健脾益肾方治疗晚期非小细胞肺癌相关性贫血的临床研究

发布时间：2018-03-24 09:05

  本文选题：肺癌　切入点：肿瘤相关性贫血　出处：《湖北中医药大学》2017年硕士论文

【摘要】：目的1.通过对388例住院肺癌病例进行回顾性分析,总结肺癌相关性贫血的发病情况及治疗现状,为临床治疗提供参考。2.观察健脾益肾方治疗晚期非小细胞肺癌(Non-Small Cell Lung Cancer,NSCLC)相关性贫血的临床疗效,为中西医结合治疗肿瘤相关性贫血提供依据。方法1.收集2015年1月至2015年12月在湖北省中医院肿瘤科住院的肺癌患者共388例,均经组织病理学确诊并有完整病历资料,统计患者住院期间肿瘤相关性贫血的发病情况、发病特点及贫血治疗情况。2.研究选取2016年1月至2016年9月在湖北省中医院肿瘤科就诊的晚期NSCLC合并轻、中度贫血的血虚型患者70例,利用随机数字表法分为治疗组(中西医结合组)和对照组(单纯西医组),每组各35例。两组患者一般情况及血红蛋白值(Hemoglobin,Hb)经统计学分析,差异无统计学意义(P0.05)。对照组采取补充铁剂、叶酸、维生素B12治疗(多糖铁复合物胶囊300 mg,每日1次口服;叶酸片10 mg,每日3次口服;维生素B12片25μg,每日3次口服)。治疗组在对照组基础上口服健脾益肾方,每日一剂,水煎至300ml,分两次温服,疗程6周。6周后观察两组治疗后血红蛋白值、卡氏评分(Karnofsky,KPS)、中医症状改善情况,并运用SPSS21.0统计学软件进行数据分析,得出结论。结果1.(1)388例住院肺癌患者肿瘤相关性贫血发生率为48.97%,贫血半数以上为轻度贫血142例(占74.14%),中度贫血42例(占22.11%),贫血细胞学分类以正常细胞性贫血(占47.37%)和小细胞低色素性贫血(占37.89%)多见。(2)男、女贫血发生率分别为53.96%、36.36%;≤65岁年龄段贫血发生率46.02%,65岁年龄段贫血发生率53.09%。小细胞肺癌贫血发生率50.00%,NSCLC贫血发生率48.85%;NSCLC中腺癌和鳞癌贫血发生率分别为42.57%、59.10%。单一治疗组患者贫血发生率42.50%,综合治疗组患者贫血发生率53.51%;中医干预组患者贫血发生率45.74%,非中医干预组患者贫血发生率57.55%。(3)从190例肺癌相关性贫血患者的治疗组成情况看,贫血治疗率为45.79%,采取输血治疗14例(7.37%),促红细胞生成素治疗5例(2.63%),补充铁剂等24例(12.63%),中药治疗44例(23.16%)。(4)单因素分析显示性别、病理类型、所采取治疗方法与贫血发生相关,年龄与贫血发生无关。2.(1)血红蛋白值:治疗组治疗后血红蛋白值为99.67±14.66g/L,与治疗前91.33±10.49 g/L相比,有统计学差异(P0.05);改善贫血疗效优于对照组,差异有统计学意义(P0.05)。(2)KPS评分:治疗组KPS评分治疗后高于治疗前,差异有统计学意义(P0.05);生活质量改善情况优于对照组,差异有统计学意义(P0.05)。(3)中医症状:治疗组中医症状显著改善率为74.29%,高于对照组的45.71%,差异有统计学意义(P0.05)。结论1.肺癌相关性贫血的发生率较高,抗肿瘤治疗会增加贫血的发生,男性、老年、鳞癌患者更易出现贫血。肺癌相关性贫血治疗率偏低,中医是重要治疗手段之一。2.健脾益肾方能有效提高晚期NSCLC合并轻、中度贫血血虚型患者的血红蛋白值,改善临床症状和生活质量。
[Abstract]:1. through the case in 388 patients with lung cancer were retrospectively analyzed. The incidence and treatment status summary lung cancer related anemia, provide reference for.2. observation of Jianpi Yishen Decoction in the treatment of advanced non-small cell lung cancer for clinical treatment (Non-Small Cell Lung Cancer, NSCLC) the clinical curative effect of related anemia, combine traditional Chinese and Western medicine in the treatment of cancer related anemia to provide the basis. Methods 1. from January 2015 to December 2015 in Hubei Provincial Traditional Chinese Medical Hospital Tumor Hospital of lung cancer patients with a total of 388 Cases were confirmed by histopathological diagnosis and complete medical records, the incidence of hospital statistics in patients with tumor related anemia,.2. study of pathogenesis and treatment of anemia from January 2016 to late September 2016 NSCLC in Hubei Provincial Traditional Chinese Medical Hospital oncology clinic with light, 70 of patients with moderate anemia patients were randomized into the treatment group ( The combination of TCM and Western Medicine) and control group (Western medicine group), 35 cases in each group. The two groups of patients with the general situation and the value of hemoglobin (Hemoglobin, Hb) by statistical analysis, the difference was not statistically significant (P0.05). The control group took iron supplements, folic acid, vitamin B12 in the treatment of oral Mg (Iron Polysaccharide Complex Capsules 300, 1 times; daily Folic Acid Tablets 10 mg 3 times a day, oral; vitamin B12 tablets 25 g, orally 3 