三焦针刺与参芪扶正汤口服联合化疗对Ⅲ~Ⅳ期结直肠癌患者免疫及CEA、CA724的影响

Effect of Sanjiao Acupuncture and Shenqi Fuzheng Decoction(仙芪扶正颗粒)Combined with Chemotherapy on Immunity,CEA and CA724 in Colorectal Cancer Patients at StageⅢ~Ⅳ

目的分析三焦针刺与参芪扶正汤口服联合化疗对Ⅲ~Ⅳ期结直肠癌患者免疫及CEA、CA724的影响,探讨有效疗法,为临床提供参考依据。方法选取该院2019年10月—2020年10月收治的72例Ⅲ~Ⅳ期结直肠癌患者,根据不同疗法将其纳入A组与B组,每组36例,A组应用化疗治疗,B组应用化疗以及三焦针刺与参芪扶正汤口服联合化疗治疗,对比两组患者的近期疗效(完全缓解、部分缓解、稳定、进展)、远期疗效(中位生存期、无进展生存期)、免疫功能指标(CD3+、CD4+、CD8+、CD4+/CD8+)、肿瘤标记物(CEA、CA724)以及不良反应(恶心呕吐、便秘、白细胞减少、神经毒性)。结果B组近期疗效的有效率为66.7%(24/36)、控制率为88.9%(32/36),A组近期疗效的有效率为41.7%(15/36)、控制率为66.7%(24/36),B组的有效率、控制率均高于A组(P<0.05);B组的中位生存期为(13.7±3.0)个月、无进展生存期为(7.0±1.5)个月;A组的中位生存期为(10.5±2.7)个月、无进展生存期(4.8±1.1)个月,B组的中位生存期、无进展生存期均长于A组(P<0.05);在免疫功能相关指标方面,治疗前,两组CD3+、CD4+、CD8+、CD4+/CD8+均无明显差异,治疗后,B组患者的CD3+为(63.5±6.2)%、CD4+为(43.6±5.8)%、、CD4+/CD8+为1.7±0.5;治疗后A组治疗后的组患者的CD3+为(58.7±7.1)%、CD4+为(38.3±4.8)%、、CD4+/CD8+为1.4±0.4;B组明显高于A组,差异具有统计学意义(P<0.05);B组治疗后的CD8+为(23.1±4.0)%,A组治疗后的CD8+为(26.3±4.9)%,B组明显低于A组,差异具有统计学意义(P<0.05);在肿瘤标志物方面,治疗前两组患者的CEA与CA724差异均无统计学意义,B组治疗后的CEA为(26.4±4.9)ng/mL、CA724为(21.3±7.7)U/mL、A组治疗后的CEA为(37.9±6.8)ng/mL、CA724为(27.3±9.2)U/mL,两组差异均具有统计学意义(P<0.05)。经治疗后,B组的不良反应发生共13例,总发生率为36.1%(13/36),A组的不良反应发生共12例,总发生率为33.3%(12/36),经卡方检验,两组差异无统计学意义(P>0.05)。结论三焦针刺与参芪扶正汤口服联合化疗治疗Ⅲ~Ⅳ期结直肠癌的近期疗效与远期疗效均较好,可提高患者的免疫功能,改善CEA、CA724水平,与单纯化疗治疗相比不增加不良反应,值得推行。

Objective To analyze the effect of Sanjiao acupuncture combined with Shenqi Fuzheng Decoction(仙芪扶正颗粒)on immunity,CEA and CA724 in colorectal cancer patients at stageⅢ~Ⅳand explore the effective therapy,so as to provide reference for clinical practice.Methods A total of 72 colorectal cancer patients at stageⅢ~Ⅳin our hospital from October 2019 to October 2020 were selected and divided into group A and group B according to different therapies,with 36 cases in each group.Group A was treated with chemotherapy,while group B was treated with chemotherapy and Sanjiao acupuncture combined with Shenqi Fuzheng Decoction.The short term efficacy(complete remission,partial remission,stability,progression),long-term efficacy(median survival,progression free survival),immune function(CD3+,CD4+,CD8+,CD4+/CD8+),tumor markers(CEA,CA724)and adverse reactions(nausea and vomiting,constipation,leukopenia,neurotoxicity)were compared.Results The short-term effective rate and control rate of group B were 66.7%(24/36)and 88.9%(32/36),respectively,while those of group A were 41.7%(15/36)and 66.7%(24/36),respectively.The effective rate and control rate of group B were higher than those of group A(P<0.05).The median survival time of group B was(13.7±3.0)months and the progression free survival time was(7.0±1.5)months.The median survival time and progression free survival time in group A were(10.5±2.7)months and(4.8±1.1)months,respectively.The median survival time and progression free survival time in group B were longer than those in group A(P<0.05).Before treatment,there was no significant difference in CD3+,CD4+,CD8+or CD4+/CD8+between the two groups.After treatment,in group B,CD3+was(63.5±6.2)%,CD4+was(43.6±5.8)%,and CD4+/CD8+was 1.7±0.5.In group A after treatment,CD3+was(58.7±7.1)%,CD4+was(38.3±4.8)%,and CD4+/CD8+was 1.4±0.4.The difference was statistically significant(P<0.05).In group B,CD8+was(23.1±4.0)%and that in group A was(26.3±4.9)%.That in group B was significantly lower than that in group A(P<0.05).In terms of tumor markers,there was no significant difference in CEA or CA724 between the two groups before treatment,the CEA of group B was(26.4±4.9)ng/mL,CA724 was(21.3±7.7)U/mL,and the CEA of group A was(37.9±6.8 ng/mL),CA724 was(27.3±9.2)U/mL.There was significant difference between the two groups(P<0.05).After treatment,there were 13 cases of adverse reactions in group B,with a total incidence of 36.1%(13/36),and 12 cases in group A,with a total incidence of 33.3%(12/36).By chi square test,there was no significant difference between the two groups(P>0.05).Conclusion Sanjiao acupuncture and Shenqi Fuzheng Decoction combined with chemotherapy in the treatment of colorectal cancer at stageⅢ~Ⅳhas good short-term and long-term efficacy.The treatment can improve the immune function of patients,improve the levels of CEA and CA724,and does not increase adverse reactions compared with chemotherapy alone,which is worthy of promotion.