针刺治疗化疗药物引起周围神经病变的临床研究
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摘要
研究目的:①观察针刺治疗化疗药物引起周围神经病变的临床疗效。②探讨化疗药物引起周围神经病变的评估方法。
研究方法:将64例紫杉醇或奥沙利铂引起周围神经病变的患者随机分为针刺治疗组和药物对照组,每组各32例。针刺组以疏经通络、益气活血化瘀、补益肝肾、养血柔筋为治则进行临床研究,对照组采用腺苷钴胺肌注。根据WHO推荐的抗癌药物毒副反应的分度标准对患者进行神经毒性分度,以及化疗药物引起周围神经病变问卷中感觉和运动神经障碍的分级,比较两组治疗前后神经毒性的情况。采用SARS统计软件分析结果。
研究结果:
1.根据WHO推荐的抗癌药物毒副反应的分度标准对治疗前后患者进行神经毒性分度的结果,针刺组总有效率40%,对照组总有效率26.67%,两组治疗结果比较总有效率P=0.328(P>0.05),无统计学差异。
2.化疗药物引起周围神经病变问卷的结果,①治疗前后感觉神经障碍比较,针刺组总有效率66.67%,对照组总有效率40%,两组治疗结果比较总有效率P=0.047(P<0.05),有统计学差异。②针刺治疗紫杉醇引起感觉神经障碍的总有效率为88%,奥沙利铂的总有效率为39%。针刺治疗紫杉醇引起的感觉神经障碍有效的患者:3例患者为4级,4例患者为3级,8例患者为2级,无1级患者。③紫杉醇引起的感觉神经障碍较奥沙利铂严重,部分患者影响日常活动。④两组治疗前后运动神经障碍改善不明显,针刺组有效率为26.67%,对照组有效率为11.76%。
结论:化疗药物引起周围神经病变的问卷较WHO推荐的抗癌药物毒副反应的分度标准更能准确反应患者的神经毒性情况。针刺优于腺苷钴胺治疗化疗药物引起的感觉神经障碍。针刺治疗紫杉醇引起的感觉神经障碍较奥沙利铂的总有效率高。其中,针刺对于紫杉醇引起的中、重度感觉神经障碍疗效为佳,在今后的研究中可以深入探索针刺治疗紫杉醇引起的周围神经病变。针刺可以明显改善化疗药物引起的感觉神经障碍,但仍需进一步大样本量的长期研究,以进一步明确针刺治疗本病的疗效。
Objective:①observing the therapeutic effects of acupuncture on the treatment of chemotherapy-induced peripheral neuropathy.②investigating evaluation methods of CIPN.
Method: 64 cases of paclitaxel or oxaliplatin induced peripheral neuropathy were divided into treatment group (32 cases) and control group (32 cases). The principle of acupuncture group is dredging meridians, promoting blood circulation, removing blood stasis, supplementing kidney and liver,tonifying blood and moisting tendons. The control group was treated with intramuscular injection of Cobamamide. Referring to the World Health Organization Toxicity Criteria by Grade and CIPN Patient Questionnaire, the grading scores before and after treatment were recorded and made a comparison after two weeks. The result was analyzed by SARS software.
Results:
1. According to the World Health Organization Toxicity Criteria by Grade, the result shows that there is no difference between two groups P=0.328(P>0.05). The total effective rate of treatment group is 40%, and control group is 26.67%.
2.①According to the CIPN Patient Questionnaire, the result of sensory neuropathy shows that there is a difference between two groups P = 0.047(P<0.05). The total effective rate of treatment group is 66.67%, and control group is 40%.②The total effective rate of paclitaxel induced sensory neuropathy on the treatment of acupuncture is 88%, and and that of oxaliplatin is 39%. The effective patients who were induced by paxlitaxel with the treatment of acupuncture include 3 cases of grade 4, 4 cases of grade 3, 8 cases of grade 2, 0 case of grade 1.③The sensory neuropathy caused by paclitaxel is much severe than that caused by oxaliplatin. Part of the paclitaxel induced sensory neuropathy affects daily activities.④The motor neuropathy improvement of both two groups is not obvious. The total effective rate of treatment group is 26.67%, and control group is 11.76%.
Conclusion: The CIPN Patient Questionnaire is more accurate than World Health Organization Toxicity Criteria by Grade on the aspect of evaluating neurotoxicity. Acupuncture is more effective than Cobamamide on the treatment chemotherapy induced sensory neuropathy. The total effective rate of acupuncture on the treatment of paclitaxel induced sensory neuropathy is higher than that of oxaliplatin. Acupuncture is effective on the treatment of moderate and severe paclitaxel induced sensory neuropathy. Acupuncture can improve the symptom of chemotherapy induced sensory neuropathy. Further studies about paclitaxel induced peripheral neuropathy are expected. In future, there are more expections on larger population study in order to confirm the effect of acupuncture on the treatment of CIPN.
