健脾消癥汤对晚期胃癌生活质量影响的临床研究
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摘要
研究目的：研究和探讨健脾消癥汤联合化疗对晚期胃癌患者生活质量的干预作用,同时综合评价其对化疗副反应的控制及肿瘤标志物的影响。
研究方法：临床观察Ⅳ期胃癌40例,分为两组,试验组(健脾消癥汤联合DCF方案化疗)20例,对照组(单纯化疗)20例。进行生活质量评分及临床、实验室疗效比较。
研究结果：根据《欧洲癌症研究与治疗组织生命治疗核心量表第3版(QOL)》测评,试验组治疗后患者生活质量评分较对照组明显降低,经统计学分析,有显著性差异(P<0.05)；试验组治疗前后生活质量改善有效率为65%,显著高于对照组,差异有统计学意义(P<0.05)。试验组症状改善有效率70.00%,明显高于对照组,差异有统计学意义(P<0.05)。试验组出现Ⅰ度、Ⅱ度、Ⅲ度、Ⅵ度骨髓抑制的例数及骨髓抑制总发生率均低于对照组,差异有统计学意义(P<0.05)。治疗后两组ALT、TBil比较,试验组出现Ⅰ度、Ⅱ度、Ⅲ度肝功能损害的例数及肝损的总发生率均低于对照组,差异有统计学意义(P<0.05)。
研究结论：健脾消癥汤联合化疗能在一定程度上提高晚期胃癌患者生活质量,改善晚期胃癌患者临床症状,减轻部分化疗的毒副作用。
Objective:To evaluate the effect on quality of life(QOL) in advanced gastric cancer patients treated by Jian Pi Xiao Zheng Tang combined with DCF regimen. The side effects of chemotherapy and the tumor markers were also observed.
Methods:forty patients of advanced gastric cancer were randomly divided into two groups:test group (n=20) received Jian Pi Xiao Zheng Tang and chemotherapy, and control group (n=20) only accepted chemotherapy. The QOL were compared in two groups.
Result:After treatment, the QOL score of test group was significantly lower than that of control group, the difference has meaning in the statistics (P<0.05). The effective rate of the test group was 65.00%, which was significantly higher compared with the control group, the difference also has meaning in the statistics (P<0.05) In symptom improvement, the effective rate of the test group was 70.00%, significantly higher than that of the control group. The number of cases of appearing 'Ⅰ°,Ⅱ°,Ⅲ°,Ⅵ°bone marrow suppression and the overall incidence of bone marrow suppression in test group were lower than that in the control group, the difference has meaning in the statistics (P<0.05) By detecting ALT/TBil expression, in the two groups, the number of cases of appearingⅠ°,Ⅱ°,Ⅲ°,liver damage and overall incidence of liver damage in the test group were lower than that in the control group after treatment, the difference makes sense in the statistics(P<0.05).
Conclusion:Jian Pi Xiao Zheng Tang combined with chemotherapy is an effective method in treating advanced gastric cancer. It can improve the quality of life and alleviate the clinical symptoms, reduce the side effects of chemotherapy.
研究方法：临床观察Ⅳ期胃癌40例,分为两组,试验组(健脾消癥汤联合DCF方案化疗)20例,对照组(单纯化疗)20例。进行生活质量评分及临床、实验室疗效比较。
研究结果：根据《欧洲癌症研究与治疗组织生命治疗核心量表第3版(QOL)》测评,试验组治疗后患者生活质量评分较对照组明显降低,经统计学分析,有显著性差异(P<0.05)；试验组治疗前后生活质量改善有效率为65%,显著高于对照组,差异有统计学意义(P<0.05)。试验组症状改善有效率70.00%,明显高于对照组,差异有统计学意义(P<0.05)。试验组出现Ⅰ度、Ⅱ度、Ⅲ度、Ⅵ度骨髓抑制的例数及骨髓抑制总发生率均低于对照组,差异有统计学意义(P<0.05)。治疗后两组ALT、TBil比较,试验组出现Ⅰ度、Ⅱ度、Ⅲ度肝功能损害的例数及肝损的总发生率均低于对照组,差异有统计学意义(P<0.05)。
研究结论：健脾消癥汤联合化疗能在一定程度上提高晚期胃癌患者生活质量,改善晚期胃癌患者临床症状,减轻部分化疗的毒副作用。
Objective:To evaluate the effect on quality of life(QOL) in advanced gastric cancer patients treated by Jian Pi Xiao Zheng Tang combined with DCF regimen. The side effects of chemotherapy and the tumor markers were also observed.
