维支气管镜或者CT引导下经皮细针肺活检获取标本，通过免疫组织化学、RT－PCR检测P53表达。依据其结果，分为P53阳性组（n=54）和P53阴性组（n=42）。依据治疗方案的不同，每组再分为吉西他滨（健择，1250mg／m^2）＋顺铂（70mg／m^2）治疗组（T1组，P53阳性，27例；T2组，P53阴性，21例）和健择（1250mg／m^2）＋顺铂（70mg／m^2）＋养肺解毒方（随症加减，1剂／d，1次／d）治疗组（T3组，P53阳性，27例；T4组，P53阴性，21例）。治疗周期为21d，共4个周期。观察各组病例治疗后的有效率和中位生存期（MST）。结果阳性组P53mRNA相对吸光度A值（57．65±4．78）明显高于阴性组（24．83±1．81）（P〈0．05）。T2组治疗有效率42．9％（9／21）高于T1组29．6％（8／27），MST（9．55±0．54）个月也长于T1组（7．82±0．48）个月（均P〈0．05）。T4组治疗有效率57．1％（12／21）高于T3组37．0％（10／27），MST（11．03±0．63）个月长于T3组的（8．78±0．51）个月（均P〈0．05）。而且T3组的治疗有效率和MST明显优于T1组，T4组优于T2组（均P〈0．05）。结论P53蛋白和mRNA基因高表达可以预测非小细胞肺癌的耐药性。中药养肺解毒方可能通过降低非小细胞肺癌化疗耐药来提高疗效。

英文摘要：

Objective To investigate the significance of P53 expression in predicting chemoresistance and the treatment response to Yang-fei-jie-du decoction （a traditional Chinese medicine formula） in non-small-cell lung cancer （NSCLC）. Methods A total of 96 NSCLC patients at stages III or IV were recruited. Specimen was collected by flexible fiberoptic bronehoscopy or CT- guided percutaneous transthoraeic pulmonary biopsy. The P53 gene expression was studied by both immunohistochemistry and reverse transcription DNA polymerase chain reaction （RT-PCR） analysis. According to the results, patients were divided into P53 positive group （P53^＋ group, n=54） and P53 negative group （P53^- group, n=42）. Each group was subdivided into gemcitabine （1250 mg/m^2） plus eisplatin （70 mg/m^2） treatment group （T1 group, P53^＋, n=27 ; T2 group, P53^-, n=21 ）, and gemcitabine （ 1250 mg/m^2） plus eisplatin （70 mg/m^2） plus Yang- fei-jie-du decoction （modified with symptoms, 1 dose daily） treatment group （T3 group, P53^＋, n=27; T4 group, P53^-, n=21 ）. The treatment cycle was 21 d and the course included 4 cycles. Treatment efficacy and median survival time （MST） were observed in all groups after treatment. Results P53 mRNA relative absorbance A value in P53^＋ group （57.65±4.78） was markedly higher than that of P53^- group （24.83±1.81 ） （P〈0. 05）. The response rate and MST were higher and longer in T2 group [42.9% （9/21） and （9.55±0.54） monthsl as compared to T1 group [29.6% （8/27） and （7.82±0.48） months] （both P〈0. 05）, so were those in T4 group [57.1% （12/21） and （11.03±0.63） months] compared to T3 group [37.0%（10/27） and （8.78± 0.51） months] （both P〈0.05）. Meanwhile, T3 group and T4 group had better efficacy as compared to T1 group and T2 group （all P〈0.05）. Conclusions Up-regulation of P53 protein and mRNA expression may be used to predict chemoresistance in NSCLC. Yang-fei-jie-du decoction may enhance the effica