健脾益肾法治疗化疗期间中晚期大肠癌癌因性疲乏的临床观察
发布时间：2018-08-17 13:40
【摘要】：背景：随着新药的开发和治疗手段的规范化,肿瘤相关性呕吐、疼痛等逐步得到了有效地处理,癌因性疲乏(the cancer-related fatigue,CRF)逐渐成为影响患者生存质量的最主要因素,它对患者生活及病情的康复都有不利影响,越来越多的医家开始关注并致力改善此病。CRF不同于传统意义的疾病概念,它在各种类型、各种年龄段的癌症患者的各个阶段普遍存在,甚至长期存在于无瘤幸存者中,却无客观指标以资诊断。它是一种复杂的、多维度个体性主观体验,不仅与肿瘤相关,与患者生理、精神、心理、社会文化背景等诸多方面均有相关,具有明显的个体差异性,其病因、病机复杂,所以治疗往往需要个体化和综合治疗的模式,现代医学缺乏有效的治疗药物和手段。而中医在治疗疾病时注重从整体出发,遵循辨证论治的原则,对疲乏症候群能更全面的把握及治疗,挖掘、整理中医药诊治CRF有重要的意义。目的：理论研究目的：通过搜索、整理古今文献中有关于CRF的论述,总结归纳相对应的中医病名、病因病机、诊断、治疗及调摄等内容。并从理论上探讨健脾益肾法治疗中晚期大肠癌CRF的意义与价值。临床研究目的：观察中晚期大肠癌患者CRF与生存质量、证候积分、卡氏评分、T淋巴细胞亚群、NK细胞、睾酮、甲状腺功能、皮质醇的相关性。观察健脾益肾法对研究对象疲乏、证候群、卡氏评分、体重、T淋巴细胞亚群、NK细胞、睾酮、甲状腺功能、皮质醇的影响,进一步探讨健脾益肾法治疗中晚期大肠癌患者CRF的疗效及机制。方法：理论研究方法：以“癌因性疲乏”为关键词,在《中国知网期刊全文数据库》搜索中西医关于CRF论治,再以中医相关病名为关键词,在《中华医典》搜索中医古籍中可能与癌因性疲乏的相关论述,归纳、总结CRF的中医病因、病机、治疗、调摄等内容。临床研究方法：选取2011年12月至2015年6月于广东省第二中医院住院及门诊就诊且符合纳入与排除标准的中晚期大肠癌合并CRF患者76例为研究对象。采用随机数字表法将其分为治疗组和对照组,各38例。两组患者均行FOLFOX6化疗,同时,治疗组患者全程辅助健脾益肾方。收集干预前生存质量评估量表、干预前后疲乏量表、症状积分量表,卡氏评分,抽取外周血检查干预前后T淋巴细胞亚群、NK细胞、睾酮、甲状腺功能、皮质醇。建立数据库,进行统计分析。统计方法：采用SPSS21.0软件包建立数据库,进行数据录入。所有计量资料以均值加减标准差(x±s)表示,两组间均值比较采用独立样本t/t’检验,干预前后自身对照均值比较,采用配对t检验；所有计数资料均以频数(f)和百分率或构成比(P)表示,无序分类资料采用Pearson卡方检验(x2),四格表资料采用Fisher确切概率法,小样本等级资料以平均秩次表示(R),进行两独立样本秩和Mann-Whitney U检验；两计量变量间相关性分析,采用Pearson相关系数(r)表示,对相关系数进行t检验,对健脾益肾法适合人群进行多重对应(最优尺度)分析。α=0.05.结果：理论研究结果：根据CRF特点及患者表现不同侧重,中医与之相对应的病名有“虚劳”、“百合病”、“脏躁”、“郁证”、“健忘”等。以上述病名搜索于《中华医典》,结果显示CRF的病因有先天不足、饮食失调、劳逸失常、情志内伤、病后失调、外感六淫等诸多因素,概而言之,不外先天、后天两端。病机为正虚邪恋,脏腑气血阴阳亏虚。治疗上包括扶正补虚、祛邪逐寇、疗程当长、杂合而治等原则和方法。临床研究结果：干预前研究结果：疲乏的总积分与生存质量量表中躯体功能、角色功能、认知功能、情绪功能、社会功能、总健康状况呈负相关(P0.05),而与疼痛、疲劳、失眠、食欲丧失、呈正相关(P0.05),与气促、恶心呕吐、便秘、腹泻、经济困难无显著相关性(P0.05)。行为、情感、感觉、认知各维度与生存质量各领域相关性与疲乏总分一致。疲乏总评分与男性睾酮呈负相关(P0.01),与女性睾酮无相关性。疲乏总评分与皮质醇呈负相关(P0.05)。疲乏总评分与CD4+、CD4+/CD8+呈负相关(P0.05),与CD8+呈正相关(P0.05),而与CD3+、NK无显著性相关(P0.05)。疲乏总评分与TSH呈正相关(P0.05),与FT3、FT4无显著性相关(P0.05)。疲乏评分与证候积分、卡氏评分呈正相关(P0.05)。疲乏疗效评价：与对照组比较,治疗组疲乏总评分、行为维度、感觉维度、认知维度显著降低(P0.05),情感维度无显著性差异(P0.05)；治疗组疲乏总评分差、行为维度差、认知维度差显著性降低(P0.05),情感维度差、感觉维度差无显著性差异(P0.05)。与干预前对比,治疗组疲乏总评分、行为维度、感觉维度、认知维度显著性降低(P0.01),情感维度无显著性差异(P0.05)；对照组疲乏总评分、行为维度、情感维度、感觉维度无显著性差异(P0.05),认知维度显著性升高(P0.05)。治疗组35例中显效2例、有效20例、无效13例,有效率62.86%；对照组中显效1例、有效6例、无效27例,有效率20.59%。治疗组疗效明显优于对照组(P0.05)。治疗组干预前轻度疲乏患者有6例,干预后增加到14例,中度疲乏患者由干预前23例减少到干预后的18例,干预前6例重度疲劳患者干预后减少到3例,干预后治疗组患者疲乏程度减轻；对照组干预前轻度疲乏患者有5例,干预后减少到2例,干预前中度疲乏患者22例,干预后仍为22例,干预前7例重度疲乏患者增加到干预后的10例,对照组干预后疲乏分级无显著性差异。两组对比,治疗组疲乏等级缓解明显优于对照组(P0.05)。证候疗效评价：与对照组对比,治疗组证候总分、神疲乏力、头晕目眩、耳鸣耳聋、形体消瘦、失眠、食少纳呆、腹胀、大便溏泄、便秘、腰酸、舌脉评分显著性降低(P0.05),恶心呕吐、腹痛、膝软无显著性差异(P0.05)；干预前后差值中证候总分、神疲乏力、头晕目眩、耳鸣耳聋、形体消瘦、失眠、食少纳呆、腹胀、大便溏泄、腰酸、舌脉积分显著性降低(P0.05),恶心呕吐、腹痛、便秘、膝软无显著性差异(P0.05)。与干预前对比,治疗组中证候总分、神疲乏力、头晕目眩、形体消瘦、失眠、食少纳呆、腹胀、腹痛、大便溏泄、便秘积分显著降低(P0.05),耳鸣耳聋、恶心呕吐、腰酸、膝软、舌脉无显著性差异(P0.05)；对照组中神疲乏力、耳鸣耳聋、腹痛、便秘、舌脉积分显著升高(P0.05),证候总分、头晕目眩、形体消瘦、失眠、食少纳呆、恶心呕吐、腹胀、大便溏泄、腰酸、膝软积分无显著性差异(P0.05)。生存状态疗效评价：与对照组对比,治疗组KPS评分有显著性增加(P0.01),干预前后KPS评分差无显著性变化(P0.05)；与干预前对比,治疗组无显著性差异(P0.05),对照组KPS评分显著性降低(P0.01)。平均体重变化评价：与对照组对比,治疗组体重无显著性差异(P0.05),干预前后体重差有显著性差异(P0.01),治疗组体重下降少；与干预前对比,治疗组体重增加(P0.01),对照组体重无明显变化(P0.05)。睾酮评价：与对照组对比,治疗组男、女睾酮浓度、浓度前后差均无显著性差异(P0.05)；与干预前对比,治疗组男、女均无显著性差异(P0.05);对照组男性睾酮浓度显著降低(P0.05),对照组女性无显著性差异(P0.05)。免疫功能评价：与对照组比较,治疗组CD3+、CD4+、NK显著升高(P0.05),CD8+、CD4+/CD8+无显著性差异；干预前后CD4+差值、NK差值有显著性差异(P0.05),CD3+差、CD8+差、CD4+/CD8+差无显著性差异(P0.05)。与干预前对比,治疗组CD3+、CD4+无显著性差异(P均0.05),CD8+显著下降、CD4+/CD8+显著升高、NK显著升高(P0.05)；对照组CD3+、CD8+、CD4+/CD8+、NK无显著性差异(P0.05),CD4+显著下降(P0.05)。皮质醇评价：与对照组对比,治疗组皮质醇浓度、浓度前后差无显著性差异(P0.05)。与干预前对比,治疗组无显著性差异(P0.05),对照组皮质醇浓度显著降低(P0.05))。结论：CRF从各方面影响中晚期大肠癌患者的生存质量,疼痛、疲劳、失眠、食欲丧失等不适症状导致中晚期大肠癌患者生存质量下降的同时,也使患者出现CRF。而气促、恶心呕吐、便秘、腹泻、经济困难等症状,或因出现频率少,或因对症治疗效果好,对CRF影响不大。患者证候积分越高,体力状态越低,疲乏越重。CRF与皮质醇分泌降低、甲状腺功能低下、免疫功能紊乱相关,在男性患者,CRF与低睾酮血症相关。健脾益肾法可缓解化疗期间中晚期大肠癌患者疲乏,主要对行为维度、感觉维度、认知维度有效,对情感维度无明显疗效。可缓解化疗患者整体症状,主要对神疲乏力、头晕目眩、耳鸣耳聋、形体消瘦、失眠、食少纳呆、腹胀、大便溏泄、便秘、腰酸、舌脉有效,对恶心呕吐、腹痛、膝软等症状无明显疗效。有改善化疗患者体力状态的作用。有增加化疗患者体重的作用。对男性患者化疗后睾酮损伤有保护作用。对化疗引起的甲状腺功能损伤有保护作用。有提高化疗患者免疫功能的作用。中晚期大肠癌患者脾肾亏虚多见,健脾益肾法对行FOLFOX6化疗的中晚期大肠癌患者癌因性疲乏、证候积分及生存状态的均有改善作用。其可能的机制与调节血清皮质醇、睾酮、免疫和甲状腺功能相关。在中晚期大肠癌患者癌因性疲乏治疗中健脾益肾法有主导性地位,但仍提倡综合治疗的模式。
