加味四君子汤对直肠癌术后脾胃气虚证患者化疗减毒增效的临床研究
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摘要
目的研究直肠癌术后脾胃气虚证患者行FOLFOX-7化疗期间联合加味四君子汤治疗对化疗增效和毒副反应的影响。方法将70例直肠癌脾胃气虚证患者随机分为观察组和对照组,每组各35例,两组均接受全直肠系膜切除术(total mesorectal excision, TME),术后观察组行FOLFOX-7化疗联合加味四君子汤治疗,对照组单纯行FOLFOX-7化疗。比较两组临床疗效和免疫功能指标,记录毒副反应发生情况,采用酶联免疫吸附法检测血管内皮生长因子(vascular endothelial growth factor, VEGF)、酸性成纤维细胞生长因子(acidity fibroblast growth factor, a FGF)及碱性成纤维细胞生长因子(basic fibroblast growth factor, bFGF)肿瘤生物学指标。结果治疗后观察组腹胀、神疲、纳呆、便溏及中医证候总分均显著低于对照组(P<0.05);观察组和对照组肿瘤控制率分别为97.14%和88.57%,差异无统计学意义(P>0.05);观察组治疗后CD3+、CD4+及CD3+/CD4+显著高于治疗前和对照组,差异有统计学意义(P<0.05);观察组治疗后VEGF、aFGF及bFGF水平显著低于治疗前和对照组,差异有统计学意义(P<0.05);观察组胃肠道反应、白细胞降低及中性粒细胞降低毒副反应的严重程度较对照组显著减轻,差异有统计学意义(P<0.05)。结论 FOLFOX-7化疗期间联合加味四君子汤用于直肠癌脾胃气虚证TME术后治疗,能显著减轻毒副反应,提高治疗效果,这可能与加味四君子汤改善机体免疫功能有关。
Objective To study the effects of FOLFOX-7 chemotherapy combined application of Jiawei Sijunzi Decoction on chemotherapy synergy and toxic side effects in patients with spleen-stomach Qi deficiency syndrome after rectal cancer operation.Methods A total of 70 patients with rectal cancer with spleen and stomach Qi deficiency were randomly divided into the observation group and the control group, with 35 cases in each group. Both groups underwent total mesorectal excision(TME). After operation, the observation group performed FOLFOX-7 chemotherapy combined with Jiawei Sijunzi Decoction, and the control group was treated with FOLFOX-7 chemotherapy alone. The clinical efficacy and immune function indexes of the 2 groups were compared, and the occurrence of toxic and side effects was recorded. The vascular endothelial growth factor(VEGF), acidity fibroblast growth factor(aFGF) and basic fibroblast growth factor(bFGF) tumor biological indicators were detected by enzyme-linked immunosorbent assay. Results After treatment, the abdominal distension, mental fatigue, anorexia, loose stool and TCM syndrome scores of the observation group were significantly lower than the control group(P <0.05). The tumor control rates of the observation group and the control group were 97.14% and 88.57%, respectively. There was no statistical significance(P>0.05). The CD3+, CD4+and CD3+/CD4+levels in the observation group were significantly higher than those before treatment and the control group(P<0.05). After treatment, the VEGF, aFGF and bFGF of the observation group was significantly lower than that before treatment and the control group, and the difference was statistically significant(P<0.05). The severity of gastrointestinal reactions,leukopenia and central neutropenia decreased significantly in the observation group compared with the control group, and the difference was statistically significant(P<0.05). Conclusion FOLFOX-7 combined with Jiawei Sijunzi Decoction for the treatment of rectal cancer with spleen and stomach Qi deficiency syndrome after TME can significantly reduce the toxic side effects and improve the therapeutic effect, which may be related to the improvement of immune function by Jiawei Sijunzi Decoction.
