加味芍药甘草汤联合硫酸吗啡缓释片治疗气血两虚证癌性疼痛疗效及对患者疼痛介质、炎症因子的影响
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摘要
目的:探讨气血两虚证癌性疼痛(癌痛)应用加味芍药甘草汤联合硫酸吗啡缓释片治疗的临床效果。方法:选取2017年1月至2018年1月本院收治的128例癌痛患者,运用随机数字表法将这128例患者随机分成观察组与对照组,各64例。对照组口服硫酸吗啡缓释片治疗,观察组联合口服加味甘草芍药汤治疗。记录比较两组疼痛缓解临床疗效,治疗前后疼痛介质5-羟色胺(5-hydroxytryptamine,5-HT),前列腺素E2(prostaglandin E2,PGE2),内皮素-1 (endothelin-1,ET-1),P物质(substance P,SP),炎症因子肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),白细胞介素-1β(interleukin 1β,IL~(-1)β),白细胞介素-2(interleuki-2,IL-2),白细胞介素-6(interleuki-6,IL-6)水平变化,不良反应发生情况。结果:治疗4周后,观察组总有效率为90. 6%,较对照组(76. 6%)明显升高(P <0. 05)。与本组治疗前比较,两组治疗后各疼痛介质(5-HT,PGE2,ET-1,SP)血清含量及血清TNF-α,IL~(-1)β,IL-6浓度均明显减少(P <0. 05),血清IL-2浓度均明显增高(P <0. 05);且观察组改善更明显(P <0. 05)。观察组不良反应率为15. 6%(10/64)较对照组23. 4%(15/64)略低,但差异无统计学意义。结论:气血两虚证癌痛应用加味芍药甘草汤联合硫酸吗啡缓释片治疗能明显缓解患者疼痛症状,降低外周疼痛介质水平,调节炎性细胞因子表达,疗效显著,患者耐受性良好。
Objective: To explore the clinical efficacy of modified Shaoyao Gancao Tang and morphine sulfate sustained release tablet for cancer pain with Qi and blood deficiency syndrome. Method: The 128 cases with caner pain in our hospital from January 2017 to January 2018 were selected as research objectives,and divided into observation group(64 cases) and control group(64 cases) randomly. Morphine sulfate sustained release tablets were given to both group for oral treatment,and modified Shaoyao Gancao Tang was additionally given to observation group. The clinical efficacy for pain relief between two groups, the changes in pain mediators[serotonin 5-hydroxytryptamine(5-HT),prostaglandin E2(PGE2),endothelin-1(ET-1),substance P(SP) ]and inflammatory factors [tumor necrosis factor(TNF)-α,interleukin(IL)-1β,IL-2,IL-6]after treatment and incidence of adverse reactions were recorded and compared. Result: After 4 weeks treatment,the overall effective rate was 90. 6% in observation group,significant higher than 76. 6% in control group(P < 0. 05). Compared with those before treatment,the serum levels of pain mediators(5-HT,PGE2,ET-1,SP),TNF-α,IL~(-1)β and IL-6 were decreased significantly in both groups after treatment(P < 0. 05),and IL-2 level in serum was increased significantly(P < 0. 05); in addition,the improvement was more obvious in observation group(P < 0. 05). The incidence of adverse reactions was 15. 6%(10/64) in observation group,slightly lower than 23. 4%(15/64) in the control group,with no statistically significant difference between two groups. Conclusion: Modified Shaoyao Gancao Tang combined with morphine sulfate sustained release tablet could significantly relieve the pain symptoms,reduce the level of peripheral pain mediators,regulate the expression of inflammatory factors with significant effect in the treatment of cancer pain with qi and blood deficiency syndrome,showing good patient tolerance.
