四君子汤加味对肺癌化疗骨髓抑制的作用机制
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摘要
目的:探讨四君子汤加味对肺癌化疗骨髓抑制气阴两虚证的疗效及对血清中粒-巨噬细胞集落刺激因子(GMCSF)和粒细胞集落刺激因子(G-CSF)水平的影响。方法:将中晚期肺癌患者104例患者,参照数字表法随机分为对照组和观察组各52例。对照组采用化疗方案(TP)。观察组在对照组治疗的基础上给予四君子汤加味,化疗第1天开始内服,2次/d,化疗后继续服用1周。比较两组骨髓抑制程度、白细胞减少、中医症状积分及近期临床疗效。测定两组患者外周血T细胞亚群CD3+,CD4+及CD8+水平变化。记录两组患者重组人粒细胞刺激因子注射液(rh G-CSF)使用量;检测两组患者血清中GMCSF和G-CSF水平。结果:治疗后1周,观察组中性粒细胞、血红蛋白、血小板及白细胞数量均显著高于对照组(P<0.01)。观察组的中性粒细胞和白细胞减少发生率均明显低于对照组(P<0.05);治疗后1周,观察组白细胞减少、中医症状积分均明显低于对照组(P<0.01);观察组的近期总有效率为86.27%,显著高于对照组66%(P<0.05)。观察组患者治疗后1周CD3+,CD4+均显著高于对照组,CD8+低于对照组(P<0.01)。观察组rh G-CSF使用量明显少于对照组。观察组治疗后1周血清中GM-CSF和G-CSF水平均明显高于对照组(P<0.01)。结论:四君子汤加味辅助用于中晚期肺癌化疗气阴两虚证患者,能改善骨髓抑制程度,降低骨髓抑制发生率,提高临床疗效,提高免疫功能和血清中GM-CSF和G-CSF水平可能是其疗效途径之一。
Objective: To investigate the efficacy of Sijunzi Tang on bone marrow suppression of lung cancer in chemotherapy with syndrome of deficiency of both Qi and Yin, and tpexplore its effect on serum granulocyte-macrophage colony-stimulating factor( GM-CSF) and granulocyte colony-stimulating factor( G-CSF).Method: One hundred and four cases of patients with advanced pulmonary carcinomas were randomly divided into observation group( 52 cases) and control group( 52 cases). The patients in control group were treated with chemotherapy regimen( TP). Based on the treatment in control group, the patients in observation group additionally received Sijunzi Tang from the first day of chemotherapy,bid,until 1 week after chemotherapy. Degree of bone marrow suppression,symptom score of traditional Chinese medicine( TCM),leukopenia,and recent clinical efficacy were compared in two between groups. Peripheral blood T-cell subsets CD3+,CD4+and CD8+changes were detected in both groups. Application amount of Recombinant Human Granulocyte Colony-stimulating Factor Injection( rh G-CSF) was recorded in both groups,and the levels of GM-CSF and G-CSF in serum were also detected in both groups. Result: One week after treatment,the counts of neutrophils,hemoglobin,platelets,and white blood cells in observation group were obviously higher than those in control group( P < 0. 01). The incidence of neutropenia and leukopenia was evidently lower than that in the control gorup( P < 0. 05). One week after treatment,TCM symptom scores and leukopenia scores were remarkably lower than those in control group( P <0. 01). Recent efficacy rate was 86. 27% in observation group,superior to 66% in control group( P < 0. 05).Observation group CD3+and CD4+in were obviously higher,while CD8+was lower than those of control group one week after treatment( P < 0. 01). Application amount of rh G-CSF in observation group was obviously less than that in control group( P < 0. 01),and the levels of GM-CSF and G-CSF in serum of observation group were evidently higher than those of control group one week after treatment( P < 0. 01). Conclusion: Adjuvant therapy of Sijunzi Tang in patients with chemotherapy for late lung cancer with syndrome of deficiency of both Qi and Yin can improve bone marrow suppression degree,reduce occurrence rate of bone marrow suppression,and increase efficacy.Improvement of immunity and up-regulation of GM-CSF and G-CSF levels in serum may be one of its curative pathways.