[Abstract]:BACKGROUND: With the development of new drugs and the standardization of treatment methods, cancer-related vomiting and pain have been effectively treated. Cancer-related fatigue (CRF) has gradually become the most important factor affecting the quality of life of patients. It has a negative impact on the life of patients and the rehabilitation of the disease. More and more doctors are working on it. CRF is a complex, multi-dimensional, individualized subjective experience that is not only associated with cancer, but also with cancer. It is related to many aspects, such as physiology, spirit, psychology, social and cultural background of patients, and has obvious individual differences. Its etiology and pathogenesis are complex, so treatment often needs individualized and comprehensive treatment mode. Modern medicine lacks effective treatment drugs and means. The principle of treatment is of great significance to comprehensively grasp and treat fatigue syndrome, excavate and sort out the treatment and treatment of CRF by TCM. Objective: Theoretical research purposes: Through searching, sorting out the discussion about CRF in ancient and modern literature, summarizing the corresponding TCM disease name, etiology and pathogenesis, diagnosis, treatment and adjustment. Objective: To observe the correlation between CRF and quality of life, syndrome score, Karl's score, T lymphocyte subsets, NK cells, testosterone, thyroid function and cortisol in patients with advanced colorectal cancer. Objective:To explore the therapeutic effect and mechanism of invigorating spleen and tonifying kidney therapy on CRF in patients with advanced colorectal cancer.Methods: Theoretical research method: Using "cancer-related fatigue" as the key word, searching the Chinese and Western medicine on the treatment of CRF in the "China Knowledge Network Journal Full Text Database" in the "China Knowledge Network Journal Full Text Database". Then, with the name of TCM-related diseases as the key words, this paper searches the ancient books of TCM for the discussion of possible cancer-related fatigue, summarizes the TCM etiology, pathogenesis, treatment and intervention of CRF. 76 patients with CRF complicated with advanced colorectal cancer were divided into treatment group and control group by random number table method, 38 cases in each group. Tables, Karl's score, T lymphocyte subsets, NK cells, testosterone, thyroid function, cortisol before and after intervention were collected and analyzed statistically. Statistical methods: SPSS21.0 software package was used to establish a database for data entry. All measurement data were expressed as mean plus or minus standard deviation (x + s). The mean values between the two groups were compared. The independent sample t/t'test was used to compare the self-control mean before and after intervention, and the paired t-test was used to compare the self-control mean before and after intervention. Two independent sample rank and Mann-Whitney U test; correlation analysis between two measurement variables, using Pearson correlation coefficient (r) expression, correlation coefficient T test, multiple corresponding (optimal scale) analysis of the method for invigorating spleen and benefiting kidney for the population. The corresponding names of the diseases are "exhaustion", "lily disease", "dirty impetuosity", "depression syndrome", "forgetfulness" and so on. The above-mentioned names were searched in the "Chinese Medical Code". The results showed