Methods:forty patients of advanced gastric cancer were randomly divided into two groups:test group (n=20) received Jian Pi Xiao Zheng Tang and chemotherapy, and control group (n=20) only accepted chemotherapy. The QOL were compared in two groups.
Result:After treatment, the QOL score of test group was significantly lower than that of control group, the difference has meaning in the statistics (P<0.05). The effective rate of the test group was 65.00%, which was significantly higher compared with the control group, the difference also has meaning in the statistics (P<0.05) In symptom improvement, the effective rate of the test group was 70.00%, significantly higher than that of the control group. The number of cases of appearing 'Ⅰ°,Ⅱ°,Ⅲ°,Ⅵ°bone marrow suppression and the overall incidence of bone marrow suppression in test group were lower than that in the control group, the difference has meaning in the statistics (P<0.05) By detecting ALT/TBil expression, in the two groups, the number of cases of appearingⅠ°,Ⅱ°,Ⅲ°,liver damage and overall incidence of liver damage in the test group were lower than that in the control group after treatment, the difference makes sense in the statistics(P<0.05).
Conclusion:Jian Pi Xiao Zheng Tang combined with chemotherapy is an effective method in treating advanced gastric cancer. It can improve the quality of life and alleviate the clinical symptoms, reduce the side effects of chemotherapy.
引文
[1]林洪生,杨宇飞,胃癌中西医综合治疗[M].北京：人民卫生出版社,2002：1
[2]孙秀娣,牧人,周有尚,等.中国胃癌死亡率20年变化情况分析及其发展趋势预测[J].中华肿瘤杂志,2004,26(1)：4-9
[3]S SWohrer, M Raderer, M Hejna. Palliative Chemotherapy for advanced gastric cancer[J]. Ann Oncol, 2004,15(11):1585～1595.
[4]周岱翰.临床中医肿瘤学[M].北京：人民卫生出版社,2003：159-166.
[5]叔逵,龚新雷.晚期胃癌化疗的现状和新进展[J].临床肿瘤学杂志,2006,11(9)：641—-652.
[6]Correa D,A human model of gastric carcinogenesis,Cancer Res,1998,48:3554.
[7]金懋林,胃癌内科化学治疗的新进展.医学临床研究,2003,20(10)：735-738.
[8]CorreMe P, Fulfaro F, Marsilis, et al. Gemcitabine(GEM) plus oxaliplatin, folinie acid, and 5-fluorouracil(FOLFOX—4)in patients with advanced gastric cancer[J]. Cancer Chemother Pharmaeol,2005, 56(6):563.
[9]Barone C, Basso M, Schinzari G, et al. Doeetaxel and oxaliplatincombination in second-line treatment of pafient8 with advanced gastric cancer[J]. Gastric Cancer,2007,10(2):104.
[10]Park YH, Kim BS, Ryoo BY, et al. A phase Ⅱ study of cap—ecitabine plus 3-weekly oxaliplatin as first—line therapy for patients with advanced gastric cancer[J]. Br J Cancer,2006,94(7):959.
[11]何天良,赵凤萍,张海龙.胃癌围手术期死亡原因的探讨[J].河北中医,2009,31(11)：1719.
[12]钱心兰,钱伯文,钱力兰.攻补兼施治疗胃癌113例[J].上海中医药杂志,1996,(2)：7-9.
[13]邱佳信.健脾为主防治胃癌[J].医学信息(西安),1995,8(12)：554-555.