研究方法:将64例紫杉醇或奥沙利铂引起周围神经病变的患者随机分为针刺治疗组和药物对照组,每组各32例。针刺组以疏经通络、益气活血化瘀、补益肝肾、养血柔筋为治则进行临床研究,对照组采用腺苷钴胺肌注。根据WHO推荐的抗癌药物毒副反应的分度标准对患者进行神经毒性分度,以及化疗药物引起周围神经病变问卷中感觉和运动神经障碍的分级,比较两组治疗前后神经毒性的情况。采用SARS统计软件分析结果。
研究结果:
1.根据WHO推荐的抗癌药物毒副反应的分度标准对治疗前后患者进行神经毒性分度的结果,针刺组总有效率40%,对照组总有效率26.67%,两组治疗结果比较总有效率P=0.328(P>0.05),无统计学差异。
2.化疗药物引起周围神经病变问卷的结果,①治疗前后感觉神经障碍比较,针刺组总有效率66.67%,对照组总有效率40%,两组治疗结果比较总有效率P=0.047(P<0.05),有统计学差异。②针刺治疗紫杉醇引起感觉神经障碍的总有效率为88%,奥沙利铂的总有效率为39%。针刺治疗紫杉醇引起的感觉神经障碍有效的患者:3例患者为4级,4例患者为3级,8例患者为2级,无1级患者。③紫杉醇引起的感觉神经障碍较奥沙利铂严重,部分患者影响日常活动。④两组治疗前后运动神经障碍改善不明显,针刺组有效率为26.67%,对照组有效率为11.76%。
结论:化疗药物引起周围神经病变的问卷较WHO推荐的抗癌药物毒副反应的分度标准更能准确反应患者的神经毒性情况。针刺优于腺苷钴胺治疗化疗药物引起的感觉神经障碍。针刺治疗紫杉醇引起的感觉神经障碍较奥沙利铂的总有效率高。其中,针刺对于紫杉醇引起的中、重度感觉神经障碍疗效为佳,在今后的研究中可以深入探索针刺治疗紫杉醇引起的周围神经病变。针刺可以明显改善化疗药物引起的感觉神经障碍,但仍需进一步大样本量的长期研究,以进一步明确针刺治疗本病的疗效。
Objective:①observing the therapeutic effects of acupuncture on the treatment of chemotherapy-induced peripheral neuropathy.②investigating evaluation methods of CIPN.
Method: 64 cases of paclitaxel or oxaliplatin induced peripheral neuropathy were divided into treatment group (32 cases) and control group (32 cases). The principle of acupuncture group is dredging meridians, promoting blood circulation, removing blood stasis, supplementing kidney and liver,tonifying blood and moisting tendons. The control group was treated with intramuscular injection of Cobamamide. Referring to the World Health Organization Toxicity Criteria by Grade and CIPN Patient Questionnaire, the grading scores before and after treatment were recorded and made a comparison after two weeks. The result was analyzed by SARS software.
Results:
1. According to the World Health Organization Toxicity Criteria by Grade, the result shows that there is no difference between two groups P=0.328(P>0.05). The total effective rate of treatment group is 40%, and control group is 26.67%.
2.①According to the CIPN Patient Questionnaire, the result of sensory neuropathy shows that there is a difference between two groups P = 0.047(P<0.05). The total effective rate of treatment group is 66.67%, and control group is 40%.②The total effective rate of paclitaxel induced sensory neuropathy on the treatment of acupuncture is 88%, and and that of oxaliplatin is 39%. The effective patients who were induced by paxlitaxel with the treatment of acupuncture include 3 cases of grade 4, 4 cases of grade 3, 8 cases of grade 2, 0 case of grade 1.③The sensory neuropathy caused by paclitaxel is much severe than that caused by oxaliplatin. Part of the paclitaxel induced sensory neuropathy affects daily activities.④The motor neuropathy improvement of both two groups is not obvious. The total effective rate of treatment group is 26.67%, and control group is 11.76%.
Conclusion: The CIPN Patient Questionnaire is more accurate than World Health Organization Toxicity Criteria by Grade on the aspect of evaluating neurotoxicity. Acupuncture is more effective than Cobamamide on the treatment chemotherapy induced sensory neuropathy. The total effective rate of acupuncture on the treatment of paclitaxel induced sensory neuropathy is higher than that of oxaliplatin. Acupuncture is effective on the treatment of moderate and severe paclitaxel induced sensory neuropathy. Acupuncture can improve the symptom of chemotherapy induced sensory neuropathy. Further studies about paclitaxel induced peripheral neuropathy are expected. In future, there are more expections on larger population study in order to confirm the effect of acupuncture on the treatment of CIPN.
引文
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