that the causes of CRF were congenital deficiency, eating disorders, maladjustment of work and rest, emotional internal injury, disorders after illness, six exogenous factors and so on. Clinical research results: Pre-intervention results: Total scores of fatigue and the physical function, role function, cognitive function, emotional function, social function, total health status in the quality of life scale were presented. Negative correlation (P 0.05), and pain, fatigue, insomnia, loss of appetite, was positively correlated (P 0.05), and shortness of breath, nausea and vomiting, constipation, diarrhea, economic difficulties were not significantly correlated (P 0.05). Behavior, emotion, sensation, cognitive dimensions and quality of life in all areas of correlation and fatigue total score was consistent. Total fatigue score was negatively correlated with cortisol (P 0.05). Total fatigue score was negatively correlated with CD4 +, CD4 + / CD8 +, and positively correlated with CD8 + (P 0.05), but not with CD3 +, NK (P 0.05). Total fatigue score was positively correlated with TSH (P 0.05), but not with FT3 and FT4 (P 0.05). There was a positive correlation between the scores (P 0.05). Fatigue efficacy evaluation: Compared with the control group, the total score, behavior dimension, sensory dimension and cognitive dimension of fatigue in the treatment group were significantly lower (P 0.05), but there was no significant difference in emotional dimension (P 0.05); the total score of fatigue in the treatment group was poor, behavior dimension was poor, cognitive dimension was significantly lower (P 0.05), emotional dimension was poor, and sensory dimension was significantly lower (P 0.05). There was no significant difference (P 0.05). Compared with pre-intervention, the total score of fatigue, behavioral dimension, sensory dimension and cognitive dimension decreased significantly (P 0.01), while the emotional dimension had no significant difference (P 0.05); the total score of fatigue, behavioral dimension, emotional dimension, sensory dimension had no significant difference (P 0.05) in the control group, and the cognitive dimension increased significantly (P 0.05). In the treatment group, 2 cases were markedly effective, 20 cases were effective, 13 cases were ineffective, the effective rate was 62.86%; in the control group, 1 case was markedly effective, 6 cases were effective, 27 cases were ineffective, the effective rate was 20.59%. In the control group, there were 5 patients with mild fatigue before intervention, 2 patients with mild fatigue after intervention, 22 patients with moderate fatigue before intervention, 22 patients with moderate fatigue after intervention, 10 patients with severe fatigue before intervention and 10 patients with dry control group. Compared with the control group, the total score of syndrome, fatigue, dizziness, tinnitus and deafness, body emaciation, insomnia, anorexia, abdominal distention, fecal discharge, constipation, lumbar acid, tongue and pulse scores decreased significantly in the treatment group. Low (P 0.05), nausea and vomiting, abdominal pain, knee weakness had no significant difference (P 0.05); before and after the intervention, the total score of syndromes, fatigue, dizziness, tinnitus and deafness, body emaciation, insomnia, anorexia, abdominal distention, fecal discharge, lumbar acid, tongue and pulse integral significantly decreased (P 0.05), nausea and vomiting, abdominal pain, constipation, knee weakness had no significant difference (P 0.05). The total score of syndromes, fatigue, dizziness, weight loss, insomnia, food intolerance, abdominal distention, abdominal pain, fecal discharge, constipation, tinnitus and deafness, nausea