升血调元颗粒在行同步放化疗白细胞减少的晚期食管癌患者中的应用价值分析
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摘要
背景在老年晚期食管癌患者进行同步放化疗的过程中,常出现骨髓抑制、免疫功能受损等毒副反应,影响治疗效果,也有许多患者因上述毒副反应而终止放化疗使得肿瘤无法控制.升血调元颗粒为中药合剂,在胃癌等肿瘤中能够减少患者化疗期间的不良反应,在食管癌患者中未见临床报道.目的观察升血调元颗粒在老年晚期食管癌同步放化疗白细胞减少患者中的应用价值分析.方法选择的研究对象2011-06/2016-06期间,衢州市中医医院收治的150例晚期老年食管癌的临床资料,均给予顺铂联合5-氟尿嘧啶(PDD 20 mg/m~2,d1-3,5-FU 500mg/m~2, d1-5,每28 d一个化疗周期,共2个化疗周期)同步放疗进行治疗,有60例白细胞减少患者,其中30例患者给予重组人粒细胞集落刺激因子进行治疗,作为对照组; 30例患者给予升血调元颗粒联合重组人粒细胞集落刺激因子进行治疗,将其作为观察组.然后将两组患者的白细胞恢复情况、免疫学相关指标等进行比较.结果经治疗后,观察组Ⅰ-Ⅳ度白细胞减少患者回升至正常的时间均低于对照组,差异有统计学意义(P<0.05);在治疗前,两组患者的白细胞介素(Interleukin,IL)-2、IL-12、分化集群(cluster of differentiation,CD)3~+、CD4~+、CD8~+、CD4~+/CD8~+比值水平无明显差异(P>0.05);在治疗后,观察组患者的IL-2、IL-12、C D3~+、CD4~+、CD4~+/CD8~+比值水平分别为68.19±7.31、70.68±7.56、46.05±4.35、33.56±3.36、1.85±0.91,明显高于对照组的57.82±6.91、50.22±5.58、39.76±3.35、26.09±2.21、0.96±0.86,差异均具有统计学意义(P<0.05);观察组患者的CD8~+为23.85±2.08,明显低于对照组的30.31±3.21,差异均具有统计学意义(P<0.05).结论在进行同步放化疗白细胞下降的晚期老年食管癌患者中,应用升血调元颗粒能够改善患者的免疫功能,促进白细胞恢复.
BACKGROUND In the process of concurrent chemoradiotherapy in elderly patients with advanced esophageal cancer, bone marrow suppression often occurs. Toxic side effects such as impaired immune function affect the therapeutic effect, and many patients discountinue the radiotherapy and chemotherapy due to the above-mentioned side effects, making the tumor uncontrollable. Shengxue Tiaoyuan granules is a traditional Chinese medicine mixture, which can reduce adverse reactions during chemotherapy in patients with gastric cancer and other tumors. However, there has been no clinical report in patients with esophageal cancer. AIM To observe the effect of Shengxue Tiaoyuan granules on the efficacy and side effects of patients with advanced esophageal cancer undergoing concurrent radiochemotherapy. METHODS One hundred and fifty patients with advanced esophageal carcinoma treated at Taizhou Hospital from June 2011 to June 2016 were initially selected. All of them were given cisplatin combined with 5-fluorouracil( P D D : 20 mg/m~2, d1-3, 5-FU : 500 mg/m~2, d1-5, one chemotherapy cycle for every 28 d, in total two chemotherapy cycles) and simultaneous radiotherapy. Among these patients, 60 having leukopenia were included in this study, including 30 treated with recombinant human granulocyte colony-stimulating factor(control group) and 30 treated with Shengxue Tiaoyuan granules combined with recombinant human granulocyte-colony stimulating factor(observation group). White blood cells and immunological indicators of the two groups of patients were compared. RESULTS After treatment, the time to recovery of white blood cells in patients with Ⅰ-Ⅳ leukopenia in the observation group was significantly shorter than that of the control group(P < 0.05). Before treatment, there was no significant difference in the levels of interleukin(IL)-2, IL-12, cluster of differentiation(CD) 3~+, CD4~+, CD8~+, and CD4~+/CD8~+(P > 0.05) between the two groups; after treatment, the values of IL-2, IL-12, CD3~+, CD4~+, and CD4~+/CD8~+ were significantly higher in the observation group than in the control group(68.19 ± 7.31 vs 57.82 ± 6.91, 70.68 ± 7.56 vs 50.22 ± 5.58, 46.05 ± 4.35 vs 39.76 ± 3.35, 33.56 ± 3.36 vs 26.09 ± 2.21, 1.85 ± 0.91 vs 0.96 ± 0.86; P < 0.05); the CD8~+ was significantly lower in the observation group than in the control group(23.85 ± 2.08 vs 30.31 ± 3.21, P < 0.05). The incidence of adverse reactions such as leukopenia, hemoglobin reduction, thrombocytopenia, gastrointestinal reaction, and radiation pneumonitis was significantly lower in the observation group than in the control group(P < 0.05).CONCLUSION In patients with advanced esophageal cancer with leukopenia due to concurrent radiochemotherapy, the application of Shengxue Tiaoyuan granules can improve the immune function and promote the recovery of white blood cells.
