健脾补肾中药对恶性骨肿瘤化疗后骨髓抑制患者外周血象的影响

Effects of Jianpi Bushen(健脾补肾)traditional Chinese medicine on peripheral hemogram of patients with my-elosuppression after chemotherapy for treatment of malignant bone tumors

目的:观察健脾补肾中药对恶性骨肿瘤化疗后骨髓抑制患者外周血象的影响。方法:将符合要求的60例恶性骨肿瘤化疗后骨髓抑制患者随机分为2组,每组30例。联合治疗组采用健脾补肾中药口服联合重组人粒细胞集落刺激因子皮下注射治疗,单纯西药组采用重组人粒细胞集落刺激因子皮下注射治疗;均连续治疗7 d为1个疗程,共治疗1个疗程。比较2组患者治疗前后外周血液中白细胞计数、血红蛋白含量及血小板计数,并评估白细胞、血红蛋白及血小板抑制程度。治疗结束1周后,评价患者临床症状改善情况及生活质量。结果:①白细胞计数。治疗前2组患者的白细胞计数比较,差异无统计学意义[(3.28±0.64)×10^(9)个·L^(-1),(3.19±0.76)×10^(9)个·L^(-1),t=0.566,P=0.576];治疗结束1周后,2组患者的白细胞计数均高于治疗前(t=-6.606,P=0.000;t=-3.583,P=0.000),且联合治疗组患者的白细胞计数高于单纯西药组[(8.68±1.75)×10^(9)个·L^(-1),(4.63±1.20)×10^(9)个·L^(-1),t=10.954,P=0.000]。②血红蛋白含量。治疗前2组患者的血红蛋白含量比较,差异无统计学意义[(112.47±10.05)g·L^(-1),(108.63±9.67)g·L^(-1),t=-1.941,P=0.062];治疗结束1周后,2组患者的血红蛋白含量均高于治疗前(t=-11.750,P=0.000;t=-5.695,P=0.000),且联合治疗组患者的血红蛋白含量高于单纯西药组[(140.83±17.36)g·L^(-1),(126.87±15.56)g·L^(-1),t=4.331,P=0.000]。③血小板计数。治疗前2组患者的血小板计数比较,差异无统计学意义[(121.10±23.51)×10^(9)个·L^(-1),(126.90±30.52)×10^(9)个·L^(-1),t=-1.250,P=0.221];治疗结束1周后,2组患者的血小板计数均高于治疗前(t=-12.528,P=0.000;t=-5.846,P=0.000),且联合治疗组患者的血小板计数高于单纯西药组[(224.23±60.28)×10^(9)个·L^(-1),(187.70±55.89)×10^(9)个·L^(-1),t=2.741,P=0.010]。④白细胞抑制程度。治疗结束1周后,联合治疗组0度9例、Ⅰ度11例、Ⅱ度7例、Ⅲ度3例,单纯西药组0度4例、Ⅰ度7例、Ⅱ度8例、Ⅲ度6例、Ⅳ度5例;联合治疗组患者的白细胞抑制程度优于单纯西药组(Z=-2.717,P=0.007)。⑤血红蛋白抑制程度。治疗结束1周后,联合治疗组0度8例、Ⅰ度10例、Ⅱ度12例,单纯西药组0度3例、Ⅰ度10例、Ⅱ度6例、Ⅲ度6例、Ⅳ度5例;联合治疗组患者的血红蛋白抑制程度优于单纯西药组(Z=-2.547,P=0.011)。⑥血小板抑制程度。治疗结束1周后,联合治疗组0度11例、Ⅰ度13例、Ⅱ度4例、Ⅲ度2例,单纯西药组0度8例、Ⅰ度7例、Ⅱ度8例、Ⅲ度4例、Ⅳ度3例;联合治疗组患者的血小板抑制程度优于单纯西药组(Z=-2.009,P=0.045)。⑦临床症状改善情况。治疗结束1周后,联合治疗组显著改善13例、部分改善14例、无效3例,单纯西药组显著改善7例、部分改善12例、无效11例;联合治疗组患者的临床症状改善情况优于单纯西药组(Z=-2.363,P=0.018)。⑧生活质量。治疗结束1周后,联合治疗组改善16例、稳定10例、降低4例,单纯西药组改善9例、稳定8例、降低13例;联合治疗组患者的生活质量高于单纯西药组(Z=-2.430,P=0.015)。⑨其他。治疗过程中,单纯西药组6例应用促红细胞生成素、3例输注血小板,联合治疗组无1例采取上述措施。结论:对于恶性骨肿瘤化疗后骨髓抑制患者,在采用重组人粒细胞集落刺激因子皮下注射治疗的基础上,应用健脾补肾中药口服治疗,可以增加外周血液中白细胞计数、血红蛋白含量及血小板计数,减轻骨髓抑制程度,有利于改善临床症状、提高生活质量,其疗效优于单纯采用重组人粒细胞集落刺激因子皮下注射治疗。