and vomiting, lumbar acid, knee weakness, tongue and pulse were significantly lower in the treatment group (P 0.05), but no significant difference was found in the control group (P 0.05). The total score of syndrome, dizziness, emaciation, insomnia, low intake of food, nausea and vomiting, abdominal distention, fecal discharge, lumbar acid, knee soft score had no significant difference (P Compared with the control group, there was no significant difference in body weight between the treatment group and the control group (P 0.05). The KPS score of the control group decreased significantly (P 0.01). The average weight change evaluation: Compared with the control group, there was no significant difference in body weight between the treatment group and the control group (P 0.05). Testosterone evaluation: Compared with the control group, there was no significant difference in the concentration of testosterone between the treatment group and the control group (P 0.05); compared with the pre-intervention, there was no significant difference in the concentration of testosterone between the treatment group and the control group (P 0.05); the concentration of testosterone in the control group decreased significantly (P 0.05), and there was no significant difference in the control group (P 0.05). (P 0.05). Immune function evaluation: Compared with the control group, CD3 +, CD4 +, NK increased significantly (P 0.05), CD8 +, CD4 + / CD8 + had no significant difference; before and after intervention, CD4 + difference, NK difference had significant difference (P 0.05), CD3 + difference, CD8 + difference, CD4 + / CD8 + difference had no significant difference (P 0.05). Cortisol evaluation: Compared with the control group, the cortisol concentration of the treatment group, before and after the difference was not significant (P 0.05). Compared with the control group, there was no significant difference in the treatment group (P 0.05). Conclusion: CRF affects the quality of life, pain, fatigue, insomnia, loss of appetite and other discomfort symptoms of patients with advanced colorectal cancer in various aspects, which leads to the decline of quality of life in patients with advanced colorectal cancer, at the same time, it also causes CRF in patients with shortness of breath, nausea and vomiting, constipation, diarrhea, economic difficulties and other symptoms. CRF is associated with decreased cortisol secretion, hypothyroidism, and immune dysfunction. In male patients, CRF is associated with hypotestosteronemia. Spleen-invigorating and kidney-nourishing therapy can alleviate the late stage of chemotherapy. Fatigue in patients with colorectal cancer is mainly effective in behavioral, sensory and cognitive dimensions, but has no obvious effect on emotional dimensions. It can relieve the overall symptoms of chemotherapy patients, mainly on mental fatigue, dizziness, tinnitus and deafness, body emaciation, insomnia, anorexia, abdominal distention, fecal discharge, constipation, lumbar acid, tongue and pulse effective, nausea and vomiting, abdominal pain, knee weakness, etc. It can improve the physical condition of patients with chemotherapy, increase the weight of patients with chemotherapy, protect the testosterone damage of male patients after chemotherapy, protect the thyroid function damage caused by chemotherapy, and improve the immune function of patients with chemotherapy. Spleen-tonifying kidney therapy can improve the cancer-related fatigue, syndrome scores and survival status of patients with advanced colorectal cancer undergoing FOLFOX6 chemotherapy. Its possible mechanism is related to the regulation of serum cortisol, testosterone, immunity and thyroid function. Advocate the mode of comprehensive treatment.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.34