Objective To study the effects of FOLFOX-7 chemotherapy combined application of Jiawei Sijunzi Decoction on chemotherapy synergy and toxic side effects in patients with spleen-stomach Qi deficiency syndrome after rectal cancer operation.Methods A total of 70 patients with rectal cancer with spleen and stomach Qi deficiency were randomly divided into the observation group and the control group, with 35 cases in each group. Both groups underwent total mesorectal excision(TME). After operation, the observation group performed FOLFOX-7 chemotherapy combined with Jiawei Sijunzi Decoction, and the control group was treated with FOLFOX-7 chemotherapy alone. The clinical efficacy and immune function indexes of the 2 groups were compared, and the occurrence of toxic and side effects was recorded. The vascular endothelial growth factor(VEGF), acidity fibroblast growth factor(aFGF) and basic fibroblast growth factor(bFGF) tumor biological indicators were detected by enzyme-linked immunosorbent assay. Results After treatment, the abdominal distension, mental fatigue, anorexia, loose stool and TCM syndrome scores of the observation group were significantly lower than the control group(P <0.05). The tumor control rates of the observation group and the control group were 97.14% and 88.57%, respectively. There was no statistical significance(P>0.05). The CD3+, CD4+and CD3+/CD4+levels in the observation group were significantly higher than those before treatment and the control group(P<0.05). After treatment, the VEGF, aFGF and bFGF of the observation group was significantly lower than that before treatment and the control group, and the difference was statistically significant(P<0.05). The severity of gastrointestinal reactions,leukopenia and central neutropenia decreased significantly in the observation group compared with the control group, and the difference was statistically significant(P<0.05). Conclusion FOLFOX-7 combined with Jiawei Sijunzi Decoction for the treatment of rectal cancer with spleen and stomach Qi deficiency syndrome after TME can significantly reduce the toxic side effects and improve the therapeutic effect, which may be related to the improvement of immune function by Jiawei Sijunzi Decoction.
引文
[1]徐勇超,王刚成,张占东,等.腹腔镜与开腹超低位直肠癌全直肠系膜切除术临床疗效的对比研究[J].中华胃肠外科杂志,2016,19(8):942-943.
[2] KANTERS A E, CLEARY R K, OBI S H, et al. Uptake of Total Mesorectal Excision(TME)and TME Grading for Rectal Cancer:A Multicenter Study[J]. Journal of the American College of Surgeons, 2017, 225(4):e117-e118.
[3]罗双灵,康亮.低位直肠癌新辅助治疗后临床完全缓解病人处理策略[J].中国实用外科杂志,2017,37(6):619-624.
[4] WILTINK L M, MARIJNEN C A, MEERSHOEK-KLEIN K E,et al. A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial[J]. Acta Oncologica, 2016, 55(4):502-508.
[5]汪佳明,任红梅.复方苦参注射液联合FOLFOX7方案化疗治疗大肠癌的临床研究[J].中国新药杂志,2012,21(17):2060-2062.
[6]杨吉勇,梅丹,叶圳,等.康艾注射液对中晚期结直肠癌患者免疫功能和生活质量影响的临床研究[J].中国肿瘤外科杂志,2016,8(2):120-122.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2012,16(10):6-9.
[8]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:214-215.
[9]蔡月,胡华斌,王文静,等.改良FOLFOXIRI方案在晚期结直肠癌患者一线治疗中的安全性和疗效分析[J].中华胃肠外科杂志,2014,17(11):1081-1086.
[10]廖灵周.基层医院腹腔镜结直肠癌根治术与开腹手术近远期疗效的比较[J].湖南中医药大学学报,2016,10(A2):1425-1425.
[11]牛坚,刘斌,朱乐乐.基于盆腔自主神经为解剖标志的腹腔镜下直肠癌系膜全切除术[J].中国普通外科杂志,2016,25(10):1402-1407.
[12]常伟,周建华,张明雷,等.胸苷酸合成酶与结直肠癌患者FOLFOX方案化疗预后的相关性分析[J].中南医学科学杂志,2017,45(1):81-84.
[13]吴艳梅,马贤德,韩晓伟,等.四君子汤治疗脾虚证实验研究进展[J].辽宁中医药大学学报,2015,7(10):67-70.
[14]李进安,王永多,王奎,等.四君子汤含药脑脊液对溃疡性结肠炎肠黏膜淋巴细胞功能的影响[J].中国免疫学杂志,2016,32(6):815-819.
[15] PENG S, ZHANG Y, PENG H, et al. Intracellular autocrine VEGF signaling promotes EBDC cell proliferation, which can be inhibited by Apatinib[J]. Cancer Letters, 2016, 373(2):193-202.
