大半夏汤治疗化疗呕吐的临床观察及其对家鸽胃Cajal间质细胞水平影响的实验研究
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摘要
目的：观察大半夏汤治疗化疗呕吐的疗效并探讨其止呕机理。
方法：①采用家鸽腹腔注射DDP法诱发呕吐模型,随机分为5组(DDP组、阳性胃复安对照组、大半夏汤高、中、低剂量组),每组10只,另选体重、月龄相当的10只家鸽作为空白对照组。治疗7天后,观察家鸽呕吐频率、呕吐物量及一般情况,用酶联免疫吸附试验(ELISA)法检测家鸽胃内组织Cajal间质细胞(ICC)的含量。②临床研究采用自身前后对照方法,观察大半夏汤治疗30例化疗呕吐患者,连续用药14天,对治疗前后患者的恶心、呕吐分级及身体一般状况Karuafsky积分进行统计分析,总结评定疗效。
结果：①大半夏汤对化疗致呕家鸽有较好的止呕作用。大半夏汤高、中、低剂量组、阳性胃复安对照组家鸽胃组织中Cajal间质细胞(ICC)的含量均较DDP组增加(P<0.05),且与剂量相关。②治疗前后患者恶心、呕吐症状比较均有统计学意义；大半夏汤改善患者身体一般状况有效率为83.3%；恶心呕吐症状完全缓解3例,部分缓解20例,总有效率为73.3%。
结论：大半夏汤对化疗呕吐有较好疗效,止呕的机制可能与升高胃内组织中Cajal间质细胞(ICC)水平、恢复胃起博区的ICC结构及功能有关。
Objective:To observe curative effect of DaBanXia Decoction(DBXD) in treating the chemotherapy-induced nausea and vomiting and explore the antiemetic mechanism.
Methods:1.Using the pigeon-induced vomiting model by Intraperitoneal injection of DDP were randomly divided into 5 groups:DDP group,positive control group high-dose of DBXD group,Middle -dose of DBXD group and Low-dose of DBXD group, each group had 10 pigeons.Another 10 weight and month considerable pigeons were selected as control group.The frequency of pigeons'vomiting, vomitus volume and the general situation,content of Cajal interstitial cells (ICC) in pigeon gastric tissue byenzyme- linked immunosorbent assay (ELISA) Detection were observed after 7 days treatment.2.30 chemotherapy-induced nausea and vomiting patients with DaBanXia Decoction treatment for 14 days were clinically observed.Patients with nausea, vomiting grading and general body condition Karuafsky points before and after treatment were statistical analysis, summarized assessment of efficacy.
Resaults:1.DaBanXia Decoction had a better antiemetic effect with pigeon that chemotherapy-induced nausea and vomiting. DaBanXia Decocti6n high, medium and low dose group and the positive control group content of ICC in pigeon gastric tissue increased and related with the dose,compared with DPP group, P< 0.05.2.Compared with nausea and vomiting symptoms in patients before and after reatmen were statistically significant. After the DaBanXia Decoction treatment general body condition improvement efficient was 83.3%;3 cases symptoms of nausea and vomiting were complete relieved and 20 cases symptoms of nausea and vomiting were partially relieved, total effective rate was 73.3%.
Conclusion:DaBanXia Decoction had better efficacy with chemotherapy-induced nausea and vomiting, the possible mechanism of antiemetic may be associated with increasing gastric tissue Cajal interstitial cells (ICC) level, restoring gastricpacemaker area of the structure and function of ICC.