BACKGROUND In the process of concurrent chemoradiotherapy in elderly patients with advanced esophageal cancer, bone marrow suppression often occurs. Toxic side effects such as impaired immune function affect the therapeutic effect, and many patients discountinue the radiotherapy and chemotherapy due to the above-mentioned side effects, making the tumor uncontrollable. Shengxue Tiaoyuan granules is a traditional Chinese medicine mixture, which can reduce adverse reactions during chemotherapy in patients with gastric cancer and other tumors. However, there has been no clinical report in patients with esophageal cancer. AIM To observe the effect of Shengxue Tiaoyuan granules on the efficacy and side effects of patients with advanced esophageal cancer undergoing concurrent radiochemotherapy. METHODS One hundred and fifty patients with advanced esophageal carcinoma treated at Taizhou Hospital from June 2011 to June 2016 were initially selected. All of them were given cisplatin combined with 5-fluorouracil( P D D : 20 mg/m~2, d1-3, 5-FU : 500 mg/m~2, d1-5, one chemotherapy cycle for every 28 d, in total two chemotherapy cycles) and simultaneous radiotherapy. Among these patients, 60 having leukopenia were included in this study, including 30 treated with recombinant human granulocyte colony-stimulating factor(control group) and 30 treated with Shengxue Tiaoyuan granules combined with recombinant human granulocyte-colony stimulating factor(observation group). White blood cells and immunological indicators of the two groups of patients were compared. RESULTS After treatment, the time to recovery of white blood cells in patients with Ⅰ-Ⅳ leukopenia in the observation group was significantly shorter than that of the control group(P < 0.05). Before treatment, there was no significant difference in the levels of interleukin(IL)-2, IL-12, cluster of differentiation(CD) 3~+, CD4~+, CD8~+, and CD4~+/CD8~+(P > 0.05) between the two groups; after treatment, the values of IL-2, IL-12, CD3~+, CD4~+, and CD4~+/CD8~+ were significantly higher in the observation group than in the control group(68.19 ± 7.31 vs 57.82 ± 6.91, 70.68 ± 7.56 vs 50.22 ± 5.58, 46.05 ± 4.35 vs 39.76 ± 3.35, 33.56 ± 3.36 vs 26.09 ± 2.21, 1.85 ± 0.91 vs 0.96 ± 0.86; P < 0.05); the CD8~+ was significantly lower in the observation group than in the control group(23.85 ± 2.08 vs 30.31 ± 3.21, P < 0.05). The incidence of adverse reactions such as leukopenia, hemoglobin reduction, thrombocytopenia, gastrointestinal reaction, and radiation pneumonitis was significantly lower in the observation group than in the control group(P < 0.05).CONCLUSION In patients with advanced esophageal cancer with leukopenia due to concurrent radiochemotherapy, the application of Shengxue Tiaoyuan granules can improve the immune function and promote the recovery of white blood cells.
