贞芪六君抑癌汤联合调强放疗对乳腺癌术后患者免疫功能影响及安全性的临床研究

A clinical study on the effect of the Zhenqi Liujun Yiai decoction plus intensity modulated radiotherapy on immune function of postoperative breast cancer patients and its safety

目的:探讨贞芪六君抑癌汤联合调强放疗(Intensity Modulated Radiotherapy,IMRT)对乳腺癌术后患者免疫功能的影响并观察其安全性。方法:以2020年3月―2022年3月于西南医科大学附属中医医院肿瘤科治疗的42例乳腺癌术后辅助放疗的患者为研究对象,采用随机对照的方法分为对照组和研究组,每组21例。对照组采用单纯IMRT,放疗剂量:根治术后50Gy/25F,保乳术后60Gy/25F,每周5次,共放疗5周。研究组在同对照组相同放疗方案的基础上配合贞芪六君抑癌汤治疗,贞芪六君抑癌汤由女贞子、黄芪、人参、茯苓、白术、陈皮、姜半夏、薏苡仁、当归、白花蛇舌草、建曲、麦芽、甘草等多味中药组成,患者在接受放疗第1天开始服用,直至放疗结束。治疗结束后比较两组T淋巴细胞亚群的变化及不良反应(骨髓抑制、胃肠道反应、肝肾功能异常)。结果:治疗前两组CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)的差异无统计学意义(P>0.05),治疗后研究组CD4^(+)、CD4^(+)/CD8^(+)的水平高于对照组,差异有统计学意义(P<0.05),治疗后两组CD8^(+)的水平均减低,且研究组CD8^(+)的降低程度高于对照组,但差异无统计学意义(P>0.05)。治疗期间,研究组骨髓抑制、胃肠道反应发生率低于对照组(P<0.05),两组肝肾功能异常发生率的差异无统计学意义(P>0.05)。结论:对乳腺癌术后辅助放疗患者采用贞芪六君抑癌汤联合IMRT可以改善患者的细胞免疫功能,减轻骨髓抑制、胃肠道反应。

Objective:To observe the effect of the Zhenqi Liujun Yiai decoction(贞芪六君抑癌汤)plus intensity modulated radiotherapy on immune function of postoperative breast cancer patients and its safety.Methods:A total of 42 patients with postoperative breast cancer who were treated in the Oncology Department of the Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University from March 2020 to March 2022 were selected as the research subjects.They were divided into the control group and the study group by randomized control method,with 21 patients in each group.The control group was treated by simple IMRT radiotherapy at a dose of 50Gy/25F after radical surgery and 60Gy/25F after breast conserving surgery,5 times a week,for a total of 5 weeks.On the basis of the same radiotherapy scheme in the control group,the study group was additionally given the Zhenqi Liujun Yiai decoction.The Zhenqi Liujun Yiai decoction was composed of many TCM medicines,such as Ligustrum lucidum,Astragalus membranaceus,Ginseng,Poria Cocos,Atractylodes atractylodes,Tangerine peel,Pinellia ginger,Coix seed,Angelica sinensis,Oldenlandia,Jianqu,malt,licorice,etc.The patient started taking it on the first day after receiving radiotherapy,until the end of radiotherapy.After treatment,the changes of T lymphocyte subsets and adverse reactions(myelosuppressin,gastrointestinal reaction,liver and kidney dysfunction)were compared between the two groups.Results:Before treatment,there were no statistically significant differences in CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)between the two groups(P>0.05).After treatment,the levels of CD4^(+)and CD4^(+)/CD8^(+)in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).The levels of CD8^(+)in both groups were decreased after treatment.The decrease of CD8^(+)in the study group was higher than that in the control group,but the difference was not statistically significant(P>0.05).During the treatment period,the incidence of myelosuppression and gastrointestinal reactions in the study group was lower than that in the control group(P<0.05),and there was no significant difference in the incidence of liver and kidney dysfunction between the two groups(P>0.05).Conclusion:The Zhenqi Liujun Yiai decoction plus intensity modulated radiotherapy can improve cellular immune function and reduce myelosuppression and gastrointestinal reactions in breast cancer patients with postoperative adjuvant radiotherapy.