益气养阴解毒方治疗晚期非小细胞肺癌临床疗效观察

Clinical Effect of Yiqi Yangyin Jiedu Decoction in Treating Patients with Advanced Non-small Cell Lung Cancer

目的观察益气养阴解毒方治疗晚期非小细胞肺癌的临床疗效和作用机理。方法将60例气阴两虚型晚期肺癌患者随机分为3组。中药组以益气养阴解毒方加减(黄芪30g北沙参30g天冬15g麦冬15g女贞子12g石上柏30g石见穿30g七叶一枝花30g等)治疗;化疗组以NP方案或GP方案治疗,化疗加中药组以益气养阴解毒方加化疗治疗,两个周期后进行疗效判定。结果治疗后中药组气阴两虚证候改善的总有效率(80%)与化疗加中药组(35%)和化疗组(20%)比较,差异有统计学意义(χ2=18·688,P<0·01);中药组、化疗加中药组卡氏评分增加稳定率分别为90%、85%,高于化疗组(75%),其中中药组与化疗组比较,差异有统计学意义(χ2=12,P<0·05);中药加化疗组疾病控制率为89·47%,高于中药组(72·22%)和化疗组(77·78%),3组间比较差异无统计学意义(P>0·05);化疗加中药组治疗后CD3+T细胞具有上升趋势(P=0·05),与中药组、化疗组比较,差异有统计学意义(P<0·05,P<0·01)。化疗加中药组治疗后CD4+T细胞升高明显(P<0·05),化疗组治疗后CD4+T细胞下降,两者比较差异有统计学意义(P<0·05)。化疗组治疗后CD4+/CD8+比值明显下降(P<0·05),化疗加中药组治疗后CD4+/CD8+比值有升高趋势(P=0·06)。中药组、化疗加中药组治疗后CD8+CD2+8T细胞明显上升(P<0·01、P<0·05),化疗组治疗后CD8+CD2+8T细胞有下降趋势(P=0·06),与化疗加中药组比较,差异有统计学意义(P<0·05)。结论益气养阴解毒方能够明显改善气阴两虚型晚期肺癌患者气阴两虚证候,提高生活质量,其作用机理可能是通过增加T细胞活性、增强辅助性T细胞及杀伤性T细胞功能,全面提高了T细胞介导的细胞免疫。

Objective To observe the clinical therapeutic effect and mechanism of Yiqi Yangyin Jiedu Decoction （ YYJD, a Chinese herbal recipe for strengthening qi, nourishing yin and removing toxic substance, consisting of milkvetch root 30 g, glehnia root 30 g, asparagus root 15 g, lilyturf root 15 g, grossy privet fruit 12 g, spikemoss herb 30 g, Chinese sage herb 30 g, manyleaf paris rhizome 30 g, etc. ） in treating patients with advanced non- small cell lung cancer （NSCLC）. Methods Sixty patients with advanced lung cancer of qi-yin deficiency syndrome were randomized into three groups： the TCM group （A） treated with YYJD, the chemotherapy group （B） treated by chemotherapy with NP or GP protocol, and the combined treated group （C） treated with YYJD and chemotherapy in combination. The efficacy was evaluated after two cycles of treatment. Results The total effective rate for alleviating qi-yin deficiency syndrome in group A was 80%, significantly higher than that in Group C and B （35% and 20% , P 〈0. 01 ） respectively. The KPS increasing and stabilizing rate in Group A and C was 90% and 85% respectively, significantly higher than that in Group B （75%） , and difference between A and B was significant （P 〈 0.05）. In Group C after treatment, CD3^＋ showed a rising trend （P = 0.05）, different to that in Group A and B （P 〈 0.05 and P 〈 0. 01 ） ; CD4 significantly increased （P 〈 0. 05） and CD4/CDs ratio showed increasing trend （P = 0. 06 ）, while in Group B both were decreased significantly, showed significantly difference （P 〈 0. 05）. CD8^＋ CD28^＋ significandy increased after treatment in Group A and C （P 〈 0. 01 and P 〈 0. 05 ）, but showeddecreasing trend （P = 0. 06） in Group B, significant difference was shown between B and C （P 〈 0. 05 ）. Conclusion YYJD can ameliorate the qi-yin deficiency syndrome evidently in advance lung cancer patients; improve their quality of life, the mechanism might be by way of enhancing T-lymphocyte activity and killer T-cell function, to elevate the T-cell mediated immunity in a round way.