Abstract:

Objective　To explore the effects of fumigation and steaming with Yiqi Wenjing Huoxue Prescription on oxaliplatin induced peripheral neurotoxicity and traditional Chinese medicine (TCM) syndromes in patients with colorectal cancer undergoing adjuvant chemotherapy after surgery. Methods　This study was a randomized controlled trial. A total of 91 patients with colorectal cancer requiring adjuvant chemotherapy after surgery were selected from March 2022 to March 2024 in the Department of Traditional Chinese and Western Medicine Oncology, the Second Affiliated Hospital of PLA Air Force Military Medical University. The patients were divided into a treatment group (46 cases) and a control group (45 cases) by the random number table method. A total of 8 cases fell off, and 42 cases were finally included in the treatment group and 41 cases in the control group. There were 23 males and 19 females in the treatment group, aged (52.37±5.25) years, and the pathological staging was stage Ⅱ in 11 cases and stage Ⅲ in 31 cases. There were 22 males and 19 females in the control group, aged (54.21±5.23) years, and the pathological staging was stage Ⅱ in 12 cases and stage Ⅲ in 29 cases. The control group was treated with XELOX regimen chemotherapy [oxaliplatin (intravenous infusion) combined with capecitabine (oral)], and the treatment group was given fumigation and steaming with Yiqi Wenjing Huoxue Prescription on the basis of the control group. Both groups were treated for 6 cycles, with 21 d as a cycle. The incidence of peripheral neurotoxicity, toxicity grading, TCM syndrome score, and levels of serum inflammatory factors [superoxide dismutase (SOD) and nerve growth factor (NGF)] were compared between the two groups. Independent sample t test, paired t test, χ² test, and rank sum test were used. Results　At the 4th and 6th cycle, the incidence of peripheral neurotoxicity in the treatment group [57.1% (24/42) and 66.7% (28/42)] was lower than that in the control group [92.6% (38/41) and 97.5% (40/41)] (both P<0.05). After 4 and 6 cycles of treatment, the degree of peripheral neurotoxicity in the treatment group was better than that in the control group (Z=-5.051, P<0.001; Z=-5.276, P<0.001). After 6 cycles of treatment, the levels of SOD [(69.63±9.11) kU/L] and NGF [(176.21±26.79) ng/L] in the treatment group were higher than those in the control group [(55.23±8.77) kU/L and (139.24±21.78) ng/L], and the TCM syndrome score [(6.62±1.31) points] was lower than that in the control group [(8.94±2.97) points] (all P<0.05). Conclusion　The application of fumigation and steaming with Yiqi Wenjing Huoxue Prescription can reduce the oxaliplatin induced peripheral neurotoxicity and improve the TCM syndromes in patients with colorectal cancer undergoing adjuvant chemotherapy after surgery.

Key words:

Colorectal cancer, Adjuvant chemotherapy, Oxaliplatin, Peripheral neurotoxicity, Inflammatory factors, Yiqi Wenjing Huoxue Prescription

摘要：

目的　探讨益气温经活血方熏蒸治疗对结直肠癌术后辅助化疗患者奥沙利铂所致周围神经毒性及中医证候的影响。方法　本研究为随机对照试验。选取2022年3月至2024年3月在中国人民解放军空军军医大学第二附属医院中西医结合肿瘤科就诊的91例结直肠癌术后需要辅助化疗患者作为研究对象。采用随机数字表法，将患者分为治疗组46例和对照组45例。共脱落8例，最终治疗组42例，对照组41例。治疗组男23例，女19例；年龄（52.37±5.25）岁；病理分期：Ⅱ期11例，Ⅲ期31例。对照组男22例，女19例；年龄（54.21±5.23）岁；病理分期：Ⅱ期12例，Ⅲ期29例。对照组采用XELOX方案化疗［奥沙利铂（静脉滴注）联合卡培他滨（口服）］，治疗组在对照组基础上采用益气温经活血方熏蒸治疗。两组均治疗6个周期（21 d为1个周期）。比较两组周围神经毒性发生率，治疗后外周神经毒性反应分级，中医证候评分，血清炎症因子水平［超氧化物歧化酶（SOD）、神经生长因子（NGF）］。采用独立样本t检验、配对t检验、χ²检验和秩和检验。结果　第4、6周期，治疗组周围神经毒性发生率［57.1%（24/42）、66.7%（28/42）］均低于对照组［92.6%（38/41）、97.5%（40/41）］（均P<0.05）。治疗4、6个周期后，治疗组周围神经毒性反应分级均优于对照组（Z=-5.051，P<0.001；Z=-5.276，P<0.001）。治疗6个周期后，治疗组SOD［（69.63±9.11）kU/L］、NGF［（176.21±26.79）ng/L］水平均高于对照组［（55.23±8.77）kU/L、（139.24±21.78）ng/L］，中医证候评分［（6.62±1.31）分］低于对照组［（8.94±2.97）分］（均P<0.05）。结论　益气温经活血方中药熏蒸可减轻结直肠癌术后辅助化疗患者奥沙利铂所致周围神经毒性，改善中医证候。

关键词:

结直肠癌, 辅助化疗, 奥沙利铂, 周围神经毒性, 炎症因子, 益气温经活血方