本文编号：2187813
[Abstract]:BACKGROUND: With the development of new drugs and the standardization of treatment methods, cancer-related vomiting and pain have been effectively treated. Cancer-related fatigue (CRF) has gradually become the most important factor affecting the quality of life of patients. It has a negative impact on the life of patients and the rehabilitation of the disease. More and more doctors are working on it. CRF is a complex, multi-dimensional, individualized subjective experience that is not only associated with cancer, but also with cancer. It is related to many aspects, such as physiology, spirit, psychology, social and cultural background of patients, and has obvious individual differences. Its etiology and pathogenesis are complex, so treatment often needs individualized and comprehensive treatment mode. Modern medicine lacks effective treatment drugs and means. The principle of treatment is of great significance to comprehensively grasp and treat fatigue syndrome, excavate and sort out the treatment and treatment of CRF by TCM. Objective: Theoretical research purposes: Through searching, sorting out the discussion about CRF in ancient and modern literature, summarizing the corresponding TCM disease name, etiology and pathogenesis, diagnosis, treatment and adjustment. Objective: To observe the correlation between CRF and quality of life, syndrome score, Karl's score, T lymphocyte subsets, NK cells, testosterone, thyroid function and cortisol in patients with advanced colorectal cancer. Objective:To explore the therapeutic effect and mechanism of invigorating spleen and tonifying kidney therapy on CRF in patients with advanced colorectal cancer.Methods: Theoretical research method: Using "cancer-related fatigue" as the key word, searching the Chinese and Western medicine on the treatment of CRF in the "China Knowledge Network Journal Full Text Database" in the "China Knowledge Network Journal Full Text Database". Then, with the name of TCM-related diseases as the key words, this paper searches the ancient books of TCM for the discussion of possible cancer-related fatigue, summarizes the TCM etiology, pathogenesis, treatment and intervention of CRF. 76 patients with CRF complicated with advanced colorectal cancer were divided into treatment group and control group by random number table method, 38 cases in each group. Tables, Karl's score, T lymphocyte subsets, NK cells, testosterone, thyroid function, cortisol before and after intervention were collected and analyzed statistically. Statistical methods: SPSS21.0 software package was used to establish a database for data entry. All measurement data were expressed as mean plus or minus standard deviation (x + s). The mean values between the two groups were compared. The independent sample t/t'test was used to compare the self-control mean before and after intervention, and the paired t-test was used to compare the self-control mean before and after intervention. Two independent sample rank and Mann-Whitney U test; correlation analysis between two measurement variables, using Pearson correlation coefficient (r) expression, correlation coefficient T test, multiple corresponding (optimal scale) analysis of the method for invigorating spleen and benefiting kidney for the population. The corresponding names of the diseases are "exhaustion", "lily disease", "dirty impetuosity", "depression syndrome", "forgetfulness" and so on. The above-mentioned names were searched in the "Chinese Medical Code". The results showed that the causes of CRF were congenital deficiency, eating disorders, maladjustment of work and rest, emotional internal