柴胡疏肝散合归脾汤治疗肿瘤化疗相关抑郁临床研究
发布时间：2018-11-05 10:18
【摘要】：目的:评价柴胡疏肝散合归脾汤治疗肿瘤化疗相关抑郁临床疗效及对患者的生活质量、骨髓功能及免疫功能的影响。方法:1患者来源:所选病例均为2015年05月至2016年9月在中国人民解放军第251医院行首次化疗,经组织病理学明确诊断为乳腺癌、肺癌住院患者。共观察293例经2个周期化疗患者,符合入组126例患者,随机分为黛力新对照组及柴胡疏肝散合归脾汤治疗组。123例患者进入统计处理分析,对照组60例,治疗组61例。2临床资料:本研究采用随机对照,以汉密尔顿抑郁量表24条目(HAMD-24)、生活质量评定量表(QLQ-C30)、骨髓功能、IL-6、IGF-1、CD4+/CD8+、Treg T/CD4+T值为观察指标。全部入组病例分别在第3、4、5化疗周期前1天进行HAMD24量表评分及生活质量量表评分,检测外周血CD4+/CD8+值、Treg T/CD4+T值和血清中白介素-6(IL-6)、胰岛素样生长因子-1(IGF-1)含量及治疗前后血常规。3采用SPSS 20.0软件对结果进行统计学分析。结果:1对照组、治疗组HAMD24评分治疗后与治疗前相比差异均有统计学意义(P0.001),治疗组1个疗程与2个疗程后比较差异有统计学意义(P=0.000);组间比较,2个疗程后和1个疗程后比较差异均有统计学意义(P=0.034)。2个疗程后,黛力新组治疗抑郁有效率为76.67%;柴胡舒肝散合归脾汤组有效率为90.16%,两组间比较差异有统计学意义(P=0.046)。2与治疗前比较,经2个疗程后两组均能明显地改善情绪功能(P0.05)。治疗组在躯体、角色功能、食欲下降、疲倦及整体生活质量较治疗前均有明显改善(P0.05),与对照组比较差异有统计学意义(P0.05)。3与治疗前比较,治疗组2个疗程后骨髓抑制发生率下降,(P=0.019);组间比较,2个疗程后治疗组骨髓抑制发生率低于对照组(P=0.001)。组内比较,两组治疗后CD4+/CD8值与治疗前相比差异均有统计学意义(P0.01),治疗组1个与2个疗程后比较差异有统计学意义(P=0.000);两组间比较,2个疗程后比较差异均有统计学意义(P=0.042)。两组治疗后Treg/CD4+值与治疗前相比差异均有统计学意义(P0.05),治疗组1个与2个疗程后比较差异有统计学意义(P=0.006);组间比较,2个疗程后比较差异均有统计学意义(P=0.005)。4两组经1、2疗程后血清IL-6水平与治疗前相比差异均有统计学意义(P0.001),治疗组1个与2个疗程后比较差异有统计学意义(P=0.000);两组间比较治疗前后比较均无统计学意义(P0.05)。两组经1、2疗程后治疗后血清IGF-1水平与治疗前相比均有统计学意义(P0.001),治疗组1个与2个疗程后比较有统计学意义(P=0.000);两组间比较,2个疗程后比较有统计学意义(P=0.006)。结论:1柴胡舒肝散合归脾汤及黛力新均能改善化疗相关抑郁患者的抑郁状态,柴胡舒肝散合归脾汤远期疗效好于西药黛力新。2柴胡舒肝散合归脾汤及黛力新能改善化疗相关抑郁患者的情绪功能,柴胡舒肝散合归脾汤可改善患者的总健康状况、躯体功能、角色功能、食欲下降、疲倦,提高患者生活质量。3柴胡舒肝散合归脾汤组方能减少骨髓抑制的发生率,能提高肿瘤化疗相关抑郁患者的免疫功能。4柴胡舒肝散合归脾汤能降低肿瘤化疗相关抑郁患者血清中IL-6、IGF-1水平,两者水平与肿瘤化疗后抑郁程度正相关。
[Abstract]:Objective: To evaluate the clinical efficacy and quality, bone marrow function and immune function in patients with tumor chemotherapy associated with chemotherapy-related depression. Method: 1 patient's source: All selected cases were first chemotherapy in the 251 Hospital of Chinese People's Liberation Army from May 2015 to September 2016, and histopathologic diagnosis was diagnosed as breast cancer and lung cancer inpatients. A total of 293 patients were treated with 2 cycles of chemotherapy, and 126 patients were randomly divided into the new control group of Deforce and the treatment group of Buihu Shugan Powder. 123 patients entered statistical processing analysis, control group (n = 60), treatment group (61 cases). Clinical data: This study adopted a randomized controlled trial. Hamilton depression scale 24 (HAMD-24), quality of life scale (QLQ-C30), bone marrow function, IL-6, IGF-1, CD4 +/ CD8 +, Treg T/ CD4 + T were observed. The HAMD24 scale scores and life quality scale scores were scored on the first day before the 3rd, 4th and 5th chemotherapy cycles, and the CD4 +/ CD8 + value, Treg T/ CD4 + T value and interleukin-6 (IL-6) in serum were tested. Insulin-like growth factor-1 (IGF-1) and blood routine before and after treatment were analyzed statistically by SPSS 10.0 software. Results: Compared with the control group, the difference between treatment group HAMD24 and treatment group was statistically significant (P = 0.001), and the difference between treatment group and treatment group was statistically significant (P = 0.000). After two courses of treatment, the effective rate of treatment depression was 76. 67%, and the effective rate was 90. 16%, and the difference between the two groups was statistically significant (P = 0.046). After 2 courses of treatment, the mood function was significantly improved (P0.05). Compared with the control group (P = 0.019), the incidence of bone marrow suppression was decreased after two courses of treatment (P = 0.019). Compared with the control group, the incidence of bone marrow suppression in the treatment group was lower than that in the control group (P = 0.01). There was significant difference in CD4 +/ CD8 after treatment (P = 0.01) compared with that in the treatment group (P = 0.000). The difference of Treg/ CD4 + after treatment was statistically significant (P = 0.05) compared with that before treatment (P = 0. 006). There was significant difference in serum IL-6 level after 1 and 2 treatment courses (P = 0. 005). The difference of serum IL-6 level in the treatment group was statistically significant (P = 0.000) compared with the treatment group (P = 0.000). There was no significant difference between the two groups before and after treatment (P0.05). After 1 and 2 courses of treatment, the serum IGF-1 level was statistically significant (P = 0.000) compared with the treatment group (P = 0.000), and there was a statistical difference between the two groups (P = 0. 