[14]赵智强,李嘉.略论周仲瑛教授的“癌毒”学说及其临床运用[J].新中医,1998,30(10)：6-8.
[15]陈四清.周仲瑛教授从癌毒辨治肿瘤经验[J].新中医,2004,36(2)：7-9.
[16]安祯祥.刘沈林论治肿瘤的临证经验[J].辽宁中医杂志,2006,33(8)：925-926.
[17]许尤琪.扶正活血.解毒方配合化疗治疗晚期胃癌临床疗效观察[J].河北中医,1999,21(6)：329-331.
[18]王润田,单保恩,李巧霞,等.黄芪提取物免疫调节活性的体外实验研究[J].中国中西医结合杂志,2002,22(6)：453456.
[19]彭轶霞,等.清瘀扶正汤对中晚期胃癌患者免疫功能的影响[J].辽宁中医杂志,2006,33,(11)：1495.
[20]代国平,杨艳霞.晚期胃癌的中西医姑息疗法[J].黑龙江中医药,2000,(5)：59.
[21]周留勇,等.六君子汤配伍藤察根治疗晚期胃癌107例[J].四川中医,2005,23(11)：4142
[22]Bai Chang-qing,Song Ying-fang,Wang De-tang,et al.Inhibitory effect of huangqi and dangshen extraction with pacilitaxel on metastasis and angiogenesis on mouse Lewis lung carcinoma model[J].Chin J Cell Mol Immunol,2008,24(4):375-377(In Chinese)
[23]Bai Chang-qing,Song Ying-fang,Wang De-tang,et al.Inhibitory effect of Astragalus and Codonopsis extraction endothelial cell migration induced by lung cancer cell[J].Medical Journal of the Chinese People's Armed Police Forces,2008,19(6):505-507(In Chinese)
[24]Bai Chang-qing,Di Xin-yu,Liu Guan-jian,et al.Effect of Astragalus and Codonopsis extraction on toxicity relief of chemotherapy for lung cancer and survival quality[J].Chinese Journal of Rehabilitation Medicine,2006,21 (8):707-709(In Chinese)
[25]Sun Yong-xu,Liu Ji-cheng.Structural characterization of a water-soluble polysaccharide from the roots of Codonopsis pilosula and its immunity activity[J].International Journal of Biological Macromolec-ules,2008,43,279-282
[26]Song Dan,Wang Zheng-tao,Li Long-yun,et al.Protective effect of lobetyolin on gastric mucosa of experimental gastric ulcer in rats[J]JTraditional Chinese Medicine&E,2008,17(7):963-964(In Chinese)
[27]熊元君,陈敏,李晓瑾,中世坤,木拉提.新疆党参多糖对MDA的影响.新疆中医药,2000,18(3)：13
[28]黄丽亚.党参、维生素C对氟哌啶醇诱导老化大鼠抗氧化酶表达作用的比较研究[J].陕西中医,2006,27(12)：1584-1586.
[29]黄丽亚,崔显念.党参与首乌等混合注射液上调抗氧化酶表达作用的实验研究[J].时珍国医国药,2006,17(11)：2195-2196.
[30]黄丽亚,叶嗣颖,刘杰书.党参与天麻对氟哌啶醇致老化大鼠抗氧化酶表达作用的比较研究[J].时珍国医国药,2006,17(9)：1687-1688.
[31]黄丽亚,叶嗣颖.党参注射液上调抗氧化酶表达作用的实验研究[J].中国老年学杂志,2006,26：70-71.
[32]王翕,刘玉瑛,史天良,等.白术挥发油抗实体瘤的作用研究[J].中国药物与临床,2002,2(4)：239—240.
[33]邱佳信,唐莱娣.健脾补肾中药对肿瘤成因多阶段学说中起始和启动的影响[J].中国医药学报,1993,8(5)：16—19.
[34]中华人民共和国药政管理局.现代实用本草[M].北京：人民卫生出版社,1997.248.
