活血温阳通痹法治疗化疗致周围神经毒性临床观察
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摘要
目的:观察黄芪桂枝五物汤口服联合血府逐瘀汤定向透药的活血温阳通痹法治疗化疗致周围神经病变(CIPN)的疗效。方法:将符合纳入标准的58例患者随机分为对照组和治疗组,每组各29例。对照组患者给予甲钴胺注射液肌肉注射,治疗组患者在对照组治疗的基础上加用黄芪桂枝五物汤口服和血府逐瘀汤定向透药,观察周期为4周。评价两组患者的临床疗效,比较两组患者正中神经、腓肠神经的感觉神经传导速度(SCV)、运动神经传导速度(MCV)疗效。结果:治疗后,治疗组的临床总有效率为79.31%,对照组为51.85%,两组临床疗效比较,差异有统计学意义(P<0.05),治疗组的疗效优于对照组。治疗后,两组患者的正中神经、腓肠神经MCV、SCV疗效比较,差异均无统计学意义(P>0.05)。结论:活血温阳通痹法可在一定程度上改善CIPN,值得临床推广应用。
Objective: To observe the efficacy of therapy of activating blood, warming yang and dredging channel blockade(Huangqi Guizhi Wuwu Decoction oral administration combined with Xuefu Zhuyu Decoction directional penetration) in the treatment of chemotherapy-induced peripheral neuropathy(CIPN). Methods: Fifty-eight patients who met the inclusion criteria were randomly divided into the control group and treatment group, 29 cases in each group. The patients in the control group were treated with mecobalamin injection by intramuscular injection, and the patients in the treatment group were orally treated with Huangqi Guizhi Wuwu Decoction combined with Xuefu Zhuyu Decoction by directional penetration based on the treatment for the control group, with a course of 4 weeks. The clinical efficacy was evaluated, and the effects on the sensory nerve conduction velocity(SCV) and the motor nerve conduction velocity(MCV) of median nerve and sural nerve were compared between the two groups. Results: After treatment, the total clinical effective rates of the treatment group and the control group were 79.31% and 51.85% respectively, with a statistical difference between the two groups(P<0.05), and the efficacy of the treatment group was better than that of the control group. After treatment, there were no statistically significant differences in the effects on SCV and MCV of median nerve and sural nerve between the two groups(P>0.05). Conclusion: Therapy of activating blood, warming yang and dredging channel blockade can improve CIPN to a certain degree, which is worthy of promotion.
Objective: To observe the efficacy of therapy of activating blood, warming yang and dredging channel blockade(Huangqi Guizhi Wuwu Decoction oral administration combined with Xuefu Zhuyu Decoction directional penetration) in the treatment of chemotherapy-induced peripheral neuropathy(CIPN). Methods: Fifty-eight patients who met the inclusion criteria were randomly divided into the control group and treatment group, 29 cases in each group. The patients in the control group were treated with mecobalamin injection by intramuscular injection, and the patients in the treatment group were orally treated with Huangqi Guizhi Wuwu Decoction combined with Xuefu Zhuyu Decoction by directional penetration based on the treatment for the control group, with a course of 4 weeks. The clinical efficacy was evaluated, and the effects on the sensory nerve conduction velocity(SCV) and the motor nerve conduction velocity(MCV) of median nerve and sural nerve were compared between the two groups. Results: After treatment, the total clinical effective rates of the treatment group and the control group were 79.31% and 51.85% respectively, with a statistical difference between the two groups(P<0.05), and the efficacy of the treatment group was better than that of the control group. After treatment, there were no statistically significant differences in the effects on SCV and MCV of median nerve and sural nerve between the two groups(P>0.05). Conclusion: Therapy of activating blood, warming yang and dredging channel blockade can improve CIPN to a certain degree, which is worthy of promotion.
引文
[1] NOGUCHI Y,NISHIMURA R,KAWARA H,et al.Survey of current status of adverse ocular reactions to paclitaxel and a retrospective analysis for aiding in early detection of adverse reactions[J].Gan to Kagaku Ryoho,2013,40(6):819- 822.
[2] GRISOLD W,CAVALETTI G,WINDEBANK A J.Peripheral neuropathies from chemotherapeutics and targeted agents:diagnosis,treatment,and prevention[J].Neuro Oncol,2012,14 (Suppl 4):iv45- 54.
[3] National Cancer Institute.Common Terminology Criteria for Adverse Events v4.0 (CTCAE) [EB/OL].[2011/09/01].http:// www.calgb.org/ Public/ meetings/ presentations/ 2009/ summer_group/ cra_cont_ed/ 06a_CTCAE- Setser_062009.pdf.
[4] VELASCO R,BRUNA J.Chemotherapy-induced peripheral neuropathy:an unresolved issue[J].Neurologia,2010,25(2):116- 131.
[5] 吴江.神经病学[M].北京:人民卫生出版社,2005.
[6] MCDONALD E S,RANDON K R,KNIGHT A,et al.Cisplatin preferentially binds to DNA in dorsal root ganglion neurons in vitro and in vivo:a potential mechanism for neurotoxicity[J].Neurobiol Dis,2005,18(2):305- 313.