006). Conclusion: We can improve the depression status of the patients with depression, and the long-term curative effect of Chaihu Shugan Powder combined with spleen soup is better than that of western medicine. The decoction can improve the overall health status, body function, role function, appetite loss, fatigue and improve the quality of life of patients. can improve the immune function of the tumor chemotherapy-related depression patient. The 4-Buhu decoction can reduce the level of IL-6 and IGF-1 in the serum of the tumor chemotherapy-related depression patients, and the level of the two levels is positively related to the degree of depression after tumor chemotherapy.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5
[Abstract]:Objective: To evaluate the clinical efficacy and quality, bone marrow function and immune function in patients with tumor chemotherapy associated with chemotherapy-related depression. Method: 1 patient's source: All selected cases were first chemotherapy in the 251 Hospital of Chinese People's Liberation Army from May 2015 to September 2016, and histopathologic diagnosis was diagnosed as breast cancer and lung cancer inpatients. A total of 293 patients were treated with 2 cycles of chemotherapy, and 126 patients were randomly divided into the new control group of Deforce and the treatment group of Buihu Shugan Powder. 123 patients entered statistical processing analysis, control group (n = 60), treatment group (61 cases). Clinical data: This study adopted a randomized controlled trial. Hamilton depression scale 24 (HAMD-24), quality of life scale (QLQ-C30), bone marrow function, IL-6, IGF-1, CD4 +/ CD8 +, Treg T/ CD4 + T were observed. The HAMD24 scale scores and life quality scale scores were scored on the first day before the 3rd, 4th and 5th chemotherapy cycles, and the CD4 +/ CD8 + value, Treg T/ CD4 + T value and interleukin-6 (IL-6) in serum were tested. Insulin-like growth factor-1 (IGF-1) and blood routine before and after treatment were analyzed statistically by SPSS 10.0 software. Results: Compared with the control group, the difference between treatment group HAMD24 and treatment group was statistically significant (P = 0.001), and the difference between treatment group and treatment group was statistically significant (P = 0.000). After two courses of treatment, the effective rate of treatment depression was 76. 67%, and the effective rate was 90. 16%, and the difference between the two groups was statistically significant (P = 0.046). After 2 courses of treatment, the mood function was significantly improved (P0.05). Compared with the control group (P = 0.019), the incidence of bone marrow suppression was decreased after two courses of treatment (P = 0.019). Compared with the control group, the incidence of bone marrow suppression in the treatment group was lower than that in the control group (P = 0.01). There was significant difference in CD4 +/ CD8 after treatment (P = 0.01) compared with that in the treatment group (P = 0.000). The difference of Treg/ CD4 + after treatment was statistically significant (P = 0.05) compared with that before treatment (P = 0. 006). There was significant difference in serum IL-6 level after 1 and 2 treatment courses (P = 0. 005). The difference of serum IL-6 level in the treatment group was statistically significant (P = 0.000) compared with the treatment group (P = 0.000). There was no significant difference between the two groups before and after treatment (P0.05). After 1 and 2 courses of treatment, the serum IGF-1 level was statistically significant (P = 0.000) compared with the treatment group (P = 0.000), and there was a statistical difference between the two groups (P = 0. 006). Conclusion: We can improve the depression status of the patients with depression, and the long-term curative effect of Chaihu Shugan Powder combined with spleen soup is better than that of western medicine. The decoction can improve the overall health status, body function, role function, appetite loss, fatigue and improve the quality of life of patients. can improve the immune function of the tumor chemotherapy-related depression patient. The 4-Buhu decoction can reduce the level of IL-6 and IGF-1 in the serum of the tumor chemotherapy-related depression patients, and the level of the two levels is positively related to the degree of depression after tumor chemotherapy.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5
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