[16]李传刚,李墨林,舒晓宏,等.四君子汤通过Fas受体诱导小鼠膀胱癌细胞凋亡[J].中华肿瘤防治杂志,2005,12(20):1539-1541.
[17]吴红梅,苟于强,胡林海,等.纹党参多糖联合环磷酰胺对S-(180)荷瘤小鼠抗肿瘤增效机制的研究[J].西部中医药,2016,29(4):17-21.
[18]金赟,武建毅,冯煜.四君子汤对化疗的结直肠癌术后肝转移患者口腔黏膜细胞凋亡率及肠道屏障功能的影响[J].上海中医药大学学报,2013,27(4):35-38.
[19]李悠然,谷云飞,陈邑岐,等.四君子汤加减联合化疗对结直肠癌患者的Meta分析[J].中国实验方剂学杂志,2016,3(6):204-209.
[2] KANTERS A E, CLEARY R K, OBI S H, et al. Uptake of Total Mesorectal Excision(TME)and TME Grading for Rectal Cancer:A Multicenter Study[J]. Journal of the American College of Surgeons, 2017, 225(4):e117-e118.
[3]罗双灵,康亮.低位直肠癌新辅助治疗后临床完全缓解病人处理策略[J].中国实用外科杂志,2017,37(6):619-624.
[4] WILTINK L M, MARIJNEN C A, MEERSHOEK-KLEIN K E,et al. A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial[J]. Acta Oncologica, 2016, 55(4):502-508.
[5]汪佳明,任红梅.复方苦参注射液联合FOLFOX7方案化疗治疗大肠癌的临床研究[J].中国新药杂志,2012,21(17):2060-2062.
[6]杨吉勇,梅丹,叶圳,等.康艾注射液对中晚期结直肠癌患者免疫功能和生活质量影响的临床研究[J].中国肿瘤外科杂志,2016,8(2):120-122.
[7]郑筱萸.中药新药临床研究指导原则[M].北京:中国医药科技出版社,2012,16(10):6-9.
[8]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:214-215.
[9]蔡月,胡华斌,王文静,等.改良FOLFOXIRI方案在晚期结直肠癌患者一线治疗中的安全性和疗效分析[J].中华胃肠外科杂志,2014,17(11):1081-1086.
[10]廖灵周.基层医院腹腔镜结直肠癌根治术与开腹手术近远期疗效的比较[J].湖南中医药大学学报,2016,10(A2):1425-1425.
[11]牛坚,刘斌,朱乐乐.基于盆腔自主神经为解剖标志的腹腔镜下直肠癌系膜全切除术[J].中国普通外科杂志,2016,25(10):1402-1407.
[12]常伟,周建华,张明雷,等.胸苷酸合成酶与结直肠癌患者FOLFOX方案化疗预后的相关性分析[J].中南医学科学杂志,2017,45(1):81-84.
[13]吴艳梅,马贤德,韩晓伟,等.四君子汤治疗脾虚证实验研究进展[J].辽宁中医药大学学报,2015,7(10):67-70.
[14]李进安,王永多,王奎,等.四君子汤含药脑脊液对溃疡性结肠炎肠黏膜淋巴细胞功能的影响[J].中国免疫学杂志,2016,32(6):815-819.
[15] PENG S, ZHANG Y, PENG H, et al. Intracellular autocrine VEGF signaling promotes EBDC cell proliferation, which can be inhibited by Apatinib[J]. Cancer Letters, 2016, 373(2):193-202.
[16]李传刚,李墨林,舒晓宏,等.四君子汤通过Fas受体诱导小鼠膀胱癌细胞凋亡[J].中华肿瘤防治杂志,2005,12(20):1539-1541.
[17]吴红梅,苟于强,胡林海,等.纹党参多糖联合环磷酰胺对S-(180)荷瘤小鼠抗肿瘤增效机制的研究[J].西部中医药,2016,29(4):17-21.
[18]金赟,武建毅,冯煜.四君子汤对化疗的结直肠癌术后肝转移患者口腔黏膜细胞凋亡率及肠道屏障功能的影响[J].上海中医药大学学报,2013,27(4):35-38.
[19]李悠然,谷云飞,陈邑岐,等.四君子汤加减联合化疗对结直肠癌患者的Meta分析[J].中国实验方剂学杂志,2016,3(6):204-209.