中医辨证治疗140例中晚期大肠癌术后患者的临床分析

Clinical Analysis of 140 Cases of Postoperative Advanced Colorectal Cancer Treated by Syndrome Differentiation

目的:探讨中医辨证治疗对中晚期大肠癌术后患者的疗效及预后的影响。方法:采用随机对照研究方法,选取ⅡB-ⅢC期大肠癌术后患者140例作为治疗组,以辨证汤药配合化疗治疗;同期选取ⅡB-ⅢC期大肠癌术后患者70例作为对照组,以单纯化疗治疗。比较两组患者的生存情况、复发转移情况及相关免疫指标、肿瘤指标的变化,同时将可能对大肠癌术后的预后产生影响的因素导入Cox风险比例模型进行多因素分析。结果:①治疗组的中位生存期为25.2个月,对照组为18.5个月;治疗组1年、3年生存率分别为87.86%、72.14%,对照组分别为85.71%、62.86%。治疗组复发转移率为22.86%,对照组为24.29%。其中,治疗组中位生存期明显长于对照组,且治疗组3年生存率显著高于对照组(P<0.05),两组的复发转移率及复发转移出现时间未见显著性差异(P>0.05)。②生存期Cox风险比例模型的多因素分析提示,疾病分期是影响预后的不利因素,中医治疗时间,中医治则中温补肾阳、补血养阴的用药原则是影响预后的有利因素;转移时间Cox风险比例模型的多因素分析提示,中医治疗时间、中医治则中理气的用药原则是影响转移的有利因素。③治疗后,治疗组CD4 T淋巴细胞的比例较治疗前明显上升,且治疗后治疗组CD4 T淋巴细胞的比例较对照组亦明显升高(P<0.05)。结论:中医辨证治疗可以延长中晚期大肠癌术后患者的生存期,改善免疫状态,特别是温补肾阳、补血养阴的中医治则对患者预后具有一定的积极作用。

Objective： To explore the effects of the treatment of syndrome differentiation on patients of postoperative advanced colorectal cancer.Methods： 210 cases were randomized into treatment group（n=140） and control group（n=70）.The treatment group was treated by decoction of syndrome differentiation and chemotherapy and the control group was treated by chemotherapy only.The survival situation,recurrence and metastasis,related immunologic and carcinoma indexes were observed.Cox regression analyses were performed to determine all the favorable factors of survival.Results： ① Median survival of treatment group was 25.2 months and the control group was 18.5 months;one-and three-year survival rates of treatment group were 87.86% and 72.14% and the control group were 85.71% and 62.86%.The rates of recurrence and metastasis of treatment group and control group were 22.86% and 24.29% respectively.Median survival of treatment group was higher than control group and the three-year survival rate of treatment group was higher than control group（P0.05）.② The carcinoma stage was the adverse factor and the time of TCM treatment and the therapeutic principles of ＂warming kidney yang＂and ＂invigorating blood to nourish yin＂were the favorable factors through Cox model analysis related survival.The time of TCM treatment and the therapeutic principle of ＂regulating qi＂ were the favorable factors through Cox model analysis related metastasis.③ After treatment the ratio of CD4 T lymphocyte in treatment group was higher than that before treatment and that in control group（P0.05）.Conclusion： The treatment of syndrome differentiation can enhance survival period and improve the immune situation.