[35]王瑾,刘君炎,夏丰年,等.当归多糖促进瘤苗抗瘤作用初探[J].辽宁中医杂志,1999；26(1)：39-40.
[36]商彭,扬铁虹,贾敏,等.当归多糖APO对小鼠移植性肿瘤的抑制作用[J].第三军医大学学报,2001；23(11)：1299-1232.
[37]郑敏,王亚平.当归多糖对K562细胞增殖抑制与诱导分化的实验研究[J].中国中西医结合杂志,2002；22(1)：54-57.
[38]徐立春,孙振华,陈志琳,等.三棱,莪术提取物的肿瘤细胞疫苗的非特异性抗瘤实验,癌症,2001,20(12)：1380-1382.
[39]李侠,宋其林,陈炳卿,等.姜黄素抗诱变作用的实验研究[J].卫生研究,1998,27(4)：263.
[40]于冬青,邓华聪.姜黄素的药理研究进展[J].山东医药,2005,45(2)：72-73.
[41]施广霞,于丽华,刘金友,等.β-榄香烯抗肿瘤作用的实验研究Ⅰ：β-榄香烯体外对L615白血病细胞直接作用的实验研究[J].大连医学院学报,1994,16(2)：137.
[42]杨骅,王仙平,郁琳琳,等.榄香烯抗癌作用与诱发肿瘤细胞凋亡[J].中华肿瘤杂志,1996,18(3)：169.
[43]吴万垠,罗云坚,程剑华,等.莪术油对小鼠肝癌细胞DNA作用的图像分析[J].中西医结合肝病杂志,1999,9(1)：18.
[44]崔秀云,李德山.β-榄香烯对RNA聚合酶活性的抑制及与DNA的结合[J].中国药理学报,1991,7(3)：228.
[45]卜长武,王东荣,郭文来,等.莪术对小白鼠免疫功能的影响[J].中国中医药信息杂志,1997,4(2)：29.
[46]钱振超,王大庆,金成刚,等.瘤苗特异性主动免疫治疗及其机制的实验研究[J].肿瘤生物治疗杂志,1999,2(2)：125
[47]红,邓德宁,范茜.莪术醇及莪术醇磷酸酯单钠对Ehrlich腹水癌细胞电位和钾离子通道的影响[J].首都医学院学报,1989,10(1)：23
[48]王毅.甘草甜素对小鼠NK细胞杀伤活性的作用.中医研究,2006,4,19(4)：26-28.
[49]Kelloff GJ, Boone CW, Steele VE, et al. Mechanistic considerations in chemopreventive drug developmen[J]. J Cell Biochem Suppl,1994,20(1):1—24.
[50]Kelloff GJ, Boone CW, Steele VE, et al. Mechanistic considerations in chemopreventive drug development[J]. J Cell Biochem Suppl,1994,20(1):1—24
[51]王银坏,范钰,张尤历,张英平.18p一甘草次酸对人胃癌细胞BGC823增殖的抑制.江苏大学学报(医学版),2007,5,17,(3)：251-253
[2]孙秀娣,牧人,周有尚,等.中国胃癌死亡率20年变化情况分析及其发展趋势预测[J].中华肿瘤杂志,2004,26(1)：4-9
[3]S SWohrer, M Raderer, M Hejna. Palliative Chemotherapy for advanced gastric cancer[J]. Ann Oncol, 2004,15(11):1585～1595.
[4]周岱翰.临床中医肿瘤学[M].北京：人民卫生出版社,2003：159-166.
[5]叔逵,龚新雷.晚期胃癌化疗的现状和新进展[J].临床肿瘤学杂志,2006,11(9)：641—-652.
[6]Correa D,A human model of gastric carcinogenesis,Cancer Res,1998,48:3554.
[7]金懋林,胃癌内科化学治疗的新进展.医学临床研究,2003,20(10)：735-738.
[8]CorreMe P, Fulfaro F, Marsilis, et al. Gemcitabine(GEM) plus oxaliplatin, folinie acid, and 5-fluorouracil(FOLFOX—4)in patients with advanced gastric cancer[J]. Cancer Chemother Pharmaeol,2005, 56(6):563.
