西医方案与益气扶正解毒汤+足三里穴位注射治疗晚期胃癌患者的临床效果

doi:10.3760/cma.j.issn.1007-1245.2022.21.014

摘要/Abstract

摘要： 目的　观察西医化疗结合益气扶正解毒汤+足三里穴位注射治疗晚期胃癌的临床效果。方法　选取平顶山市第二人民医院2019年1月至2022年1月院内收治的70例晚期胃癌患者为研究对象，经抽签法将患者分为两组。对照组35例，男20例，女15例，年龄（55.17±2.24）岁；研究组35例，男23例，女12例，年龄（55.44±2.37）岁。两组均予以同种化疗方案治疗，研究组在此基础联合应用益气扶正解毒汤+足三里穴位注射治疗，比较两组的中医主证、次证积分，癌胚抗原（CEA）、糖类抗原724（CA724）、CA125、CA199、甲胎蛋白（AFP）等肿瘤标志物水平，T淋巴细胞亚群（CD）CD3+、CD4+、CD8+等免疫指标，客观缓解率、疾病控制率和不良反应发生率。统计学方法采用t检验和χ²检验。结果　治疗后，研究组的中医主证胃脘疼痛、食少纳差积分，次证气短乏力、精神萎靡积分分别为（1.21±0.36）分、（1.04±0.27）分、（1.13±0.45）分、（1.25±0.33）分，均低于对照组［（1.96±0.44）分、（1.88±0.62）分、（2.02±0.17）分、（2.29±0.41）分］，差异均有统计学意义（t=7.805、7.349、10.946、11.690，均P<0.05）。研究组CEA水平、CA724水平、CA125水平、CA199水平、AFP水平分别为（3.12±0.45）μg/ml、（6.63±0.24）U/ml、（30.21±1.14）U/ml、（32.14±1.15）IU/ml、（20.12±2.23）mg/L，均低于对照组［（5.41±0.26）μg/ml、（8.92±0.71）U/ml、（32.47±1.36）U/ml、（34.24±1.36）IU/ml、（23.25±2.76）mg/L］，差异均有统计学意义（t=26.068、18.077、7.534、6.976、5.219，均P<0.05）；研究组CD3+、CD4+、CD8+、ORR、DCR均高于对照组，差异均有统计学意义（t=3.183、11.144、8.822，χ²=7.198、9.181，均P<0.05）；研究组的不良反应发生率为14.29%（5/35），略高于对照组［11.43%（4/35）］，差异无统计学意义（χ²=0.365，P>0.05）。结论　将益气扶正解毒汤+足三里穴位注射等中医疗法与西医化疗相结合，可促进晚期胃癌患者临床症候、体征改善，对降低各项肿瘤标志物水平、延缓病情进展均有积极意义，此中西结合疗法未明显增强不良反应，安全性尚可。