引文
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2赫捷,邵康.中国食管癌流行病学现状、诊疗现状及担任中华未来对策.中国癌症杂志2011;10:501-504[DOI:10.3969/j.issn.1007-3969.2011.07.001]
3王希龙.不同的放化疗方法治疗Ⅲ期食管癌患者的临床效果分析.实用癌症杂志2015;4:577-579[DOI:10.3969/j.issn.1001-5930.2015.04.034]
4谭立君,肖泽芬,张红星,陈东福,冯勤付,周宗玫,吕纪马,梁军,殷蔚伯.不能手术食管癌三维放疗与同期放化疗生存比较.中华放射肿瘤学杂志2015;24:106-110[DOI:10.3760/cma.j.issn.1004-4221.2015.02.002]
5王孟,郝长青,赵德利,李变云,王进武,雷复华,周瑞雪,马山蕊,马箐,李琰琰,冯昊,李新庆,魏文强.2005-2009年中国食管癌高发区河南省林州市、山东省肥城市食管癌及其癌前病变人群分布研究.中华预防医学杂志2015;8:677-682[DOI:10.3760/cma.j.issn.0253-9624.2015.08.003]
6凃桂红.顺铂联合氟尿嘧啶化疗同步放疗治疗食管癌患者不良反应的护理.中国实用护理杂志2012;28:56-57[DOI:10.3760/cma.j.issn.1672-7088.2012.08.070]
7贺宇彤,李道娟,梁迪,靳晶,温登瑰,陈万青,赫捷.2013年中国食管癌发病和死亡估计.中华肿瘤杂志2017;39:315-320[DOI:10.3760/cma.j.issn.0253-3766.2017.04.016]
8段晓峰,于振涛.食管癌新辅助放化疗联合手术与单纯手术治疗效果的随机对照试验Meta分析.中华胃肠外科杂志2017;20:809-815[DOI:10.3760/cma.j.issn.1671-0274.2017.07.020]
9左婷婷,郑荣寿,曾红梅,张思维,陈万青,赫捷.中国食管癌发病状况与趋势分析.中华肿瘤杂志2016;38:703-708[DOI:10.3760/cma.j.issn.0253-3766.2016.09.013]
10钟胜,吴清泉,王万伟,陶光州,彭进,朱卫国.Ⅱ/Ⅲ期食管癌术前放化疗的影像学评价对预后的影响.中华放射医学与防护杂志2015;35:270-273[DOI:10.3760/cma.j.issn.0254-5098.2015.04.008]
11周明镇,余元祥,郭竑,李东升.不同放疗剂量同期化疗治疗不能手术食管癌的临床分析.实用医学杂志2015;10:940-943[DOI:10.3969/j.issn.1006-5725.2015.06.024]
12李舰波,黄益波,郑志范.替吉奥和顺铂方案同步调强放疗治疗胸中上段及胸上段食管癌的临床研究.中国临床药理学杂志2015;3:175-177[DOI:10.13699/j.cnki.1001-6821.2015.03.005]
13李小军,冯春兰,罗海亮,陈东基.八珍汤辅助放化疗治疗中晚期食管癌45例临床观察.中医杂志2016;57:416-419[DOI:10.13288/j.11-2166/r.2016.05.014]
14任雪姣,王澜,韩春,丁博月,韩晶,尤杨.食管癌同期放化疗不同放疗剂量远期疗效分析.中华放射肿瘤学杂志2017;26:1006-1011[DOI:10.3760/cma.j.issn.1004-4221.2017.09.006]
15程刚,蒋祥德,张华鹏,杨培,刘华,顾康生.卡培他滨节拍化疗联合同期加量调强放疗治疗未手术食管癌54例临床观察.山东医药2017;57:87-89[DOI:10.3969/j.issn.1002-266X.2017.25.030]
16刘金平,尤传文,陆坤,朱青.三维适形放疗与同步化疗食管癌的效果及不良反应.实用癌症杂志2015;30:1656-1659[DOI:10.3969/j.issn.1001-5930.2015.11.021]
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