[7] MONTERO M,ALONSO M T,CARNICERO E,et al.Chromaffin- cell stimulation triggers fast millimolar mitochondrial Ca2+ transients that modulate secretion[J].Nat Cell Biol,2000,2(2):57- 61.
[8] ARGYRIOU A A,KYRITSIS A P,MAKATSORIS T,et al.Chemotherapy-induced peripheral neuropathy in adults:a comprehensive update of the literature[J].Cancer Manag Res,2014,6:135- 147.
[9] 马伊磊,叶伟成,周荣耀,等.黄芪桂枝五物汤对奥沙利铂周围神经毒性大鼠病理形态的影响[J].中医杂志,2011,52(S1):173- 174.
[10] 徐先容.黄芪桂枝五物汤加减对卵巢癌TP方案化疗引起神经毒性的防治效果[J].陕西中医,2016,37 (4):396- 397.
[11] 王永辉,李艳彦,周然,等.黄芪桂枝五物汤对实验性冻疮大鼠血液流变性的影响[J].中国实验方剂学杂志,2010,16(6):231- 233.
[12] 王浩,朱莹杰.中医药防治奥沙利铂所致周围神经毒性研究进展[J].解放军医药杂志,2015,7(4):76- 80.
[13] 王媛媛,邓博,段锦龙,等.温经通络散外用对奥沙利铂周围神经毒性大鼠神经保护作用的研究[J].中华中医药杂志,2015,30(8):2917- 2920.
[14] 王伟英,李海金,葛丽娜,等.活血化瘀汤口服联合中药熏洗预防奥沙利铂所致周围神经毒性的临床观察[J].浙江临床医学,2016,18(12):2286- 2287.
[15] 李凤姣,王珊.补阳还五汤和弥可保联合中药熏蒸防治化疗后周围神经病变的临床观察及护理[J].湖南中医药大学学报,2013,33(2):41- 42.
[16] 谭亦波.血府逐瘀汤结合辨证护理治疗糖尿病神经病变(瘀血阻滞证)的疗效观察[J].中国医药指南,2013,11(5):337- 339.
[2] GRISOLD W,CAVALETTI G,WINDEBANK A J.Peripheral neuropathies from chemotherapeutics and targeted agents:diagnosis,treatment,and prevention[J].Neuro Oncol,2012,14 (Suppl 4):iv45- 54.
[3] National Cancer Institute.Common Terminology Criteria for Adverse Events v4.0 (CTCAE) [EB/OL].[2011/09/01].http:// www.calgb.org/ Public/ meetings/ presentations/ 2009/ summer_group/ cra_cont_ed/ 06a_CTCAE- Setser_062009.pdf.
[4] VELASCO R,BRUNA J.Chemotherapy-induced peripheral neuropathy:an unresolved issue[J].Neurologia,2010,25(2):116- 131.
[5] 吴江.神经病学[M].北京:人民卫生出版社,2005.
[6] MCDONALD E S,RANDON K R,KNIGHT A,et al.Cisplatin preferentially binds to DNA in dorsal root ganglion neurons in vitro and in vivo:a potential mechanism for neurotoxicity[J].Neurobiol Dis,2005,18(2):305- 313.
[7] MONTERO M,ALONSO M T,CARNICERO E,et al.Chromaffin- cell stimulation triggers fast millimolar mitochondrial Ca2+ transients that modulate secretion[J].Nat Cell Biol,2000,2(2):57- 61.
[8] ARGYRIOU A A,KYRITSIS A P,MAKATSORIS T,et al.Chemotherapy-induced peripheral neuropathy in adults:a comprehensive update of the literature[J].Cancer Manag Res,2014,6:135- 147.
[9] 马伊磊,叶伟成,周荣耀,等.黄芪桂枝五物汤对奥沙利铂周围神经毒性大鼠病理形态的影响[J].中医杂志,2011,52(S1):173- 174.
[10] 徐先容.黄芪桂枝五物汤加减对卵巢癌TP方案化疗引起神经毒性的防治效果[J].陕西中医,2016,37 (4):396- 397.
[11] 王永辉,李艳彦,周然,等.黄芪桂枝五物汤对实验性冻疮大鼠血液流变性的影响[J].中国实验方剂学杂志,2010,16(6):231- 233.
[12] 王浩,朱莹杰.中医药防治奥沙利铂所致周围神经毒性研究进展[J].解放军医药杂志,2015,7(4):76- 80.
[13] 王媛媛,邓博,段锦龙,等.温经通络散外用对奥沙利铂周围神经毒性大鼠神经保护作用的研究[J].中华中医药杂志,2015,30(8):2917- 2920.
[14] 王伟英,李海金,葛丽娜,等.活血化瘀汤口服联合中药熏洗预防奥沙利铂所致周围神经毒性的临床观察[J].浙江临床医学,2016,18(12):2286- 2287.
[15] 李凤姣,王珊.补阳还五汤和弥可保联合中药熏蒸防治化疗后周围神经病变的临床观察及护理[J].湖南中医药大学学报,2013,33(2):41- 42.
[16] 谭亦波.血府逐瘀汤结合辨证护理治疗糖尿病神经病变(瘀血阻滞证)的疗效观察[J].中国医药指南,2013,11(5):337- 339.