关键词: 晚期胃癌, 西医化学治疗, 益气扶正解毒汤, 足三里穴位注射, 肿瘤标志物

Abstract: Objective　To observe the clinical effect of Western medicine chemotherapy combined with Yiqi Fuzheng Jiedu Decoction + Zusanli acupoint injection in the treatment of advanced gastric cancer. Methods　Seventy patients with advanced gastric cancer admitted to Second People's Hospital of Pingdingshan City from January 2019 to January 2022 were selected as the study objects. The patients were divided into a control group and a study group by lottery, with 35 cases in each group. There were 20 males and 15 females in the control group, and they were (55.17±2.24) years old. There were 23 males and 12 females in the study group, and they were (55.44±2.37) years old. Both groups were treated with the same chemotherapy regimen; on this basis, the study group were treated with Yiqi Fuzheng Jiedu Decoction + Zusanli acupoint injection. The scores of main and secondary syndromes of traditional Chinese medicine (TCM), the levels of tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 724 (CA724), CA125, CA199, and alpha fetoprotein (AFP), the levels of immune indicators, such as T lymphocyte subsets (CD) CD3+, CD4+, and CD8+, objective remission rates (ORR), disease control rates (DCR), and incidences of adverse reaction were compared between the two groups. t and χ² tests were applied. Results　After the treatment, the scores of the main (stomachache and deficiency of appetite) and secondary (short of breath and lack of strength and listlessness) syndromes of TCM in the study group were lower than those in the control group [(1.21±0.36) vs. (1.96±0.44), (1.04±0.27) vs. (1.88±0.62), (1.13±0.45) vs. (2.02±0.17), and (1.25±0.33) vs. (2.29±0.41)], with statistical differences (t=7.805, 7.349, 10.946, and 11.690; all P<0.05). The levels of CEA, CA724, CA125, CA199, and AFP in the study group were lower than those in the control group [(3.12±0.45) μg/ml vs. (5.41±0.26) μg/ml, (6.63±0.24) U/ml vs. (8.92±0.71) U/ml, (30.21±1.14) U/ml vs. (32.47±1.36) U/ml, (32.14±1.15)IU/ml vs. (34.24±1.36) IU/ml, and (20.12±2.23) mg/L vs. (23.25±2.76) mg/L], with statistical differences (t=26.068, 18.077, 7.534, 6.976, and 5.219; all P<0.05). The CD3+, CD4+, CD8+, ORR, and DCR in the study group were higher than those in the control group, with statistical differences (t=3.183, 11.144, and 8.822; χ²=7.198 and 9.181; all P<0.05). The incidence of adverse reactions was 14.29% (5/35) in the study group, and was 11.43% (4/35) in the control group, with no statistical difference (χ²=0.365; P>0.05). Conclusions　The combination of traditional Chinese medicine therapies such as Yiqi Fuzheng Jiedu Decoction + Zusanli acupoint injection and Western medicine chemotherapy for patients with advanced gastric cancer can improve their clinical symptoms and signs, reduce the levels of tumor markers, and delay the disease progress. This combination has not significantly enhanced adverse reactions, and its safety is acceptable.

Key words: Advanced gastric cancer, Western medicine chemotherapy, Yiqi Fuzheng Jiedu Decoction, Zusanli acupoint injection, Tumor markers

张少朋. 西医方案与益气扶正解毒汤+足三里穴位注射治疗晚期胃癌患者的临床效果[J]. 国际医药卫生导报, 2022, 28(21): 3032-3036.

Zhang Shaopeng. Effect of Western medicine and Yiqi Fuzheng Jiedu Decoction + Zusanli acupoint injection for patients with advanced gastric cancer[J]. International Medicine and Health Guidance News, 2022, 28(21): 3032-3036.

