健脾化瘀法治疗脾虚血瘀型肝癌TACE术后患者的临床研究

发布时间：2018-02-02 10:17

  本文关键词： 脾虚血瘀 原发性肝癌 健脾化瘀法 中医药　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：肝癌是我国甚至世界上常见的恶性肿瘤,其预后具有肿瘤中“最差”之称,目前一部分肝癌发现时已是中晚期,失去了一期手术切除机会,对于不可切除的肝癌患者最常采用经皮肝动脉栓塞化疗术(TACE)进行局部治疗,但只是阻止肿瘤局部血供及化疗药局部杀死肿瘤细胞,介入术后对生存质量及出现的栓塞术后系列症状的情况影响患者的生活质量,中医药在辅助治疗肝癌方面存在一定的优势,根据《金匮要略》肝病治脾之理,通过健脾化瘀法中药对肝癌行TACE术后患者的临床观察,进一步探索健脾化瘀法中药在治疗TACE术后肝癌患者的疗效及对其生活质量的影响。方法：将符合本研究入组标准80个病例做为研究对象,通过采用随机对照研究的方法分为2组,每组各40例,患者均经行TACE术后,治疗组采用健脾化瘀法中药联合西医对症综合治疗,对照组只采用西医对症综合治疗,观察两组患者治疗前及治疗后1个月、3个月的QOL评分(包括食欲、精神、睡眠、疲乏、疼痛),生存状况KPS评分表及血分析、肝功能,肾功能,凝血功能,AFP及CA19-9,影像学检查肿瘤大小变化情况。结果：1.两组治疗前的一般情况一致性良好,差异无明显的统计学意义(P0.05)。2.两组患者的疗效(RR)进行评估,治疗组与对照组RR的差异无统计学意义(P0.05),两组患者1个月有效率分别为(治疗组：10%,对照组：10%),3个月有效率为(治疗组：15%,对照组：5%),虽其疗效差异无统计学意义,但是术后1个月健脾化瘀组恶化(PD)病例数较对照组少(34),术后3个月健脾化瘀组恶化(PD)病例数较对照组少(1012),术后3个月健脾化瘀组部分缓解(PR)病例数较对照组多(62)。两组的临床缓解率虽其疗效差异无统计学意义,TACE术后1个月两组患者的临床获益率分别为(治疗组：92.5%,对照组：90%),两组差异无统计学意义(P0.05)；术后3个月两组患者的临床获益率分别为(治疗组：75%,对照组：70%),治疗组的获益率大于对照组。3.肝脏功能：两组患者TACE术后健脾化瘀中药治疗1个月后的AST、ALT、TB、ALB差异有统计学意义(P0.05),两组患者TACE术后健脾化瘀中药治疗3个月后的AST、ALT、TB、ALB差异有统计学意义(P0.05)。4.肿瘤指标：两组患者术后1个月、3个月CA19-9差异无统计学意义(P0.05)；两组患者TACE术后1个月AFP差异有统计学意义(P=0.0320.05),两组患者TACE术后3个月AFP差异有统计学意义(P=0.0340.05),两组患者治疗1个月后及3个月后的AFP下降值差异无统计学意义(P0.05)。5.QOL生活质量：食欲、精神、睡眠、乏力、疼痛这五个症状,肝癌TACE术后1个月两组患者症状评分经秩和检验后除食欲外,差异具有统计学意义(P0.05)；术后3个月两组患者食欲、睡眠两个症状差异具有统计学意义(P0.05),术后3个月两组患者精神、乏力、疼痛三个症状差异无统计学意义(P0.05)。五个症状的总体评分,两组患者TACE术后1个月总积分比较(Z=3.136,P=0.002)差异有统计学意义(P0.05),3个月的总积分比较(Z=3.098,P=0.02)差异有统计学意义(P0.05) ；6.两组患者生存质量KPS评分：TACE术后1个月两组患者的KPS评分比较(Z=2.230,P=0.026)差异有统计学意义(P0.05),术后3个月比较(Z=1.990,P=0.047)差异有统计学意义(P0.05)。结论：健脾化瘀法组方的中药在改善肝癌患者TACE术后脾虚血瘀证患者有积极作用,在一定程度上可以改善患者肝功能,改善患者睡眠及饮食情况,提高患者的生活质量。
[Abstract]:Objective: liver cancer is our country and even the world common malignant tumor, its prognosis with tumor in the "worst", currently part of hepatocellular carcinoma is advanced when found, lost an opportunity to surgery, for unresectable liver cancer most commonly used percutaneous hepatic artery embolization chemotherapy (TACE) local treatment, but only to prevent the local blood supply of tumors and local chemotherapy drugs kill tumor cells, the influence of the quality of life and the emergence of the series of symptoms after embolization of the quality of life of patients after interventional therapy, traditional Chinese medicine has some advantages in the adjuvant treatment of liver cancer, according to < > liver spleen Jinkui yaolue Daniel the traditional Chinese medicine of invigorating spleen and removing blood stasis, clinical observation of patients after TACE for hepatocellular carcinoma, to further explore the Chinese medicine invigorating spleen and removing blood stasis in the treatment of TACE postoperative liver cancer patients and the influence on the quality of life. Methods: according to This study enrolled 80 cases as the research object, by using the random control study divided into 2 groups, 40 cases in each group, patients were treated after TACE, treatment group were treated with Jianpi Huayu of Chinese medicine combined with western medicine symptomatic treatment, while the control group only with western medicine treatment, observation of 1 months two groups of patients before and after treatment, 3 months QOL score (including spirit, appetite, sleep, fatigue, pain), survival analysis, KPS score and serum liver function, renal function, blood coagulation function, AFP and CA19-9 imaging of tumor size changes. Results: the general situation of the 1. two before treatment, good consistency, no difference was statistically significant (P0.05.2.) the curative effect of two groups of patients (RR) were evaluated, no statistically significant difference between treatment group and control group RR (P0.05), two groups of patients 1 months respectively (the treatment group: 10%, control group: 10% ),3涓�鏈堟湁鏁堢巼涓�(娌荤枟缁勶細15%,瀵圭収缁勶細5%),铏藉叾鐤楁晥宸�寮傛棤缁熻�″�︽剰涔�,浣嗘槸鏈�鍚�1涓�鏈堝仴鑴惧寲鐦�缁勬伓鍖，

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