二苓苡仁汤联合XELOX方案化疗治疗肠癌术后脾虚湿热证的临床研究

发布时间：2018-04-04 18:48

本文选题：二苓苡仁汤　切入点：肠癌术后　出处：《南京中医药大学》2017年硕士论文

【摘要】：目的:评价二苓苡仁汤治疗大肠癌术后脾虚湿热证患者的临床疗效,探讨其可能的作用机制。方法:根据西医诊断依据和中医证候辨证标准,搜集40例脾虚湿热证的大肠腺癌术后患者,随机分为治疗组(中药+化疗)20例和对照组(单纯化疗)20例。两组均采用XELOX方案化疗,治疗组在化疗基础上给予二苓苡仁汤加减治疗,每3周为一个周期,连续观察4个周期,观察两组治疗前后临床症状、体力状况、生存质量、细胞免疫功能状态、血清肿瘤指标等的变化情况及化疗后不良反应,并进行统计学分析。结果:1.对中医症状的影响:治疗后,治疗组中医症状总积分低于对照组,差异有统计学意义(P0.05)。治疗组治疗前后"纳呆食少"、"口干口苦"、"腹痛"、"失眠多梦"、"面色萎黄"、"肢体困重"、"消瘦"症状积分比较,差异有统计学意义(P0.05);"脘腹胀满"、"疲倦乏力"、"气短懒言"、"大便干结"、"大便稀溏"症状积分治疗前后差异无统计学意义(P0.05)。对照组治疗后"腹痛"、"大便稀溏"、"消瘦"症状较治疗前比较,差异有统计学意义(P0.05)。治疗后治疗组对"纳呆食少"、"口干口苦"、"肢体困重"症状改善明显,与对照组比较差异有统计学意义(P0.05)。2.对生活质量评分的影响:KPS评分方面,治疗后,治疗组KPS评分明显高于对照组,差异有统计学意义(P0.05)。两组治疗前后比较,治疗组差异有统计学意义(P0.05),对照组差异无统计学意义(P0.05)。生存质量评分方面,治疗后,治疗组在生理状况、社会家庭状况、情感状况、功能状况、附加状况方面评分均明显高于对照组,有统计学差异(P0.05)。两组治疗前后比较,治疗组治疗后各评分高于治疗前,差异有统计学意义(P0.05),对照组除情感状况评分提高有统计学意义(P0.05),其余差异不明显(P0.05)。3.对细胞免疫功能的影响:治疗后,治疗组细胞免疫指标CD3、CD4、CD4/CD8均较前升高,CD8较前降低,对照组CD3、CD4、CD4/CD8均较前降低,CD8较前升高,治疗组免疫功能提高,对照组免疫功能降低。两组患者治疗后各细胞免疫指标差异有统计学意义(P0.05)。4.对血清肿瘤指标的影响:两组CEA、CA199治疗前后及组间对比,差异均无统计学意义(P0.05)。5.对化疗不良反应的影响:两组治疗后骨髓抑制、肝肾功能损伤、神经毒性组间比较,差异无统计学意义(P0.05),两组治疗后消化道反应恶心呕吐及腹泻组间比较,差异有统计学意义(P0.05)。结论:与单纯化疗相比,二苓苡仁汤联合化疗治疗肠癌术后脾虚湿热证患者,可在临床症状、体力状况、生存质量、细胞免疫功能等方面有明显改善作用,可减轻化疗所致消化道反应,在血清肿瘤指标、骨髓抑制、肝肾功能损害及神经毒性方面未见明显优势。
[Abstract]:Objective: to evaluate the clinical effect of Erling Yi Ren decoction on spleen deficiency and dampness heat syndrome after operation of colorectal cancer and to explore its possible mechanism.The changes of cellular immune function, serum tumor indexes and adverse reactions after chemotherapy were analyzed statistically.The result is 1: 1.Effect on TCM symptom: after treatment, the total score of TCM symptom in the treatment group was lower than that in the control group, and the difference was statistically significant (P 0.05).Before and after treatment, the scores of symptoms such as "less food intake", "dry mouth and bitter mouth", "abdominal pain", "insomnia and dreams", "yellow complexion", "body weight" and "wasting weight" were compared before and after treatment in the treatment group.The difference was statistically significant (P 0.05), but there was no significant difference between before and after treatment for symptoms of "abdominal distention", "fatigue and fatigue", "shortness of breath and lazy speech", "dry stool knot" and "loose stool" before and after treatment.The symptoms of "abdominal pain", "loose stools" and "emaciation" in the control group were significantly different from those before treatment (P 0.05).After treatment, the symptoms of "less food intake", "bitter mouth dry mouth" and "heavy limbs" in the treatment group were obviously improved, and the difference was statistically significant compared with that in the control group (P 0.05).The effect on the quality of life score: after treatment, the KPS score in the treatment group was significantly higher than that in the control group, and the difference was statistically significant (P 0.05).The difference between the two groups before and after treatment was statistically significant (P 0.05), while that in the control group was not significant (P 0.05).The scores of quality of life in the treatment group were significantly higher than those in the control group in terms of physiological status, social and family status, emotional status, functional status, and additional status after treatment, with statistical difference (P 0.05).Before and after treatment, the scores in the treatment group were higher than those before treatment, the difference was statistically significant (P 0.05). In the control group, there was no significant difference except for the improvement of the emotional status score (P 0.05), while the other differences were not significant (P 0.05).After treatment, there was a significant difference in the cellular immune indexes between the two groups (P 0.05, P < 0. 05, P 0. 05, P 0. 05).Effect on serum tumor index: there was no significant difference between the two groups before and after CEACA199 treatment.Effects of chemotherapy on adverse reactions: there was no significant difference in bone marrow suppression, liver and kidney function injury and neurotoxicity between the two groups after treatment, but there was significant difference between the two groups in digestive tract reaction, nausea, vomiting and diarrhea after treatment.Conclusion: compared with chemotherapy alone, Erling Yi Ren decoction combined with chemotherapy can improve the clinical symptoms, physical condition, quality of life and cellular immune function in patients with spleen deficiency and dampness heat syndrome after operation.It has no obvious advantage in serum tumor index, bone marrow suppression, liver and kidney function damage and neurotoxicity.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.3

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