[9]Barone C, Basso M, Schinzari G, et al. Doeetaxel and oxaliplatincombination in second-line treatment of pafient8 with advanced gastric cancer[J]. Gastric Cancer,2007,10(2):104.
[10]Park YH, Kim BS, Ryoo BY, et al. A phase Ⅱ study of cap—ecitabine plus 3-weekly oxaliplatin as first—line therapy for patients with advanced gastric cancer[J]. Br J Cancer,2006,94(7):959.
[11]何天良,赵凤萍,张海龙.胃癌围手术期死亡原因的探讨[J].河北中医,2009,31(11)：1719.
[12]钱心兰,钱伯文,钱力兰.攻补兼施治疗胃癌113例[J].上海中医药杂志,1996,(2)：7-9.
[13]邱佳信.健脾为主防治胃癌[J].医学信息(西安),1995,8(12)：554-555.
[14]赵智强,李嘉.略论周仲瑛教授的“癌毒”学说及其临床运用[J].新中医,1998,30(10)：6-8.
[15]陈四清.周仲瑛教授从癌毒辨治肿瘤经验[J].新中医,2004,36(2)：7-9.
[16]安祯祥.刘沈林论治肿瘤的临证经验[J].辽宁中医杂志,2006,33(8)：925-926.
[17]许尤琪.扶正活血.解毒方配合化疗治疗晚期胃癌临床疗效观察[J].河北中医,1999,21(6)：329-331.
[18]王润田,单保恩,李巧霞,等.黄芪提取物免疫调节活性的体外实验研究[J].中国中西医结合杂志,2002,22(6)：453456.
[19]彭轶霞,等.清瘀扶正汤对中晚期胃癌患者免疫功能的影响[J].辽宁中医杂志,2006,33,(11)：1495.
[20]代国平,杨艳霞.晚期胃癌的中西医姑息疗法[J].黑龙江中医药,2000,(5)：59.
[21]周留勇,等.六君子汤配伍藤察根治疗晚期胃癌107例[J].四川中医,2005,23(11)：4142
[22]Bai Chang-qing,Song Ying-fang,Wang De-tang,et al.Inhibitory effect of huangqi and dangshen extraction with pacilitaxel on metastasis and angiogenesis on mouse Lewis lung carcinoma model[J].Chin J Cell Mol Immunol,2008,24(4):375-377(In Chinese)
[23]Bai Chang-qing,Song Ying-fang,Wang De-tang,et al.Inhibitory effect of Astragalus and Codonopsis extraction endothelial cell migration induced by lung cancer cell[J].Medical Journal of the Chinese People's Armed Police Forces,2008,19(6):505-507(In Chinese)
[24]Bai Chang-qing,Di Xin-yu,Liu Guan-jian,et al.Effect of Astragalus and Codonopsis extraction on toxicity relief of chemotherapy for lung cancer and survival quality[J].Chinese Journal of Rehabilitation Medicine,2006,21 (8):707-709(In Chinese)
[25]Sun Yong-xu,Liu Ji-cheng.Structural characterization of a water-soluble polysaccharide from the roots of Codonopsis pilosula and its immunity activity[J].International Journal of Biological Macromolec-ules,2008,43,279-282
[26]Song Dan,Wang Zheng-tao,Li Long-yun,et al.Protective effect of lobetyolin on gastric mucosa of experimental gastric ulcer in rats[J]JTraditional Chinese Medicine&E,2008,17(7):963-964(In Chinese)
[27]熊元君,陈敏,李晓瑾,中世坤,木拉提.新疆党参多糖对MDA的影响.新疆中医药,2000,18(3)：13
[28]黄丽亚.党参、维生素C对氟哌啶醇诱导老化大鼠抗氧化酶表达作用的比较研究[J].陕西中医,2006,27(12)：1584-1586.