方法：①采用家鸽腹腔注射DDP法诱发呕吐模型,随机分为5组(DDP组、阳性胃复安对照组、大半夏汤高、中、低剂量组),每组10只,另选体重、月龄相当的10只家鸽作为空白对照组。治疗7天后,观察家鸽呕吐频率、呕吐物量及一般情况,用酶联免疫吸附试验(ELISA)法检测家鸽胃内组织Cajal间质细胞(ICC)的含量。②临床研究采用自身前后对照方法,观察大半夏汤治疗30例化疗呕吐患者,连续用药14天,对治疗前后患者的恶心、呕吐分级及身体一般状况Karuafsky积分进行统计分析,总结评定疗效。
结果：①大半夏汤对化疗致呕家鸽有较好的止呕作用。大半夏汤高、中、低剂量组、阳性胃复安对照组家鸽胃组织中Cajal间质细胞(ICC)的含量均较DDP组增加(P<0.05),且与剂量相关。②治疗前后患者恶心、呕吐症状比较均有统计学意义；大半夏汤改善患者身体一般状况有效率为83.3%；恶心呕吐症状完全缓解3例,部分缓解20例,总有效率为73.3%。
结论：大半夏汤对化疗呕吐有较好疗效,止呕的机制可能与升高胃内组织中Cajal间质细胞(ICC)水平、恢复胃起博区的ICC结构及功能有关。
Objective:To observe curative effect of DaBanXia Decoction(DBXD) in treating the chemotherapy-induced nausea and vomiting and explore the antiemetic mechanism.
Methods:1.Using the pigeon-induced vomiting model by Intraperitoneal injection of DDP were randomly divided into 5 groups:DDP group,positive control group high-dose of DBXD group,Middle -dose of DBXD group and Low-dose of DBXD group, each group had 10 pigeons.Another 10 weight and month considerable pigeons were selected as control group.The frequency of pigeons'vomiting, vomitus volume and the general situation,content of Cajal interstitial cells (ICC) in pigeon gastric tissue byenzyme- linked immunosorbent assay (ELISA) Detection were observed after 7 days treatment.2.30 chemotherapy-induced nausea and vomiting patients with DaBanXia Decoction treatment for 14 days were clinically observed.Patients with nausea, vomiting grading and general body condition Karuafsky points before and after treatment were statistical analysis, summarized assessment of efficacy.
Resaults:1.DaBanXia Decoction had a better antiemetic effect with pigeon that chemotherapy-induced nausea and vomiting. DaBanXia Decocti6n high, medium and low dose group and the positive control group content of ICC in pigeon gastric tissue increased and related with the dose,compared with DPP group, P< 0.05.2.Compared with nausea and vomiting symptoms in patients before and after reatmen were statistically significant. After the DaBanXia Decoction treatment general body condition improvement efficient was 83.3%;3 cases symptoms of nausea and vomiting were complete relieved and 20 cases symptoms of nausea and vomiting were partially relieved, total effective rate was 73.3%.
Conclusion:DaBanXia Decoction had better efficacy with chemotherapy-induced nausea and vomiting, the possible mechanism of antiemetic may be associated with increasing gastric tissue Cajal interstitial cells (ICC) level, restoring gastricpacemaker area of the structure and function of ICC.
引文
【1】陶汉华.经方药量换算与考证[J].山东中医药大学学报,1997,21(4)：307-308.
【2】张再康,韩晓,白建乐,等.对顺铂所致家鸽化疗呕吐模型方法的改进[J].中国药理学通报,2002,18(5)：584-585.
【3】国家中医药管理局.中医病证诊断与疗效判定标准.【4】中华人民共和国卫生部.中国常见恶性肿瘤诊治规范.
[5]FlorczykA P,Sehuring J E,BtadnerWT.Cisplatin induced emesis in the ferret:A new animal model[J].Cancer Treat Rep,1982,66:187-189.
[6]TakodaN,HasegawaS,MoritaM,MatsunagaT.Picaintats is analogousto emesis:ananimal model in emesis research [J].Pharmacol Biochem Behav, 1993,45(4):817-821.
[7]Steven M,avl.J. Control of the motherapy induced emesis[G].N Eng. JMED,1993,329:1790-1795.
【8】霍美玲.化疗呕吐与治疗[J].国外医学,1994,2：90.
【9】何舒.化疗呕吐研究进展[J].宁夏医学杂志,2003,25(3)：186-189.
[10]Mitchelson F.phamacological agents affecting emesis Drugs 43 (3):295.