Objective: To investigate the efficacy of Sijunzi Tang on bone marrow suppression of lung cancer in chemotherapy with syndrome of deficiency of both Qi and Yin, and tpexplore its effect on serum granulocyte-macrophage colony-stimulating factor( GM-CSF) and granulocyte colony-stimulating factor( G-CSF).Method: One hundred and four cases of patients with advanced pulmonary carcinomas were randomly divided into observation group( 52 cases) and control group( 52 cases). The patients in control group were treated with chemotherapy regimen( TP). Based on the treatment in control group, the patients in observation group additionally received Sijunzi Tang from the first day of chemotherapy,bid,until 1 week after chemotherapy. Degree of bone marrow suppression,symptom score of traditional Chinese medicine( TCM),leukopenia,and recent clinical efficacy were compared in two between groups. Peripheral blood T-cell subsets CD3+,CD4+and CD8+changes were detected in both groups. Application amount of Recombinant Human Granulocyte Colony-stimulating Factor Injection( rh G-CSF) was recorded in both groups,and the levels of GM-CSF and G-CSF in serum were also detected in both groups. Result: One week after treatment,the counts of neutrophils,hemoglobin,platelets,and white blood cells in observation group were obviously higher than those in control group( P < 0. 01). The incidence of neutropenia and leukopenia was evidently lower than that in the control gorup( P < 0. 05). One week after treatment,TCM symptom scores and leukopenia scores were remarkably lower than those in control group( P <0. 01). Recent efficacy rate was 86. 27% in observation group,superior to 66% in control group( P < 0. 05).Observation group CD3+and CD4+in were obviously higher,while CD8+was lower than those of control group one week after treatment( P < 0. 01). Application amount of rh G-CSF in observation group was obviously less than that in control group( P < 0. 01),and the levels of GM-CSF and G-CSF in serum of observation group were evidently higher than those of control group one week after treatment( P < 0. 01). Conclusion: Adjuvant therapy of Sijunzi Tang in patients with chemotherapy for late lung cancer with syndrome of deficiency of both Qi and Yin can improve bone marrow suppression degree,reduce occurrence rate of bone marrow suppression,and increase efficacy.Improvement of immunity and up-regulation of GM-CSF and G-CSF levels in serum may be one of its curative pathways.
引文
[1]施子夏,张劲,张兵兵,等.艾迪注射液联合TP方案治疗非小细胞肺癌的临床观察[J].中国药房,2016,27(23):3234-3237.
[2]Lee L Y,Kuo T T.Hyaline globules in a nasopharyngeal carcinoma[J].Int J Surg Pathol,2013,21(1):44-46.
[3]赵炳芬.吉西他滨或长春瑞滨联合顺铂治疗国人非小细胞肺癌近期疗效与骨髓抑制的Meta分析[J].重庆医学,2016,45(29):4092-4094.
[4]王珏,魏澹宁,张卫平,等.龟鹿二仙胶巴布剂辅助治疗大肠癌患者化疗后骨髓抑制的临床观察[J].中国中西医结合杂志,2014,34(8):947-951.
[5]姚嵋方,李凤云,刘志,等.升血方剂对结直肠癌化疗患者免疫功能及骨髓抑制的影响[J].重庆医学,2016,45(27):3799-3801.
[6]魏光敏.四君子汤对气阴两虚型肺癌化疗的增效减毒[J].中国实验方剂学杂志,2013,19(5):312-316.
[7]常彦祥,孙利平,李斌.四君子汤对乳腺癌术后化疗副作用的影响[J].河南中医,2014,34(10):2050-2051.
[8]孙燕,石远凯.临床肿瘤内科手册[M].北京:人民卫生出版社,2007:401.
[9]中国抗癌协会.新编常见恶性肿瘤诊治规范.第9分册.原发性支气管肺癌[M].北京:中国协和医科大学出版社,1999:773.
[10]支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版)[J].中华肿瘤杂志,2015,37(1):67-78.
[11]周际昌.实用肿瘤内科学[M].2版.北京:人民卫生出版社,2003:29.
[12]顾芳红,张翔.三奇汤防治气阴两虚型非小细胞肺癌化疗后骨髓抑制的临床观察[J].上海中医药杂志,2017,51(5):39-41,
[13]刘嘉湘.中医药治疗肺癌研究思路和临床经验[J].世界中医药,2007,2(2):67-69.
