加味甘麦大枣汤对老年恶性肿瘤抑郁患者免疫状态、抑郁及生活质量的影响

发布时间：2018-06-30 22:00

本文选题：疏肝养心法 + 恶性肿瘤　；参考：《中国老年学杂志》2017年06期

【摘要】：目的探讨甘麦大枣汤疏肝养心法对恶性肿瘤抑郁患者免疫状态、抑郁状态及生活质量的影响。方法选取老年恶性肿瘤抑郁患者100例,根据随机数字表法将患者随机分为对照组和观察组各50例,对照组予以常规治疗,观察组在对照组基础上予以服用中药加味甘麦大枣汤,测量治疗前后两组患者的血清免疫球蛋白(IgA、IgG、IgM)、T细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)、NK细胞等免疫指标,同时采用抑郁自评量表评分及汉密顿抑郁量表对患者的心理状态进行评价,采用癌症患者生活质量问卷(QLQ-C30)对患者的生活质量进行评价,并比较两组患者的近期疗效及不良反应等。结果治疗后,对照组IgA、IgG、IgM水平与治疗前比较明显降低(P0.05),观察组患者的IgA、IgG、IgM水平明显高于治疗前及对照组(均P0.05)。观察组患者的CD3~+细胞治疗后与治疗前比较,差异无统计学意义(P0.05);而对照组患者的CD3~+细胞治疗后水平明显低于治疗前(P0.05)。疗程结束后两组患者CD4~+指标均有所下降,其中以对照组更为明显(P0.05);与治疗前相比观察组CD8~+指标显著降低,而对照组指标则较治疗前有所升高(P0.05),治疗后两组对比差异显著(P0.05)。治疗前后CD4~+/CD8~+值两组并无显著差异(P0.05)。对照组的NK细胞绝对数水平与治疗前比较明显降低(P0.05),观察组患者的NK细胞绝对数水平明显高于治疗前及对照组(P0.05)。治疗后对照组的SDS、HAMD评分与治疗前比较明显升高(P0.05);而观察组患者对应的SDS与HAMD评分则有所降低,且与对照组相比亦显著偏低(均P0.05)。两组患者健康状况评分比较之下观察组显著优于对照组(P0.05);两组患者的功能量表各维度得分比较差异无统计学意义(P0.05);症状领域方面,观察组患者的恶心呕吐、乏力、纳差、便秘得分明显高于对照组(均P0.05);两组患者的呼吸困难、疼痛、失眠、腹泻、经济困难维度得分比较差异无统计学意义(P0.05)。观察组疾病控制率(DCR)为90.00%,明显高于对照组(80.00%,P0.05);观察组客观有效率(ORR)为58.00%,明显高于对照组(44.00%,P0.05)。结论在老年恶性肿瘤抑郁患者中应用加味甘麦大枣汤加减疏肝养心法能有效改善患者的抑郁症状,提高患者的免疫状态及生活质量。
[Abstract]:Objective to investigate the effect of Gan Mai Da zizzao Decoction on the immune state, depression and quality of life of the patients with malignant tumor depression. Methods 100 patients with malignant tumor and depression were selected and randomly divided into control group and 50 cases in the observation group according to the random digital table method. The control group was treated with routine treatment, and the observation group was based on the control group. Taking Chinese traditional Chinese medicine plus flavored jujube soup, the serum immunoglobulin (IgA, IgG, IgM), T cell subgroup (CD3~+, CD4~+, CD8~+, CD4~+/CD8~+) and NK cells were measured before and after treatment in two groups, and the psychological state of the patients was evaluated by the self rating depression scale and Hamilton Depression scale, and the patients were born with cancer. The living quality questionnaire (QLQ-C30) was used to evaluate the quality of life of the patients and to compare the short-term effect and adverse reaction of the two groups. Results after treatment, the level of IgA, IgG, IgM in the control group was significantly lower than that before treatment (P0.05). The level of IgA, IgG, IgM in the observation group was significantly higher than that before and in the control group (all P0.05). The CD3~+ of the patients in the observation group was CD3~+. Compared with before treatment, the difference was not statistically significant (P0.05), but the level of CD3~+ cells in the control group was significantly lower than that before treatment (P0.05). After the treatment, the CD4~+ indexes of the two groups were all decreased, and the control group was more obvious (P0.05). Compared with the control group, the CD8~+ index was significantly lower than the control group, and the control group was compared with the control group. The index was higher than that before treatment (P0.05), and there was significant difference between the two groups after treatment (P0.05). There was no significant difference between the two groups of CD4~+/CD8~+ values before and after treatment (P0.05). The absolute number of NK cells in the control group was significantly lower than that before the treatment (P0.05). The absolute number of NK cells in the observation group was significantly higher than that before the treatment and the control group (P0.05). After treatment, the SDS and HAMD scores in the control group were significantly higher than before the treatment (P0.05), while the corresponding SDS and HAMD scores in the observation group were significantly lower than those in the control group (P0.05). The two groups of patients were significantly better than the control group (P0.05) compared with the control group (P0.05); the scores of the functional scales in the two groups were scored. There was no statistically significant difference (P0.05), and the scores of nausea and vomiting, fatigue, nausea and constipation in the observation group were significantly higher than those in the control group (P0.05); the scores of dyspnea, pain, insomnia, diarrhea, and economic difficulties in the two groups were not statistically significant (P0.05). The rate of disease control (DCR) in the observation group was 90%. It was significantly higher than the control group (80%, P0.05), and the objective effective rate (ORR) of the observation group was 58%, which was significantly higher than that of the control group (44%, P0.05). Conclusion the added flavored jujube zizzao Decoction plus subtraction of liver and nourishing heart can effectively improve the depressive symptoms and improve the immune status and quality of life of the elderly patients with malignant tumor.
【作者单位】：辽宁中医药大学附属医院药剂科;深圳市蛇口人民医院;
【分类号】：R730.5;R749.4

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