[11]Maylor RJ.Mmechanisms of chemotheraphy induced emesis in animal model[J],1996,53:Ssupp118R.
[12]Cubeddu Lx Mechanisms by which cancer chem other apentic drugs induce emesis.seminars in oncology.19(6supp115):2,1992:Dec.
【13】刘俊昌.肿瘤化疗对肾上腺皮质功能的影响[J].宁夏医学杂志,1994,21(4)：245.
[14]Valentine AD,Meyers CA,kling MA, et al.mood and cognitive side effect of interferon therapy[J].SeminOncol,1998,25(5):538.
[15]韩锐主编.肿瘤化学预防及药物治疗.第1版.北京：北京医科大学出版社,1994：283.
[16]陈泽莲,唐尧.治疗肿瘤化疗、放疗所致呕吐的临床应用评价[J].中国医院药学杂志,2000,20(6)：355-356.
[17]韩少良主编.癌症化学治疗的毒副反应及其处理.上海：复旦大学出版社,2001：122.
[18]aeki M,Sakai M,stito R,et al.Effects of HSP-117,a novel techykinin NK1 -teceptor antagonist,on cisplatin-incluced pica as a new evaluation of delayed emesis in rats[T].Tpn J Pharmacol,2001, 86:359.
[19]王忠武,陈志雄.肿瘤化疗中消化道反应呕吐的辨证治疗[J].中医药学刊,2004,22(8)：15-19.
[20]田卫卫,王庆苗.肿瘤化疗毒副反应从脾论治探讨[J].陕西中医,2001,22(1)：32.
[21】郝卫平,林艳翠.加味旋复代赭汤防治化疗呕吐[J].光明中医,2008,23(10)：1573.
[22]沈秀华.围化疗期消化道反应的中医药护理和预防[J].现代护理,2008,5(18)：130-131.
【23】孙本强,吴笛,严娜.等.中药治疗顺铂化疗口区吐反应临床研究[J].中华实用中西医杂志,2008,21(6)：508-508,510.
[24]郑鸿轩,王应新,靳亲文.扶正镇吐汤治疗化疗延缓性呕吐52例[J].中医研究,2008,21(1)：46-47.
[25]李鹰.耳穴压籽合止吐药防治化疗呕吐疗效观察[J].辽宁中医杂志,2008,35(2)：237-239.
[26]罗雪冰.益气养阴化浊汤改善乳腺癌患者化疗恶心呕吐证的临床观察[J].第四军医大学学报,2007,28(18)：1725-1725.
【27】刘小青,毛维国.肿瘤术后化疗期间呕吐的中药调治[J].中国中医急症,2006年,15(12)：1416-1417.
[28】柏玉举,石磊,肖冬英.等.半夏茯苓胶囊防治化疗所致呕吐38例[J].陕西中医,2006,27(10)：1224-1226.
[29]孙艳.中医分型辨治化疗期间呕吐[J].实用中医内科杂志,2006年,20(5)：489.
[30]杨舒瑾.中医辨证论冶对抗恶性肿瘤化疗后消化道毒副反应的临床观察[J].成都中医药大学学报,2003,26(4)：11.
[31]王忠武,陈志雄.肿瘤化疗中消化道反应呕吐的辨证治疗[J].中医药学刊.2004,22(8)：15-19.
[32]田卫卫,王庆苗.肿瘤化疗毒副反应从脾论治探讨[J].陕西中医,2001,22(1)：32.
[33]李仁廷.半夏泻心汤治疗肿瘤化疗引起消化道反应128例[J].四川中医,2003,21(1)：35.
[34]钟小溱,黄和平.中药治疗减轻消化道肿瘤化疗毒副反应45例观察与护理[J].时珍国医国药,2003,14(4)：25.
[35]王莹,李湘奇,孙国权.针刺防治肿瘤化疗中胃肠反应48例[J].中国民间疗法,2003,11(2)：14.