injury, disorders after illness, six exogenous factors and so on. Clinical research results: Pre-intervention results: Total scores of fatigue and the physical function, role function, cognitive function, emotional function, social function, total health status in the quality of life scale were presented. Negative correlation (P 0.05), and pain, fatigue, insomnia, loss of appetite, was positively correlated (P 0.05), and shortness of breath, nausea and vomiting, constipation, diarrhea, economic difficulties were not significantly correlated (P 0.05). Behavior, emotion, sensation, cognitive dimensions and quality of life in all areas of correlation and fatigue total score was consistent. Total fatigue score was negatively correlated with cortisol (P 0.05). Total fatigue score was negatively correlated with CD4 +, CD4 + / CD8 +, and positively correlated with CD8 + (P 0.05), but not with CD3 +, NK (P 0.05). Total fatigue score was positively correlated with TSH (P 0.05), but not with FT3 and FT4 (P 0.05). There was a positive correlation between the scores (P 0.05). Fatigue efficacy evaluation: Compared with the control group, the total score, behavior dimension, sensory dimension and cognitive dimension of fatigue in the treatment group were significantly lower (P 0.05), but there was no significant difference in emotional dimension (P 0.05); the total score of fatigue in the treatment group was poor, behavior dimension was poor, cognitive dimension was significantly lower (P 0.05), emotional dimension was poor, and sensory dimension was significantly lower (P 0.05). There was no significant difference (P 0.05). Compared with pre-intervention, the total score of fatigue, behavioral dimension, sensory dimension and cognitive dimension decreased significantly (P 0.01), while the emotional dimension had no significant difference (P 0.05); the total score of fatigue, behavioral dimension, emotional dimension, sensory dimension had no significant difference (P 0.05) in the control group, and the cognitive dimension increased significantly (P 0.05). In the treatment group, 2 cases were markedly effective, 20 cases were effective, 13 cases were ineffective, the effective rate was 62.86%; in the control group, 1 case was markedly effective, 6 cases were effective, 27 cases were ineffective, the effective rate was 20.59%. In the control group, there were 5 patients with mild fatigue before intervention, 2 patients with mild fatigue after intervention, 22 patients with moderate fatigue before intervention, 22 patients with moderate fatigue after intervention, 10 patients with severe fatigue before intervention and 10 patients with dry control group. Compared with the control group, the total score of syndrome, fatigue, dizziness, tinnitus and deafness, body emaciation, insomnia, anorexia, abdominal distention, fecal discharge, constipation, lumbar acid, tongue and pulse scores decreased significantly in the treatment group. Low (P 0.05), nausea and vomiting, abdominal pain, knee weakness had no significant difference (P 0.05); before and after the intervention, the total score of syndromes, fatigue, dizziness, tinnitus and deafness, body emaciation, insomnia, anorexia, abdominal distention, fecal discharge, lumbar acid, tongue and pulse integral significantly decreased (P 0.05), nausea and vomiting, abdominal pain, constipation, knee weakness had no significant difference (P 0.05). The total score of syndromes, fatigue, dizziness, weight loss, insomnia, food intolerance, abdominal distention, abdominal pain, fecal discharge, constipation, tinnitus and deafness, nausea and vomiting, lumbar acid, knee weakness, tongue and pulse were significantly lower in the treatment group (P 0.05), but no significant