Objective: To explore the clinical efficacy of modified Shaoyao Gancao Tang and morphine sulfate sustained release tablet for cancer pain with Qi and blood deficiency syndrome. Method: The 128 cases with caner pain in our hospital from January 2017 to January 2018 were selected as research objectives,and divided into observation group(64 cases) and control group(64 cases) randomly. Morphine sulfate sustained release tablets were given to both group for oral treatment,and modified Shaoyao Gancao Tang was additionally given to observation group. The clinical efficacy for pain relief between two groups, the changes in pain mediators[serotonin 5-hydroxytryptamine(5-HT),prostaglandin E2(PGE2),endothelin-1(ET-1),substance P(SP) ]and inflammatory factors [tumor necrosis factor(TNF)-α,interleukin(IL)-1β,IL-2,IL-6]after treatment and incidence of adverse reactions were recorded and compared. Result: After 4 weeks treatment,the overall effective rate was 90. 6% in observation group,significant higher than 76. 6% in control group(P < 0. 05). Compared with those before treatment,the serum levels of pain mediators(5-HT,PGE2,ET-1,SP),TNF-α,IL~(-1)β and IL-6 were decreased significantly in both groups after treatment(P < 0. 05),and IL-2 level in serum was increased significantly(P < 0. 05); in addition,the improvement was more obvious in observation group(P < 0. 05). The incidence of adverse reactions was 15. 6%(10/64) in observation group,slightly lower than 23. 4%(15/64) in the control group,with no statistically significant difference between two groups. Conclusion: Modified Shaoyao Gancao Tang combined with morphine sulfate sustained release tablet could significantly relieve the pain symptoms,reduce the level of peripheral pain mediators,regulate the expression of inflammatory factors with significant effect in the treatment of cancer pain with qi and blood deficiency syndrome,showing good patient tolerance.
引文
[1] Bandieri E, Romero M, Ripamonti C I, et al.Randomized trial of low-dose morphine versus weak opioids in moderate cancer pain[J]. J Clin Oncol,2016,34(5):436-442.
[2] LIU W C, ZHONG X Z, TAN K H, et al.Multidimensional treatment of cancer pain[J]. Curr Oncol Rep,2017,19(2):10.
[3]杜延军,赵瑞霞.真武汤联合硫酸吗啡缓释片治疗癌性疼痛临床研究[J].中医学报,2017,32(8):1394-1396.
[4]杜志华,王菊勇,董昌盛,等.中西医结合治疗癌痛临床疗效及安全性Meta分析[J].辽宁中医杂志,2015,42(12):2290-2296.
[5]中华人民共和国卫生部.癌症疼痛诊疗规范(2011年版)[J].临床肿瘤学杂志,2012,17(2):153-158.
[6]张家锡.中医诊断学[M].成都:四川科学技术出版社,2007:263.
[7]孙燕,顾慰萍.癌症三阶梯镇痛指导原则[M].北京:北京医科大学出版社,2002:100-101.
[8]殷东风.实用晚期恶性肿瘤综合治疗手册[M].辽宁:辽宁科学技术出版社,2007:41-49.
[9]孔祥鸣,朱均权,龚黎燕.癌痛规范化治疗与临床实践[M].上海:上海科学技术出版社,2013:27-45.
[10]中国中医药研究促进会肿瘤专业委员会.癌性疼痛中医外治诊疗规范专家共识意见[J].北京中医药,2014,33(4):305-307.
[11] Drejdi M M, Hamdan-Mansour A R. Pain, sleep disturbance, and quality of life among palestinian patients diagnosed with cancer[J]. J Cancer Educ,2016,31(4):796-803.
[12]王辉,李娜,杨小立,等.硫酸吗啡缓释片治疗中重度癌性疼痛临床疗效[J].现代肿瘤医学,2017,25(14):2301-2304.
[13]程尧,奚胜艳,王彦晖,等.癌性疼痛的中医再认识及临证用药规律探析[J].中华中医药杂志,2015,30(11):3960-3964.
[14]黄建国,黄朝頔,龚启英,等. 5-羟色胺与疼痛[J].中国皮肤性病学杂志,2015,29(9):974-977.
[15] TANG Y, PENG H, LIAO Q, et al. Study of breakthrough cancer pain in an animal model induced by endothelin-1[J]. Neurosci Lett,2016,617:108-115.
[16]赵国敏,尹金淑. P物质及其受体神经激肽1受体与疼痛的相关性研究[J].医学综述,2015,21(16):2890-2893.
[17]李建,张洁瑛,孙鹏,等.平胃散合桂枝芍药知母汤加减治疗慢性痛风性关节炎的疗效机制[J].中国实验方剂学杂志,2018,24(1):180-185.
[18]许红,宋长春,张一昕,等.生地黄对血瘀证模型大鼠血浆内皮素水平的影响[J].河北中医药学报,2008,23(2):5-6.
[19] LU C,LIU Y,SUN B,et al. Intrathecal injection of JWH-015 attenuates bone cancer pain via timedependent modification of pro-inflammatory cytokines expression and astrocytes activity in spinal cord[J].Inflammation,2015,38(5):1880-1890.
