目的 探究四君子汤加减辅助化疗治疗结直肠癌的临床疗效及其对化疗患者肿瘤微环境的影响。方法 回顾性分析 30 例结直肠癌化疗患者的临床资料，按照化疗期间是否服用过四君子汤加减分 为两组，服用过四君子汤者为联合治疗组，未服用者为对照组。并对同一患者治疗前后配对的肿瘤组织进 行单细胞RNA测序分析。结果 联合治疗组与对照组分别纳入15例患者，两组患者的性别构成、年龄、结直肠癌分期、分化程度比较差异无统计学意义（P > 0.05）。治疗后，联合治疗组食少纳呆（P < 0.05）、神疲乏 力（P < 0.05）、腹胀（P < 0.05）、便溏（P < 0.05）的中医证候评分均低于对照组，差异有统计学意义。通过单 细胞测序数据分析发现，与对照组相比，治疗后联合治疗组 CD8+ T 细胞比例更高，而且联合治疗组 CD8+ T 细胞的TNF⁃α/NF⁃κB信号通路、IL6/JAK/STAT3信号通路、IL2/STAT5信号通路激活。此外，两组效应T细胞 的差异基因比较显示，联合治疗组的效应 T 细胞在治疗后 LTB、IL7R 等基因高表达。效应 T 细胞在联合治 疗组功能被激活，可能与 TNF⁃α/NF⁃κB 通路和 IL2/STAT5 通路活性增高有关。最后，四君子汤加减可能还 通过激活巨噬细胞吞噬功能及促进巨噬细胞与效应 T 细胞的细胞互作发挥潜在治疗作用。结论 四君子 汤加减在结直肠癌化疗患者的治疗中有效，可显著改善患者生活质量。四君子汤加减对结直肠癌化疗患 者的肿瘤微环境有显著影响，其可能通过增强效应T细胞功能和增强巨噬细胞抗肿瘤免疫活性发挥作用。 

Objective To explore the clinical curative effect of modified Sijunzi decoction on adjuvant che⁃ motherapy for colorectal cancer and its effect on the tumor microenvironment of patients receiving chemotherapy. Methods The clinical data of 30 patients with colorectal cancer who received chemotherapy were retrospectively analyzed. They were divided into combined treatment group and control group according to whether they took Sijunzi decoction during chemotherapy. Single ⁃cell RNA ⁃sequencing of paired tumor tissues from the same patient before and after treatment was performed. Results Fifteen patients were included in the combined treatment group and the control group，respectively. There was no statistically significant difference between the two groups in terms of gender composition，age，colorectal cancer stage，and differentiation. After treatment，the TCM symptom scores of anorexia（P < 0.05），loss of spirit（P < 0.05），abdominal distension（P < 0.05）and loose stools（P < 0.05）in the combined treatment group were lower than those of the control group，and the differences were statistically significant. Analysis of single ⁃cell sequencing data revealed that the proportion of CD8 + T cells was higher in the combined treatment group after treatment compared with the control group，and the TNF ⁃α/NF ⁃kB signaling path⁃ way，IL6/JAK/STAT3 signaling pathway，and IL2/STAT5 signaling were activated in CD8 + T cells in the combined treatment group. In addition，comparison of differential genes of effector T cells in the two groups showed that effector T cells in the combined treatment group highly expressed genes such as LTB and IL7R after treatment. The effector T cell function was activated in the combination treatment group，which may be related to the increased activity of TNF⁃ α/NF⁃kB pathway and IL2/STAT5 pathway. Finally，modified Sijunzi decoction may also play a potential therapeutic role by activating macrophage phagocytosis and promoting cellular interactions between macrophages and effector T cells. Conclusion Modified Sijunzi decoction was effective for patients with colorectal cancer undergoing chemo⁃ therapy，and could significantly improve the quality of life of patients. Modified Sijunzi decoction has a significant effect on the tumor microenvironment of colorectal cancer patients undergoing chemotherapy，which may play a role by enhancing the function of effector T cells and enhancing the anti⁃tumor immune activity of macrophages.