养阴补肝汤结合TACE治疗原发性肝癌的临床研究

发布时间：2018-04-24 12:19

  本文选题：原发性肝癌 + 养阴补肝汤　； 参考：《河北医科大学》2017年硕士论文

【摘要】：目的:观察并对比养阴补肝汤联合TACE与单纯TACE治疗肝肾阴虚型原发性肝癌的临床疗效,评价临床受益及毒副反应,从而为养阴补肝汤在肝癌综合治疗中的应用提供指导意义,为临床肝癌的辨证论治提供新的思路。方法:选择2014年12月至2015年12月在石家庄市第五医院住院的80例肝肾阴虚型原发性肝癌患者。80例原发性肝癌患者均符合卫生部制定的原发性肝癌诊疗规范(2011年版)的诊断标准,随机分为两组:对照组40例、综合治疗组40例。对照组给予常规介入治疗,介入术后常规西医基础治疗。综合治疗组在对照组治疗方案基础上于TACE术后第3天开始服养阴补肝汤,每日1剂,分两次口服。两组患者均连续治疗4周为1个疗程,1个疗程后作疗效判定。观察两组患者治疗前后行为状态Karnofsky评分变化、实体瘤大小及TACE后毒副反应(恶心呕吐、胁痛、发热、肝损伤等)发生情况,比较两组临床获益情况。TACE前3天、TACE后1周分别查肝功能观察肝损伤情况,治疗结束后复查肝功能了解肝损伤情况;治疗前行CT或MRI评价肿瘤大小,治疗结束后行CT或MRI评价肿瘤大小。实验结果以x±s表示,用SPSS 13.0统计软件作单因素方差分析(One-Way ANOVA),取P0.05为有显著性意义。结果:综合治疗组与对照组80例患者,均完成4周治疗,可评价疗效及毒副反应。(1)实体瘤疗效:按照WHO实体瘤疗效评价标准,综合治疗组40例:完全缓解(CR):9例,部分缓解(PR):11例,稳定(SD):11例,进展(PD):9例,控制率:76%。对照组40例:完全缓解(CR):5例,部分缓解(PR):5例,稳定(SD):16例,进展(PD):14例,控制率:68%。两组控制率比较差异无统计学意义(P0.05)。(2)生活治疗改善情况:两组均治疗4周后评价生活质量改善情况,根据国家中医药管理局颁布的《中医病证诊断疗效标准》,治疗组40例:改善25例,稳定7例,恶化8例,有效率80.0%;对照组40例:改善10例,稳定11例,恶化19例,有效率52.5%。两组有效率比较差异无统计学意义(P0.05)。(3)毒副反应:采用WHO制定的抗肿瘤药物毒副反应分度标准,分为0-Ⅳ度。主要包括肝损害、骨髓抑制(WBC、HBC、PLT)、恶心呕吐、发热。其中肝损害及恶心呕吐IV度不良反应在治疗后未见发生,综合治疗组上述不良反应发生率分别为45.0%、25.0%、45.0%、52.5%,对照组上述不良反应发生率分别为50.0%、50.0%、75.0%、60.0%。两组肝损害及发热的发生率比较差异无统计学意义(P0.05);骨髓抑制及恶心呕吐的发生率比较,综合治疗组发生率低于对照组,且差异有统计学意义(P0.05)。结论:养阴补肝汤治疗肝肾阴虚型原发性肝癌具有显著的临床疗效,且在药物毒副反应,尤其是减轻TACE后骨髓抑制及恶心呕吐的发生上有较明显疗效,且由于其药物组成简单,药味少,价格低廉,临床疗效肯定等原因,更值得进一步研究及推广。
[Abstract]:Objective: to observe and compare the clinical efficacy of Yangyin Bugan decoction combined with TACE and TACE in the treatment of liver and kidney yin deficiency primary liver cancer, and to evaluate the clinical benefits and side effects, so as to provide guidance for the application of Yangyin Bugan decoction in the comprehensive treatment of liver cancer. To provide a new way for clinical liver cancer treatment based on syndrome differentiation. Methods: from December 2014 to December 2015, 80 patients with primary liver cancer with liver and kidney yin deficiency were selected from the Fifth Hospital of Shijiazhuang. All of them were in accordance with the diagnostic criteria of the criteria for diagnosis and treatment of primary liver cancer (2011 edition) formulated by the Ministry of Health. They were randomly divided into two groups: control group (n = 40) and comprehensive treatment group (n = 40). The control group was treated with routine interventional therapy and basic western medicine after interventional operation. Combined treatment group on the basis of the control group on the third day after TACE began to take Yangyin Bugan decoction, 1 dose per day, divided into two oral. The patients in both groups were treated continuously for 4 weeks as a course of treatment, and the curative effect was evaluated after one course of treatment. The changes of Karnofsky score, size of solid tumor and side effects (nausea and vomiting, hypochondriac pain, fever, liver injury, etc.) were observed before and after treatment in the two groups. The clinical benefit of the two groups was compared. 1 week before TACE, 1 week after TACE, the liver function was examined to observe the liver injury, and the liver function was reviewed to understand the liver injury after the treatment, and the tumor size was evaluated by CT or MRI before treatment. Tumor size was evaluated by CT or MRI after treatment. The results were expressed as x 卤s, and One-way ANOVAV was analyzed by SPSS 13.0 statistical software. Results: 80 patients in the combined treatment group and the control group were treated for 4 weeks, which could be used to evaluate the efficacy and toxicity of solid tumor. According to the evaluation standard of WHO solid tumor efficacy, 40 cases in the combined treatment group were as follows: 9 cases of complete remission, 11 cases of partial remission of WHO. There were 11 cases of SDU: 1, 9 cases of PDW, and 76% of control rate. In the control group, there were 5 cases of complete remission, 5 cases of partial remission, 16 cases of stabilization, 14 cases of progress and 14 cases of control. There was no significant difference in the control rate between the two groups (P 0.05). The improvement of life therapy was evaluated after 4 weeks of treatment in both groups, and the improvement of quality of life was evaluated after 4 weeks of treatment in both groups. According to the criteria for the diagnosis and treatment of TCM diseases and syndromes issued by the State Administration of traditional Chinese Medicine, the treatment group (40 cases) showed improvement in 25 cases, stable in 7 cases, deterioration in 8 cases, and effective rate in 80.0.The control group (40 cases) improved 10 cases, stabilized 11 cases, deteriorated 19 cases, and the effective rate was 52.5%. There was no significant difference in the effective rate between the two groups (P 0.05). The side effects were classified into 0-鈪，

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