difference was found in the control group (P 0.05). The total score of syndrome, dizziness, emaciation, insomnia, low intake of food, nausea and vomiting, abdominal distention, fecal discharge, lumbar acid, knee soft score had no significant difference (P Compared with the control group, there was no significant difference in body weight between the treatment group and the control group (P 0.05). The KPS score of the control group decreased significantly (P 0.01). The average weight change evaluation: Compared with the control group, there was no significant difference in body weight between the treatment group and the control group (P 0.05). Testosterone evaluation: Compared with the control group, there was no significant difference in the concentration of testosterone between the treatment group and the control group (P 0.05); compared with the pre-intervention, there was no significant difference in the concentration of testosterone between the treatment group and the control group (P 0.05); the concentration of testosterone in the control group decreased significantly (P 0.05), and there was no significant difference in the control group (P 0.05). (P 0.05). Immune function evaluation: Compared with the control group, CD3 +, CD4 +, NK increased significantly (P 0.05), CD8 +, CD4 + / CD8 + had no significant difference; before and after intervention, CD4 + difference, NK difference had significant difference (P 0.05), CD3 + difference, CD8 + difference, CD4 + / CD8 + difference had no significant difference (P 0.05). Cortisol evaluation: Compared with the control group, the cortisol concentration of the treatment group, before and after the difference was not significant (P 0.05). Compared with the control group, there was no significant difference in the treatment group (P 0.05). Conclusion: CRF affects the quality of life, pain, fatigue, insomnia, loss of appetite and other discomfort symptoms of patients with advanced colorectal cancer in various aspects, which leads to the decline of quality of life in patients with advanced colorectal cancer, at the same time, it also causes CRF in patients with shortness of breath, nausea and vomiting, constipation, diarrhea, economic difficulties and other symptoms. CRF is associated with decreased cortisol secretion, hypothyroidism, and immune dysfunction. In male patients, CRF is associated with hypotestosteronemia. Spleen-invigorating and kidney-nourishing therapy can alleviate the late stage of chemotherapy. Fatigue in patients with colorectal cancer is mainly effective in behavioral, sensory and cognitive dimensions, but has no obvious effect on emotional dimensions. It can relieve the overall symptoms of chemotherapy patients, mainly on mental fatigue, dizziness, tinnitus and deafness, body emaciation, insomnia, anorexia, abdominal distention, fecal discharge, constipation, lumbar acid, tongue and pulse effective, nausea and vomiting, abdominal pain, knee weakness, etc. It can improve the physical condition of patients with chemotherapy, increase the weight of patients with chemotherapy, protect the testosterone damage of male patients after chemotherapy, protect the thyroid function damage caused by chemotherapy, and improve the immune function of patients with chemotherapy. Spleen-tonifying kidney therapy can improve the cancer-related fatigue, syndrome scores and survival status of patients with advanced colorectal cancer undergoing FOLFOX6 chemotherapy. Its possible mechanism is related to the regulation of serum cortisol, testosterone, immunity and thyroid function. Advocate the mode of comprehensive treatment.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.34
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