[14]周华,孙红文,赵培珠,等.三阳血傣合剂辅助放化疗对头颈鳞癌患者骨髓抑制的影响[J].中国实验方剂学杂志,2015,21(21):173-176.
[15]杨国良,张学进,胡丹丹.肺积方联合化疗治疗气阴两虚证非小细胞肺癌患者的临床观察[J].中华中医药学刊,2011,29(3):663-666.
[16]李静,任小沧.香菇多糖联合化疗治疗肺癌的疗效及免疫功能影响[J].中华肿瘤防治杂志,2016,23(S1):98-99.
[17]汪波,丁德秭.四君子汤合沙参麦冬汤加减配合化疗治疗中晚期非小细胞肺癌临床观察[J].世界中西医结合杂志,2009,4(8):564-566.
[18]路玫,肖婷婷,曹大明,等.针灸对骨髓抑制模型小鼠血清造血生长因子等含量的影响[J].中国针灸,2015,35(3):264-268.
[19]Terazawa T,Goto M,Miyamoto T,et al.Efficacy of prophylactic G-CSF in patients receiving FOLFIRINOX:a preliminary retrospective rtudy[J].Intern Med,2015,54(23):2969-2973.
[2]Lee L Y,Kuo T T.Hyaline globules in a nasopharyngeal carcinoma[J].Int J Surg Pathol,2013,21(1):44-46.
[3]赵炳芬.吉西他滨或长春瑞滨联合顺铂治疗国人非小细胞肺癌近期疗效与骨髓抑制的Meta分析[J].重庆医学,2016,45(29):4092-4094.
[4]王珏,魏澹宁,张卫平,等.龟鹿二仙胶巴布剂辅助治疗大肠癌患者化疗后骨髓抑制的临床观察[J].中国中西医结合杂志,2014,34(8):947-951.
[5]姚嵋方,李凤云,刘志,等.升血方剂对结直肠癌化疗患者免疫功能及骨髓抑制的影响[J].重庆医学,2016,45(27):3799-3801.
[6]魏光敏.四君子汤对气阴两虚型肺癌化疗的增效减毒[J].中国实验方剂学杂志,2013,19(5):312-316.
[7]常彦祥,孙利平,李斌.四君子汤对乳腺癌术后化疗副作用的影响[J].河南中医,2014,34(10):2050-2051.
[8]孙燕,石远凯.临床肿瘤内科手册[M].北京:人民卫生出版社,2007:401.
[9]中国抗癌协会.新编常见恶性肿瘤诊治规范.第9分册.原发性支气管肺癌[M].北京:中国协和医科大学出版社,1999:773.
[10]支修益,石远凯,于金明.中国原发性肺癌诊疗规范(2015年版)[J].中华肿瘤杂志,2015,37(1):67-78.
[11]周际昌.实用肿瘤内科学[M].2版.北京:人民卫生出版社,2003:29.
[12]顾芳红,张翔.三奇汤防治气阴两虚型非小细胞肺癌化疗后骨髓抑制的临床观察[J].上海中医药杂志,2017,51(5):39-41,
[13]刘嘉湘.中医药治疗肺癌研究思路和临床经验[J].世界中医药,2007,2(2):67-69.
[14]周华,孙红文,赵培珠,等.三阳血傣合剂辅助放化疗对头颈鳞癌患者骨髓抑制的影响[J].中国实验方剂学杂志,2015,21(21):173-176.
[15]杨国良,张学进,胡丹丹.肺积方联合化疗治疗气阴两虚证非小细胞肺癌患者的临床观察[J].中华中医药学刊,2011,29(3):663-666.
[16]李静,任小沧.香菇多糖联合化疗治疗肺癌的疗效及免疫功能影响[J].中华肿瘤防治杂志,2016,23(S1):98-99.
[17]汪波,丁德秭.四君子汤合沙参麦冬汤加减配合化疗治疗中晚期非小细胞肺癌临床观察[J].世界中西医结合杂志,2009,4(8):564-566.
[18]路玫,肖婷婷,曹大明,等.针灸对骨髓抑制模型小鼠血清造血生长因子等含量的影响[J].中国针灸,2015,35(3):264-268.
[19]Terazawa T,Goto M,Miyamoto T,et al.Efficacy of prophylactic G-CSF in patients receiving FOLFIRINOX:a preliminary retrospective rtudy[J].Intern Med,2015,54(23):2969-2973.