参考文献

[1] Yang L,Ying X,Liu S,et al.Gastric cancer: Epidemiology, risk factors and prevention strategies[J].Chin J Cancer Res,2020,32(6):695-704.DOI:10.21147/j.issn.1000-9604. 2020.06.03.
[2] Li Y,Wang JS,Guo Y,et al.Use of the alkaline phosphatase to prealbumin ratio as an independent predictive factor for the prognosis of gastric cancer[J].World J Gastroenterol,2020,26(44):6963-6978.DOI:10.3748/wjg.v26.i44.6963.
[3] 王玉军,韩小兵,陈克河,等.贝伐单抗联合奥沙利铂、亚叶酸钙、氟尿嘧啶化疗对ⅢB～Ⅳ期胃癌癌胚抗原和糖类抗原199水平的影响[J].西北药学杂志,2020,35(2):267-272.DOI:10.3969/j.issn.1004-2407.2020.02.025.
[4] 窦建卫,杨小娟,李康乐,等.从气机升降探讨胃癌的病机治则[J].辽宁中医杂志,2020,47(2):76-77.DOI:10.13192/j.issn.1000-1719.2020.02.023.
[5] 洪青,王洪洲,初晓红,等.复方苦参注射液穴位注射联合刺血疗法治疗胃癌疼痛的临床研究[J].辽宁中医杂志,2020,47(1):150-152.DOI:10.13192/j.issn.1000-1719. 2020.01.047.
[6] 邱海波,周志伟.NCCN胃癌临床实践指南2017年第五版更新要点解读[J].中华胃肠外科杂志,2018,21(2):160-164.DOI:10.3760/cma.j.issn.1671-0274.2018.02.008.
[7] 姜苗,李忠.胃癌的中西医结合诊治[J].中国临床医生,2007,35(4):18-22.DOI:10.3969/j.issn.1008-1089.2007.04.006.
[8] 邵建平,苏锋,李永元.小承气汤保留灌肠对胃癌根治全胃切除术后患者腹胀症状及中医证候积分的影响[J].中国中西医结合外科杂志,2022,28(2):191-194.DOI:10.3969/j.issn.1007-6948.2021.02.008.
[9] Triviño JC,Ceba A,Rubio-Solsona E,et al.Combination of phenotype and polygenic risk score in breast cancer risk evaluation in the Spanish population: a case -control study[J].BMC Cancer,2020,20(1):1079.DOI:10.1186/s12885-020-07584-9.
[10] 顾阳春,白洋,张煜,等.D2术后淋巴结转移≥16枚(N3b)的胃癌患者不同辅助化疗方案的疗效对比研究[J].临床肿瘤学杂志,2020,25(8):710-716.DOI:10.3969/j.issn.1009-0460. 2020.08.007.
[11] 梁红,魏可新,范晶晶.不同化疗方案治疗晚期胃癌的效果及对患者血清肿瘤标志物水平的影响[J].癌症进展,2020,18(20):2110-2113.DOI:10.11877/j.issn.1672-1535. 2020.18.20.16.
[12] 罗伟平,何雩霏,钟礼信,等.2008—2019年广州某综合医院肿瘤病例分析[J].广州医药,2020,51(4):114-118.DOI:10.3969/j.issn.1000-8535.2020.04.025.
[13] 伍旭明,章煌杰,许亚萍,等.健脾消癌方联合mFOLFOX6化疗对胃癌患者增效减毒及肿瘤标志物的影响[J].中华中医药学刊,2018,36(6):1435-1438.DOI:10.13193/j.issn. 1673-7717.2018.06.039.
[14] 宋卓,杨宇飞,孙凌云,等.胃肠恶性肿瘤以脾虚为核心病机的理论与实践探讨[J].世界中医药,2021,16(9):1357-1363,1371.DOI:10.3969/j.issn.1673-7202.2021.09.003.
[15] 颜莉芳,黄慧,王斌.足三里穴位注射黄芪注射液对晚期胃癌患者白细胞介素-6及肿瘤坏死因子水平影响分析[J].新中医,2016,48(8):213-215.DOI:10.13457/j.cnki.jncm. 2016.08.093.
[16] 叶亚萍,陈沙沙.穴位注射盐酸甲氧氯普胺联合穴位按压、敷贴预防胃癌化疗患者恶心呕吐临床研究[J].新中医,2022,54(5):164-167.DOI:10.13457/j.cnki.jncm.2022. 05.038.
[17] 崔丽,于壮.胃复安预防羟考酮诱导的恶心呕吐的前瞻性观察[J].基础医学与临床,2020,40(9):1201-1205.DOI:10.3969/j.issn.1001-6325.2020.09.007.
[18] 陈倩雅,杨广达,谢德荣.CLDN11在肿瘤中的表达水平及临床预后价值研究[J].国际医药卫生导报,2020,26(19):2875-2880.DOI:10.3760/cma.j.issn.1007-1245.2020. 19.014.
[19] 王巍.益气扶正解毒汤结合足三里穴位注射复方当归注射液治疗晚期胃癌患者疗效及对肿瘤标志物、免疫功能的影响[J].辽宁中医杂志,2021,48(12):129-132.DOI:10.13192/j.issn.1000-1719.2021.12.037.