Objective:To observe the effects of Jianpi Bushen(健脾补肾,JPBS)traditional Chinese medicine(TCM)on peripheral hemogram of patients with myelosuppression after chemotherapy for treatment of malignant bone tumors.Methods:Sixty patients with myelosuppression after chemotherapy for malignant bone tumors were enrolled in the study and were randomly divided into 2 groups,30 cases in each group.The patients were treated with combination therapy of subcutaneous injection of recombinant human granulocyte colony-stimu-lating factor(rhG-CSF)and oral application of JPBS TCM(combination therapy group)and monotherapy of subcutaneous injection of rhG-CSF(monotherapy group)respectively for one course of treatment,consecutive 7 days for each course.The white blood cell(WBC)counts,hemoglobin(HGB)contents and platelet counts in peripheral blood were recorded and compared between pretreatment and posttreat-ment and between the 2 groups,and the inhibition degrees of WBC,HGB and platelet were evaluated.Moreover,the improvement of clinical symptoms and life quality of patients in the 2 groups were evaluated at 1 week after the end of the treatment.Results:There was no statisti-cal difference in WBC counts between the 2 groups before the treatment(3.28±0.64 vs 3.19±0.76×10(9)cells/L,t=0.566,P=0.576).The WBC counts were higher at 1 week after the end of the treatment compared to pretreatment in the 2 groups(t=-6.606,P=0.000;t=-3.583,P=0.000),and were higher in combination therapy group compared to monotherapy group(8.68±1.75 vs 4.63±1.20×10(9)cells/L,t=10.954,P=0.000).There was no statistical difference in HGB contents between the 2 groups before the treat-ment(112.47±10.05 vs 108.63±9.67 g/L,t=-1.941,P=0.062).The HGB contents were higher at 1 week after the end of the treat-ment compared to pretreatment in the 2 groups(t=-11.750,P=0.000;t=-5.695,P=0.000),and were higher in combination therapy group compared to monotherapy group(140.83±17.36 vs 126.87±15.56 g/L,t=4.331,P=0.000).There was no statistical difference in platelet counts between the 2 groups before the treatment(121.10±23.51 vs 126.90±30.52×10(9)cells/L,t=-1.250,P=0.221).The platelet counts were higher at 1 week after the end of the treatment compared to pretreatment in the 2 groups(t=-12.528,P=0.000;t=-5.846,P=0.000),and were higher in combination therapy group compared to monotherapy group(224.23±60.28 vs 187.70±55.89×10(9)cells/L,t=2.741,P=0.010).At 1 week after the end of the treatment,the inhibition degree of WBC belonged to grade 0(9 cases),Ⅰ(11 cases),Ⅱ(7 cases)andⅢ(3 cases)in combination therapy group;and belonged to grade 0(4 cases),Ⅰ(7 cases),Ⅱ(8 cases),Ⅲ(6 cases)andⅣ(5 cases)in monotherapy group.The patients in combination therapy group got better inhibition de-gree of WBC compared to the patients in monotherapy group(Z=-2.717,P=0.007).At 1 week after the end of the treatment,the inhibi-tion degree of HGB belonged to grade 0(8 cases),Ⅰ(10 cases)andⅡ(12 cases)in combination therapy group;and belonged to grade 0(3 cases),Ⅰ(10 cases),Ⅱ(6 cases),Ⅲ(6 cases)andⅣ(5 cases)in monotherapy group.The patients in combination therapy group got bet-ter inhibition degree of HGB compared to the patients in monotherapy group(Z=-2.547,P=0.011).At 1 week after the end of the treat-ment,the inhibition degree of platelet belonged to grade 0(11 cases),Ⅰ(13 cases),Ⅱ(4 cases)andⅢ(2 cases)in combination therapy group;and belonged to grade 0(8 cases),Ⅰ(7 cases),Ⅱ(8 cases),Ⅲ(4 cases)andⅣ(3 cases)in monotherapy group.The patients in combination therapy group got better inhibition degree of platelet compared to the patients in monotherapy group(Z=-2.009,P=0.045).At 1 week after the end of the treatment,the clinical symptoms got dramatic improvement in 13 patients,partial in 14 patients and poor in 3 patients in combination therapy group;while the clinical symptoms got dramatic improvement in 7 patients,partial in 12 patients and poor in 11 patients in monotherapy group.The combination therapy group surpassed the monotherapy group in the improvement of clini-cal symptoms(Z=-2.363,P=0.018).At 1 week after the end of the treatment,the life quality was improved in 16 patients,stabilized in 10 patients and reduced in 4 patients in combination therapy group;and was improved in 9 patients,stabilized in 8 patients and reduced in 13 patients in monotherapy group.The combination therapy group surpassed the monotherapy group in the life quality(Z=-2.430,P=0.015).During the treatment period,erythropoietin(6 cases)and platelet transfusion(3 cases)were applied to patients of monotherapy group;while none of these measures was used in patients of combination therapy group.Conclusion:The combination therapy of subcutane-ous injection of rhG-CSF and oral application of JPBS TCM can effectively increase WBC counts,HGB contents and platelet counts in pe-ripheral blood,reduce myelosuppression degree,improve clinical symptoms and promote life quality of patients with myelosuppression after chemotherapy for treatment of malignant bone tumors,and it surpasses the monotherapy of subcutaneous injection of rhG-CSF in the clini-cal curative effects.