【36】龙萍,匡美玲.足三里穴位注射胃复安治疗化疗呕吐的临床观察与护理[J],当代护土,2004(2)：29
[37]胡定政.穴位注射对恶性肿瘤化疗的解毒作用[J].中国针灸2003.23(10)：587.
[38]吴国琳,余国友,李剑平.藿香正气软胶囊防治肠道肿瘤化疗后出现的毒副反应45例[J].中国中西医结合杂志,2004,24(3)：226.
【39】王鲁军,李明英,李大佑,等.健脾降逆口服液在恶性肿瘤化疗中的临床应用研究[J].齐鲁肿瘤杂志,2002,4(4)：289.
[40]姚祖培,陈建新,王亚非,等.呕宁方防治化疔呕吐反应及对肾上腺皮质功能的影响[J].湖北中医杂志,2001,21(11)：490.
[41]葛剑波.化疗病人呕吐的护理[J].现代医药卫生,2005,21(21)：2981.
[42]窦永起,冯宇,高丽萍.肿瘤化疗所致消化道病症的中医治疗[J].中华临床医学杂志,,2005,6(10]：51-52.
[43]范亚硕.针刺及穴位封闭治疗化疗所致的呕吐[J].中国社区医师：综合版,2005,7(6)：58-59.
[44]周晓军,郝传铮,姜秀芹,等.止呕神贴治疗恶性肿瘤化疗所致呕吐临床观察与实验研究[J].甘肃中医,2004,17(12)：4
【2】张再康,韩晓,白建乐,等.对顺铂所致家鸽化疗呕吐模型方法的改进[J].中国药理学通报,2002,18(5)：584-585.
【3】国家中医药管理局.中医病证诊断与疗效判定标准.【4】中华人民共和国卫生部.中国常见恶性肿瘤诊治规范.
[5]FlorczykA P,Sehuring J E,BtadnerWT.Cisplatin induced emesis in the ferret:A new animal model[J].Cancer Treat Rep,1982,66:187-189.
[6]TakodaN,HasegawaS,MoritaM,MatsunagaT.Picaintats is analogousto emesis:ananimal model in emesis research [J].Pharmacol Biochem Behav, 1993,45(4):817-821.
[7]Steven M,avl.J. Control of the motherapy induced emesis[G].N Eng. JMED,1993,329:1790-1795.
【8】霍美玲.化疗呕吐与治疗[J].国外医学,1994,2：90.
【9】何舒.化疗呕吐研究进展[J].宁夏医学杂志,2003,25(3)：186-189.
[10]Mitchelson F.phamacological agents affecting emesis Drugs 43 (3):295.
[11]Maylor RJ.Mmechanisms of chemotheraphy induced emesis in animal model[J],1996,53:Ssupp118R.
[12]Cubeddu Lx Mechanisms by which cancer chem other apentic drugs induce emesis.seminars in oncology.19(6supp115):2,1992:Dec.
【13】刘俊昌.肿瘤化疗对肾上腺皮质功能的影响[J].宁夏医学杂志,1994,21(4)：245.
[14]Valentine AD,Meyers CA,kling MA, et al.mood and cognitive side effect of interferon therapy[J].SeminOncol,1998,25(5):538.
[15]韩锐主编.肿瘤化学预防及药物治疗.第1版.北京：北京医科大学出版社,1994：283.
[16]陈泽莲,唐尧.治疗肿瘤化疗、放疗所致呕吐的临床应用评价[J].中国医院药学杂志,2000,20(6)：355-356.
[17]韩少良主编.癌症化学治疗的毒副反应及其处理.上海：复旦大学出版社,2001：122.
[18]aeki M,Sakai M,stito R,et al.Effects of HSP-117,a novel techykinin NK1 -teceptor antagonist,on cisplatin-incluced pica as a new evaluation of delayed emesis in rats[T].Tpn J Pharmacol,2001, 86:359.
[19]王忠武,陈志雄.肿瘤化疗中消化道反应呕吐的辨证治疗[J].中医药学刊,2004,22(8)：15-19.
