益气养阴通络方联合阿帕替尼和替加氟治疗晚期胃癌临床观察
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摘要
目的:观察益气养阴通络方联合阿帕替尼和替加氟治疗二线及以上药物治疗失败的气阴两虚型晚期胃癌的临床疗效、安全性及对患者生活质量的影响。方法:选择安徽医科大学第一附属医院2017年5月—2018年3月收治的中医辨证属气阴两虚夹瘀型、既往未使用靶向治疗及替加氟口服化疗的晚期癌症患者60例;每组纳入30例患者,对照组采用阿帕替尼联合替加氟方案进行治疗,观察组在对照组的基础上加用益气养阴通络方,比较两组临床疗效、中医证候积分评价、生活质量评估、不良反应发生率、治疗前后T淋巴细胞亚群数量差异、治疗前后血清细胞因子等指标。结果:两组临床疗效的差异比较无统计学意义,但观察组的客观缓解率、疾病控制率高于对照组;观察组中医证候改善、生活质量较前提高明显要优于对照组,两组不良反应发生率、治疗前后免疫功能、治疗前后血清细胞因子具有差异性。结论:益气养阴通络方结合西医化疗药及靶向药治疗晚期胃癌可减毒、增强患者免疫功能、减少炎性反应、提高生活质量,具有重要的临床意义。
Objective:To observe the clinical efficacy,safety and quality of life of patients with advanced gastric cancer with deficiency of Qi and Yin due to Yiqi Yangyin Tongluo Decoction combined with apatinib and tegafur in the treatment of second-line or above drug failure. Methods:We selected patients with terminal cancer who had not previously used targeted therapy and tegafur oral chemotherapy in the TCM differentiation syndromes of the first affiliated hospital of Anhui medical university from May 2017 to March 2018. 30 patients were included in each group. The control group was treated with apatinib combined with tegafur. The observation group was supplemented with Yiqi Yangyin Tongluo Decoction on the basis of the control group. The clinical efficacy,evaluation of TCM syndrome score,life quality assessment,incidence of adverse reaction,difference of the number of T lymphocyte subsets,serum cytokines before and after treatment were compared between the two groups. Results:There was no significant difference in clinical efficacy between the two groups,but the objective remission rate and disease control rate in the observation group was higher than that control group;the improvement in TCM symptoms and life quality after treatment in the observation group was significantly higher than that control group,and the difference was statistically significant. There was a difference in the incidence of adverse reactions in the two groups,the immune function and the serum cytokines before and after treatment between the two groups. Conclusion:Yiqi Yangyin Tongluo Decoction combined with Western medicine chemotherapeutic drugs and targeted drugs in the treatment of advanced gastric cancer can achieve detoxification,enhance the immune function of patients,reduce inflammatory reaction and improve the quality of life,which has important clinical significance.
Objective:To observe the clinical efficacy,safety and quality of life of patients with advanced gastric cancer with deficiency of Qi and Yin due to Yiqi Yangyin Tongluo Decoction combined with apatinib and tegafur in the treatment of second-line or above drug failure. Methods:We selected patients with terminal cancer who had not previously used targeted therapy and tegafur oral chemotherapy in the TCM differentiation syndromes of the first affiliated hospital of Anhui medical university from May 2017 to March 2018. 30 patients were included in each group. The control group was treated with apatinib combined with tegafur. The observation group was supplemented with Yiqi Yangyin Tongluo Decoction on the basis of the control group. The clinical efficacy,evaluation of TCM syndrome score,life quality assessment,incidence of adverse reaction,difference of the number of T lymphocyte subsets,serum cytokines before and after treatment were compared between the two groups. Results:There was no significant difference in clinical efficacy between the two groups,but the objective remission rate and disease control rate in the observation group was higher than that control group;the improvement in TCM symptoms and life quality after treatment in the observation group was significantly higher than that control group,and the difference was statistically significant. There was a difference in the incidence of adverse reactions in the two groups,the immune function and the serum cytokines before and after treatment between the two groups. Conclusion:Yiqi Yangyin Tongluo Decoction combined with Western medicine chemotherapeutic drugs and targeted drugs in the treatment of advanced gastric cancer can achieve detoxification,enhance the immune function of patients,reduce inflammatory reaction and improve the quality of life,which has important clinical significance.
引文
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[13]李永亮,刑珊珊,罗以,等.替加氟或氟尿嘧啶联合奥沙利铂对结直肠癌术后辅助化疗的疗效比较[J].世界华人消化杂志,2013(31):3460-3463.
[14]李平,张梅,陶宋词.元气化生异常,内生瘤毒致肿瘤[C]//中国中西医结合学会.全国中西医结合肿瘤学术大会论文集.宁波:中国中西医结合学会,2010.
[2]李加桩,王凯冰,郑红艳,等.胃癌分子靶向药物治疗的研究进展[J].中国肿瘤,2017,26(4):279-285.
[3]Kozloff M,Yood M U,Berlin J,et al. Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer:The BRiTE observational cohort study[J]. Oncologist,2009,14(9):862-870.
[4]蔡立业.扶正清解方加减对气阴两虚型胃癌根治术后化疗的临床疗效观察[D].福州:福建中医药大学,2013.
[5]中国华人民共和国卫生部.中国常见恶性肿瘤诊治规范[M].北京:北京医科大学、中国协和医科大学联合出版社,1991.
[6]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2002.
[7]周际昌.实用肿瘤内科学(精)[M]. 2版.北京:人民卫生出版社,2005.
[8]Shepard HM,Brdlik C M,Schreiber H. Signal integration:a framework for understanding the efficacy of therapeutics targeting the human EGFR family[J]. Journal of Clinical Investigation,2008,118(11):3574-3581.
[9]LI J,QIN S,XU J,et al. Apatinib for chemotherapy-refractory advanced metastatic gastric cancer:results from a randomized,placebo-controlled,parallel-arm,phase II trial[J]. Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology,2013,31(26):3219.
[10]张天泽,徐光炜.肿瘤学[M].2版.天津:天津科学技术出版社,2005.
[11]Chen W,Zheng R,Baade PD,et al. Cancer statistics in China,2015[J]. Ca Cancer J Clin,2016,66(2):115-132.
[12]徐泽宽. 2015年V1版《NCCN胃癌临床实践指南》更新解读[J].中国实用外科杂志,2015(5):512-514.
[13]李永亮,刑珊珊,罗以,等.替加氟或氟尿嘧啶联合奥沙利铂对结直肠癌术后辅助化疗的疗效比较[J].世界华人消化杂志,2013(31):3460-3463.
[14]李平,张梅,陶宋词.元气化生异常,内生瘤毒致肿瘤[C]//中国中西医结合学会.全国中西医结合肿瘤学术大会论文集.宁波:中国中西医结合学会,2010.