times a day). The treatment group in the control group treated with Jianpi Yishen Decoction, one dose a day, decocted in water to 300ml, two clothes, 6 weeks after.6 weeks on hemoglobin values in two groups after treatment observation, Karnofsky score (Karnofsky, KPS), TCM symptoms, and the use of SPSS21.0 statistical software for data analysis, draw the conclusion. Results 1. (1) occurred in 48.97% of 388 patients with cancer-related anemia in patients with lung cancer, more than half the number of mild anemia anemia in 142 cases (74.14%), moderate and poor The blood of 42 cases (22.11%), anemia with normal cytology cell anemia (47.37%) and microcytic anemia (37.89%) found. (2) male, female incidence of anemia were 53.96%, 36.36%; less than 65 years of age the incidence of anemia in 46.02%, 65 years of age, poor the incidence rate of blood 53.09%. in small cell lung cancer incidence of anemia was 50%, the incidence of anemia in 48.85% NSCLC; NSCLC in adenocarcinoma and squamous cell carcinoma incidence of anemia was 42.57%, single 59.10%. anemia occurred in 42.50% patients in the treatment group, combined treatment group patients the incidence of anemia in 53.51% patients; the TCM group the incidence of anemia in 45.74% patients in the intervention group, the non Chinese medicine the incidence of anemia in 57.55%. (3) in the treatment of 190 cases of patients with lung cancer related anemia composition, anemia treatment rate was 45.79%, blood transfusion therapy in 14 cases (7.37%), erythropoietin treatment in 5 cases (2.63%), the iron supplement in 24 cases (12.63%), Chinese medicine treatment 44 Cases (23.16%). (4) single factor analysis showed that gender, pathological type, and take treatment for anemia associated with anemia, age has nothing to do with.2. (1) value of hemoglobin: after treatment, the hemoglobin value was 99.67 + 14.66g/L, compared with before treatment, 91.33 + 10.49 g/L, there were significant differences (P0.05); improve anemia effect is better than the control group, the difference was statistically significant (P0.05). (2) KPS score: the KPS score of the treatment group after treatment than before treatment, the difference was statistically significant (P0.05); to improve the quality of life is better than the control group, the difference was statistically significant (P0.05). (3): the treatment of TCM symptoms group of TCM symptoms significantly improved rate of 74.29%, higher than 45.71% in the control group, the difference was statistically significant (P0.05). Conclusion: 1. lung cancer related anemia and higher incidence of tumor treatment will increase the incidence of anemia, male, older, more prone to anemia. Patients with squamous cell carcinoma of lung cancer. The treatment rate of anemia is low. Chinese medicine is an important treatment..2. Jianpi Yishen Decoction can effectively improve the hemoglobin value of patients with advanced NSCLC and mild to moderate anemia and blood deficiency, and improve the clinical symptoms and quality of life.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R556

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