[20]田卫卫,王庆苗.肿瘤化疗毒副反应从脾论治探讨[J].陕西中医,2001,22(1)：32.
[21】郝卫平,林艳翠.加味旋复代赭汤防治化疗呕吐[J].光明中医,2008,23(10)：1573.
[22]沈秀华.围化疗期消化道反应的中医药护理和预防[J].现代护理,2008,5(18)：130-131.
【23】孙本强,吴笛,严娜.等.中药治疗顺铂化疗口区吐反应临床研究[J].中华实用中西医杂志,2008,21(6)：508-508,510.
[24]郑鸿轩,王应新,靳亲文.扶正镇吐汤治疗化疗延缓性呕吐52例[J].中医研究,2008,21(1)：46-47.
[25]李鹰.耳穴压籽合止吐药防治化疗呕吐疗效观察[J].辽宁中医杂志,2008,35(2)：237-239.
[26]罗雪冰.益气养阴化浊汤改善乳腺癌患者化疗恶心呕吐证的临床观察[J].第四军医大学学报,2007,28(18)：1725-1725.
【27】刘小青,毛维国.肿瘤术后化疗期间呕吐的中药调治[J].中国中医急症,2006年,15(12)：1416-1417.
[28】柏玉举,石磊,肖冬英.等.半夏茯苓胶囊防治化疗所致呕吐38例[J].陕西中医,2006,27(10)：1224-1226.
[29]孙艳.中医分型辨治化疗期间呕吐[J].实用中医内科杂志,2006年,20(5)：489.
[30]杨舒瑾.中医辨证论冶对抗恶性肿瘤化疗后消化道毒副反应的临床观察[J].成都中医药大学学报,2003,26(4)：11.
[31]王忠武,陈志雄.肿瘤化疗中消化道反应呕吐的辨证治疗[J].中医药学刊.2004,22(8)：15-19.
[32]田卫卫,王庆苗.肿瘤化疗毒副反应从脾论治探讨[J].陕西中医,2001,22(1)：32.
[33]李仁廷.半夏泻心汤治疗肿瘤化疗引起消化道反应128例[J].四川中医,2003,21(1)：35.
[34]钟小溱,黄和平.中药治疗减轻消化道肿瘤化疗毒副反应45例观察与护理[J].时珍国医国药,2003,14(4)：25.
[35]王莹,李湘奇,孙国权.针刺防治肿瘤化疗中胃肠反应48例[J].中国民间疗法,2003,11(2)：14.
【36】龙萍,匡美玲.足三里穴位注射胃复安治疗化疗呕吐的临床观察与护理[J],当代护土,2004(2)：29
[37]胡定政.穴位注射对恶性肿瘤化疗的解毒作用[J].中国针灸2003.23(10)：587.
[38]吴国琳,余国友,李剑平.藿香正气软胶囊防治肠道肿瘤化疗后出现的毒副反应45例[J].中国中西医结合杂志,2004,24(3)：226.
【39】王鲁军,李明英,李大佑,等.健脾降逆口服液在恶性肿瘤化疗中的临床应用研究[J].齐鲁肿瘤杂志,2002,4(4)：289.
[40]姚祖培,陈建新,王亚非,等.呕宁方防治化疔呕吐反应及对肾上腺皮质功能的影响[J].湖北中医杂志,2001,21(11)：490.
[41]葛剑波.化疗病人呕吐的护理[J].现代医药卫生,2005,21(21)：2981.
[42]窦永起,冯宇,高丽萍.肿瘤化疗所致消化道病症的中医治疗[J].中华临床医学杂志,,2005,6(10]：51-52.
[43]范亚硕.针刺及穴位封闭治疗化疗所致的呕吐[J].中国社区医师：综合版,2005,7(6)：58-59.
[44]周晓军,郝传铮,姜秀芹,等.止呕神贴治疗恶性肿瘤化疗所致呕吐临床观察与实验研究[J].甘肃中医,2004,17(12)：4