邓老金福安汤治疗中晚期非小细胞肺癌的临床观察

Therapeutic Effect of Professor Deng's Jinfu An Decoction on Intermediate and Advanced Non-small Cell Lung Cancer

【目的】观察邓老金福安汤治疗中晚期非小细胞肺癌(NSCLC)的临床疗效。【方法】按简单随机法将90例患者分为化疗组(Ⅰ组)、单纯中药组(Ⅱ组)、中西医综合治疗组(Ⅲ组)3组,每组30例。Ⅰ组单纯采用化疗方案治疗,Ⅱ组采用金福安汤(由生南星、生半夏、太子参、苇茎、生薏仁、桃仁、浙贝母、守宫、山慈菇、丹参等组成)治疗,Ⅲ组采用金福安汤与化疗综合治疗。3周为1周期,2周期为1个疗程。观察各组患者临床症状积分改善情况,瘤体变化、生存质量、体质量、免疫功能和血液流变学等指标的改善情况以及毒副反应情况。【结果】治疗后3组患者的各项临床症状积分均较治疗前显著下降(P<0.05或P<0.01),在咳嗽、血痰、气短、乏力等症状缓解方面,Ⅱ组、Ⅲ组显著优于Ⅰ组(P<0.05或P<0.01):在胸痛方面,Ⅰ组、Ⅲ组的效果显著优于Ⅱ组(P<0.05)。在瘤体变化方面,Ⅰ组、Ⅱ组、Ⅲ组的有效率分别为20.00%、3.33%、16.67%,Ⅰ组、Ⅲ组与Ⅱ组比较有显著性差异(P<0.01),Ⅲ组与Ⅰ组比较无显著性差异(P>0.05);而稳定率Ⅰ组为86.67%,Ⅱ组为66.67%,Ⅲ组为90.00%,Ⅰ组、Ⅲ组显著优于Ⅱ组(P<0.05),Ⅰ组与Ⅲ组比较无显著性差异(P>0.05)。在卡氏评分方面,治疗后Ⅱ组、Ⅲ组卡氏评分均较治疗前有显著改善(P<0.05或P<0.01),Ⅰ组卡氏评分较治疗前虽有一定提高,但无显著性差异(P>0.05),提示Ⅱ组、Ⅲ组在改善生存质量方面显著优于Ⅰ组(P<0.05或P<0.01),Ⅱ组与Ⅲ组比较无显著性差异(P>0.05)。在体质量变化方面,治疗后Ⅱ组、Ⅲ组体质量增加,与Ⅰ组比较差异有显著性意义(P<0.05或P<0.01)。在免疫功能方面,治疗后Ⅱ组、Ⅲ组患者的淋巴细胞转化率(LBT)及T细胞亚群CD_4^+、CD_4^+/CD_8^+比值等均较治疗前显著增高,CD_8^+水平则显著下降(均P<0.05),Ⅱ组、Ⅲ组与Ⅰ组治疗后比较均有显著性差异(P<0.01)。治疗后Ⅱ组、Ⅲ组血液流变学各项指标均较治疗前有显著改善(P<0.05),Ⅰ组除血浆黏度有改善(P<0.05)外,其他指标均无显著改善(P>0.05)。在毒副反应方面,Ⅱ组治疗前后均无明显变化,Ⅲ组发生毒副反应较Ⅰ组显著减轻(P<0.05)。【结论】邓老金福安汤具有良好的临床效果,能够改善中晚期NSCLC患者主要临床症状,提高患者免疫力,降低血液黏稠度,配合化疗时可减轻化疗毒副反应。

Objective To observe the therapeutic effect of Professor Deng＇s Jinfu An Decoction （JAD） on intermediate and advanced non-small cell lung cancer （NSCLC）. Methods Ninety patients with intermediate and advanced NSCLC were equally randomized into 3 groups. Group Ⅰ received routine chemical therapy （CT）, group Ⅱ received oral use of JAD, which is mainly composed of raw Arisaema cum Bile, raw Rhizoma Pinelliae, Radix Pseudostellariae, Culmus Phragmitis, Poria, Semen Persicae, Bulbus Fritillariae Thunbergii, Gekko Chinensis, Pseudobulbus Cremastrae seu Pleiones, Radix Salviae Mihiorrhizae, and group Ⅲ received JAD ＋ CT. Three weeks constituted one phase, two phases constituted one treatment courses, and the treatment lasted 2 courses. The changes of clinical symptom and signs scoring, tumor mass, immune function, hemorrheological indexes, and quality of life （QOL） as well as body weight and toxic and side reactions were observed in the three groups. Results The symptom scores decreased in the 3 groups obviously （P 〈0. 05 or P 〈0. 01 compared with those before treatment）, the relief of cough, bloody sputum, shortness of breath, lassitude was obvious in groups Ⅱ and Ⅲ （P 〈0.05 or P 〈0.01 compared with group Ⅰ）, and the relief of chest pain was obvious in groups Ⅰ and Ⅲ （P 〈 0. 05 compared with group Ⅱ）. The effective rate on reducing tumor mass was 20.00% in group Ⅰ and 16. 67% in group Ⅲ, higher than 3.33% in group Ⅱ （P 〈0. 01 ） ; the stable rate was 86. 67% in group Ⅰ and 90. 00% in group Ⅲ, higher than 66.67% in group Ⅱ （ P 〈 0. 05 ）. The Karnofsky scores were improved obviously in groups Ⅱ and Ⅲ （P 〈 0. 05 compared with those before treatment ） after treatment, but the difference of Karnofsky scores before and after treatment in group Ⅰ was insignificant （ P 〉 0. 05 ）. Between the 3 groups, the improvement of QOL in groups Ⅱ and Ⅲ differed from that in group Ⅰ （P 〈0. 05 or P 〈0. 01 ）. The effective rate on body weight 86. 67% in group Ⅱ and 76.67% in group Ⅲ, higher than 53.33% in group Ⅰ （P 〈0. 05 or P 〈0. 01 ）. The lymphocyte transformation rate and CD4^＋ , CD4^＋/CD8^＋ of T lymphocyte subtypes were obviously improved in groups Ⅱ and Ⅲ （P 〈0. 05 or P 〈0. 01 compared with those before treatment）, but the imbalance of T lymphocyte subtypes got worse in group Ⅰ （P 〈 0. 01 compared with groups Ⅱ and Ⅲ ）. As for the hemorrheological indexes, the whole blood low-shear viscosity, whole blood high-shear viscosity and plasma viscosity were improved in groups Ⅱ and Ⅲ （P 〈 0. 05 compared with those before treatment）, while in group Ⅰ , only the improvement of plasma viscosity was obvious （P 〈 0. 05 compared with those before treatment）. No obvious relief of toxic and side reactions was found in group Ⅱ, but the relief in group Ⅲ was obvious as compared that in group Ⅰ （ P 〈 0.05）. Conclusion Professor Deng＇s Jinfu An Decoction can relieve the main symptoms, increase the immune function and QOL, decrease the blood viscosity and reduce the toxic and side reactions induced by chemical therapy in patients with intermediate and advanced non-small cell lung cancer.