[20] ZHOU N,FU Z,LI H,et al. Ketamine,as adjuvant analgesics for patients with refractory cancer pain,does affect IL-2/IFN-γexpression of T cells in vitro:a prospective, randomized, double-blind study[J].Medicine:Baltimore,2017,96(16):e6639.
[21]聂安政,林志健,王雨,等.秦艽化学成分及药理作用研究进展[J].中草药,2017,48(3):597-608.
[22]程瑶,邵云云,常壮鹏,等.加味芍药甘草汤对多囊卵巢综合征模型大鼠的干预作用[J].中国实验方剂学杂志,2018,24(6):139-144.
[2] LIU W C, ZHONG X Z, TAN K H, et al.Multidimensional treatment of cancer pain[J]. Curr Oncol Rep,2017,19(2):10.
[3]杜延军,赵瑞霞.真武汤联合硫酸吗啡缓释片治疗癌性疼痛临床研究[J].中医学报,2017,32(8):1394-1396.
[4]杜志华,王菊勇,董昌盛,等.中西医结合治疗癌痛临床疗效及安全性Meta分析[J].辽宁中医杂志,2015,42(12):2290-2296.
[5]中华人民共和国卫生部.癌症疼痛诊疗规范(2011年版)[J].临床肿瘤学杂志,2012,17(2):153-158.
[6]张家锡.中医诊断学[M].成都:四川科学技术出版社,2007:263.
[7]孙燕,顾慰萍.癌症三阶梯镇痛指导原则[M].北京:北京医科大学出版社,2002:100-101.
[8]殷东风.实用晚期恶性肿瘤综合治疗手册[M].辽宁:辽宁科学技术出版社,2007:41-49.
[9]孔祥鸣,朱均权,龚黎燕.癌痛规范化治疗与临床实践[M].上海:上海科学技术出版社,2013:27-45.
[10]中国中医药研究促进会肿瘤专业委员会.癌性疼痛中医外治诊疗规范专家共识意见[J].北京中医药,2014,33(4):305-307.
[11] Drejdi M M, Hamdan-Mansour A R. Pain, sleep disturbance, and quality of life among palestinian patients diagnosed with cancer[J]. J Cancer Educ,2016,31(4):796-803.
[12]王辉,李娜,杨小立,等.硫酸吗啡缓释片治疗中重度癌性疼痛临床疗效[J].现代肿瘤医学,2017,25(14):2301-2304.
[13]程尧,奚胜艳,王彦晖,等.癌性疼痛的中医再认识及临证用药规律探析[J].中华中医药杂志,2015,30(11):3960-3964.
[14]黄建国,黄朝頔,龚启英,等. 5-羟色胺与疼痛[J].中国皮肤性病学杂志,2015,29(9):974-977.
[15] TANG Y, PENG H, LIAO Q, et al. Study of breakthrough cancer pain in an animal model induced by endothelin-1[J]. Neurosci Lett,2016,617:108-115.
[16]赵国敏,尹金淑. P物质及其受体神经激肽1受体与疼痛的相关性研究[J].医学综述,2015,21(16):2890-2893.
[17]李建,张洁瑛,孙鹏,等.平胃散合桂枝芍药知母汤加减治疗慢性痛风性关节炎的疗效机制[J].中国实验方剂学杂志,2018,24(1):180-185.
[18]许红,宋长春,张一昕,等.生地黄对血瘀证模型大鼠血浆内皮素水平的影响[J].河北中医药学报,2008,23(2):5-6.
[19] LU C,LIU Y,SUN B,et al. Intrathecal injection of JWH-015 attenuates bone cancer pain via timedependent modification of pro-inflammatory cytokines expression and astrocytes activity in spinal cord[J].Inflammation,2015,38(5):1880-1890.
[20] ZHOU N,FU Z,LI H,et al. Ketamine,as adjuvant analgesics for patients with refractory cancer pain,does affect IL-2/IFN-γexpression of T cells in vitro:a prospective, randomized, double-blind study[J].Medicine:Baltimore,2017,96(16):e6639.
[21]聂安政,林志健,王雨,等.秦艽化学成分及药理作用研究进展[J].中草药,2017,48(3):597-608.
[22]程瑶,邵云云,常壮鹏,等.加味芍药甘草汤对多囊卵巢综合征模型大鼠的干预作用[J].中国实验方剂学杂志,2018,24(6):139-144.