[29]黄丽亚,崔显念.党参与首乌等混合注射液上调抗氧化酶表达作用的实验研究[J].时珍国医国药,2006,17(11)：2195-2196.
[30]黄丽亚,叶嗣颖,刘杰书.党参与天麻对氟哌啶醇致老化大鼠抗氧化酶表达作用的比较研究[J].时珍国医国药,2006,17(9)：1687-1688.
[31]黄丽亚,叶嗣颖.党参注射液上调抗氧化酶表达作用的实验研究[J].中国老年学杂志,2006,26：70-71.
[32]王翕,刘玉瑛,史天良,等.白术挥发油抗实体瘤的作用研究[J].中国药物与临床,2002,2(4)：239—240.
[33]邱佳信,唐莱娣.健脾补肾中药对肿瘤成因多阶段学说中起始和启动的影响[J].中国医药学报,1993,8(5)：16—19.
[34]中华人民共和国药政管理局.现代实用本草[M].北京：人民卫生出版社,1997.248.
[35]王瑾,刘君炎,夏丰年,等.当归多糖促进瘤苗抗瘤作用初探[J].辽宁中医杂志,1999；26(1)：39-40.
[36]商彭,扬铁虹,贾敏,等.当归多糖APO对小鼠移植性肿瘤的抑制作用[J].第三军医大学学报,2001；23(11)：1299-1232.
[37]郑敏,王亚平.当归多糖对K562细胞增殖抑制与诱导分化的实验研究[J].中国中西医结合杂志,2002；22(1)：54-57.
[38]徐立春,孙振华,陈志琳,等.三棱,莪术提取物的肿瘤细胞疫苗的非特异性抗瘤实验,癌症,2001,20(12)：1380-1382.
[39]李侠,宋其林,陈炳卿,等.姜黄素抗诱变作用的实验研究[J].卫生研究,1998,27(4)：263.
[40]于冬青,邓华聪.姜黄素的药理研究进展[J].山东医药,2005,45(2)：72-73.
[41]施广霞,于丽华,刘金友,等.β-榄香烯抗肿瘤作用的实验研究Ⅰ：β-榄香烯体外对L615白血病细胞直接作用的实验研究[J].大连医学院学报,1994,16(2)：137.
[42]杨骅,王仙平,郁琳琳,等.榄香烯抗癌作用与诱发肿瘤细胞凋亡[J].中华肿瘤杂志,1996,18(3)：169.
[43]吴万垠,罗云坚,程剑华,等.莪术油对小鼠肝癌细胞DNA作用的图像分析[J].中西医结合肝病杂志,1999,9(1)：18.
[44]崔秀云,李德山.β-榄香烯对RNA聚合酶活性的抑制及与DNA的结合[J].中国药理学报,1991,7(3)：228.
[45]卜长武,王东荣,郭文来,等.莪术对小白鼠免疫功能的影响[J].中国中医药信息杂志,1997,4(2)：29.
[46]钱振超,王大庆,金成刚,等.瘤苗特异性主动免疫治疗及其机制的实验研究[J].肿瘤生物治疗杂志,1999,2(2)：125
[47]红,邓德宁,范茜.莪术醇及莪术醇磷酸酯单钠对Ehrlich腹水癌细胞电位和钾离子通道的影响[J].首都医学院学报,1989,10(1)：23
[48]王毅.甘草甜素对小鼠NK细胞杀伤活性的作用.中医研究,2006,4,19(4)：26-28.
[49]Kelloff GJ, Boone CW, Steele VE, et al. Mechanistic considerations in chemopreventive drug developmen[J]. J Cell Biochem Suppl,1994,20(1):1—24.
[50]Kelloff GJ, Boone CW, Steele VE, et al. Mechanistic considerations in chemopreventive drug development[J]. J Cell Biochem Suppl,1994,20(1):1—24
[51]王银坏,范钰,张尤历,张英平.18p一甘草次酸对人胃癌细胞BGC823增殖的抑制.江苏大学学报(医学版),2007,5,17,(3)：251-253