四君子汤加味治疗Ⅲ、Ⅳ期恶性肿瘤脾胃亏虚型癌性厌食症的临床研究

发布时间：2018-01-13 07:30

本文关键词：四君子汤加味治疗Ⅲ、Ⅳ期恶性肿瘤脾胃亏虚型癌性厌食症的临床研究　出处：《湖南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的:本研究通过观察四君子汤加味对Ⅲ、Ⅳ期恶性肿瘤脾胃亏虚型癌性厌食症患者食欲、食量、体重、卡氏评分、中医症候积分及外周血T细胞亚群等各项指标的影响,为今后临床上运用该方治疗癌性厌食症提供临床参考依据,亦为中医药方剂改善中晚期肿瘤患者食欲、提高患者免疫力及生活质量等方面提供临床依据。研究方法:选择60例Ⅲ、Ⅳ期恶性肿瘤脾胃亏虚型癌性厌食症患者,采用随机分组原则,随机分为治疗组和对照组,其中治疗组(四君子汤加味组)30例,对照组(甲地孕酮胶囊剂组)30例。自纳入研究日起连续观察4周。比较两组治疗前后食量、食欲、体重、生活质量、外周血T细胞亚群(CD4、CD8、CD4/CD8)、中医症状及不良反应发生情况等指标。数据结果采用美国SPSS 17.0统计软件包进行统计分析。结果:(1)在食量和食欲方面,四君子汤加味及甲地孕酮胶囊均可有效改善患者食欲,增加进食量,且两组疗效相当,差别无统计学意义(P0.05);(2)在体重变化方面,治疗组和对照组两组患者体重均有增加,治疗后与治疗前对比,差异有统计学意义(P0.01),但比较两组治疗前后体重改善情况,差异无统计学意义(P0.05);(3)在KPS评分改善方面,四君子汤加味及甲地孕酮均能增加患者KPS评分值,改善患者生活质量,两组治疗前后差值有统计学意义(P0.05),但治疗组KPS评分改善情况优于对照组(P0.05);(4)在中医症候积分变化方面,两组治疗后中医症候积分均较治疗前下降,差值均有高度统计学意义(P0.01),其中治疗组疗效总有效率为90%,对照组为70%,两者治疗后组间差异具高度统计学意义(P0.01),故四君子汤加味对患者中医症候改善较甲地孕酮更佳;(5)在免疫功能方面,四君子加味可显著升高患者外周血中CD4、CD4/CD8值,降低CD8值,有效提高患者免疫功能(P0.01),而甲地孕酮对患者免疫功能改变影响不明显(P0.05),两药相比,四君子加味疗效较甲地孕酮佳(P0.01);(6)在安全指标观察及不良反应监测方面,对照组有1人出现轻度凹陷性水肿,予利尿消肿等对症处理后水肿消退,余未出现其他不良反应,治疗组未观察到不良反应,两组在安全性指标方面对比无明显异常。结论:四君子汤加味可有效改善中晚期恶性肿瘤脾胃亏虚型癌性厌食症患者的食欲,增加其进食量,同时提高改善患者的KPS评分,增加患者体重,其中在食欲、食量及体重改变方面,四君子汤加味功效和甲地孕酮胶囊相当,但在KPS评分改善方面,四君子汤加味优于甲地孕酮胶囊。且汤药四君子汤加味可有效提高患者免疫功能,降低患者中医症候积分,改善临床症状,其疗效明显优于甲地孕酮胶囊,且无明显副作用及不良反应,与西药甲地孕酮相比有其独特的优势,值得临床推广应用。
[Abstract]:Objective: This study through the observation of four Decoction of III, IV malignant tumor of the spleen and stomach deficiency type cancer anorexia patients appetite, food intake, body weight, Karnofsky score, TCM syndrome score and the effect of T cell subsets in peripheral blood and other indicators, to provide clinical reference for future clinical use of the treatment of cancer anorexia, is also the advanced traditional Chinese medicine prescriptions in cancer patients to improve appetite, to provide clinical basis to improve immunity and quality of life of patients and so on. Research methods: 60 cases of III, IV malignant tumor of the spleen and stomach deficiency type cancer anorexia patients, randomly divided into the treatment group and the the control group, the treatment group (four Decoction group) 30 cases, control group (megestrol group) 30 cases were included in the study. Since the date of observation for 4 weeks before and after treatment between the two groups of food intake, appetite, body weight, quality of life, T cells in peripheral blood Subsets (CD4, CD8, CD4/CD8), TCM symptoms and the incidence of adverse reactions and other indicators. The data using SPSS 17 statistical software package for statistical analysis. Results: (1) in terms of food intake and appetite, four Decoction and megestrol capsule can effectively improve patients' appetite, increased food intake, and the efficacy of the two groups, the difference was not statistically significant (P0.05); (2) changes in body weight, weight of each treatment group and control group two groups increased after treatment compared with before treatment, the difference was statistically significant (P0.01) before and after treatment between the two groups, but the weight to improve the situation, there was no statistically significant difference (P0.05); (3) the KPS score improvement, four Decoction and megestrol acetate were increased in patients with KPS score, improve the quality of life of patients, the two groups before and after treatment the difference was statistically significant (P0.05), but the KPS score of treatment group was better than that of the control group (P0. 05); (4) in TCM syndrome integral change, two groups after treatment of TCM syndrome integral were lower than that before treatment, the difference was statistically significant (P0.01), the treatment group total effective rate was 90%, the control group was 70%, the difference between groups after treatment with a high degree of statistical significance (P0.01 therefore, four) Decoction on patients with TCM symptoms improved compared with megestrol acetate plus; (5) on immune function, four modified significantly increased in peripheral blood of patients with CD4, CD4/CD8 value, reduce the value of CD8, effectively improve the immune function of the patients (P0.01), and megestrol acetate on immune function in patients with no change obviously, the two drugs (P0.05) compared to four with better effect than a gentleman of megestrol acetate (P0.01); (6) in terms of safety indicators and adverse reactions were observed and monitored, 1 in the control group had mild pitting edema, diuresis detumescence to symptomatic treatment after edema, no other than Adverse reactions, the treatment group had no adverse reaction, two groups of the safety index contrast had no obvious abnormalities. Conclusion: four the decoction can effectively improve the late malignant tumor of the spleen and stomach deficiency type cancer anorexia patients appetite, increase their food intake, and improve the patient's KPS score, and increase patients the body weight, appetite, food intake and body weight changes, four Decoction efficacy and megestrol capsule, but in the KPS score improvement, four decoction is better than megestrol capsules. And four Decoction decoction can effectively improve the immune function of patients with high and lower score in patients with clinical symptoms, improve clinical symptoms, the the curative effect was significantly better than that of megestrol capsule, and no obvious side effects and adverse reactions, has its unique advantages compared with western medicine megestrol, worthy of clinical application.

【学位授予单位】：湖南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R273

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