加味五参四苓汤联合逐饮散配合顺铂胸腔化疗对癌性胸水的影响

Effect of Cisplatin Combined with Decoction of Jiaweiwushensiling and Powder of Zuyin in Treating Cancer Hydrothorax

目的观察加味五参四苓汤联合逐饮散敷贴配合顺铂胸腔化疗对癌性胸水的影响。方法 65例恶性胸腔积液患者分为实验组35例,对照组30例。实验组在胸腔抽液后向胸腔内注入顺铂注射液30mg,并予以中药加味五参四苓汤煎服和逐饮散外敷;对照组在抽取胸腔积液后仅向胸腔内注入顺铂注射液30mg;两组均每周两次。比较两组胸水控制疗效,检测胸水肿瘤标志物CEA、CA125、CA153、CYFRA21-1、NSE下降程度和外周血免疫指标T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+变化情况以及观察对生活质量(KPS评分)和不良反应发生的影响。结果实验组控制胸腔积液总有效率85.71%,对照组控制胸腔积液总有效率63.33%(P<0.05);实验组CEA、CA125、CA153、CYFRA21-1和NSE下降程度高于对照组(统计学意义不明显,P>0.05);实验组CD3+、CD4+和CD4+/CD8+比值较本组治疗前明显增高而CD8+下降(P<0.05),并且CD3+、CD4+和CD4+/CD8+比值较对照组也明显增高而CD8+下降(P<0.05);治疗后实验组KPS评分上升例数多于对照组,有效率分别是80.00%和53.33%(P<0.05);两组不良反应比较实验组明显少于对照组。结论加味五参四苓汤联合逐饮散敷贴配合顺铂化疗能有效控制患者胸腔积液,能改善患者的免疫功能和提高生活质量,比单用顺铂治疗癌性胸水患者疗效好。

Objective To evaluate the effect of cisplatin combined with decoction of jiaweiwushensiling and powder of zuyin in treating cancer hydrothorax. Methods This study was divided into two groups：35 cases with cisplatin combined with decoction of jiaweiwushensiling and powder of zuyin in experimental group, 30 cases with cisplatin in control group compared cancer hydrothorax curative effect, detection hydrothorax tumor markers CEA, CA125,CA153,CYFRA21-1,NSE and immune index CD3^＋ ,CD4^＋ ,CD8^＋ and CD4^＋/CD8^＋ value and observation to the life quality（KPS score）and adverse reaction. Results The rate of treating were 85.71% in experimental group and 63.33 % in control group （ P〈 0.05 ） respectively; the value of tumor markers including CEA, CA153, CYFRA21-1 and NSE were reduced more （ no obvious statistical significance, P〉0.05 ） ; CD3^＋ , CD4^＋ and CD4^＋/CD8^＋ were higher but CD8＋ to decrease than before treatment in experimental group（P〈0.05）, and CD3^＋ ,CD4^＋ ,CD4^＋/CD8^＋ were higher but CD8^＋ to decrease in experimental group than the control group（P〈0.05）;KPS score rise cases were 80.00% in experimental group and 53. 33% in control group （P〈0. 05） respectively after treatment; adverse reaction were obviously less in the experimental group than in control group. Conclusion Cisplatin combined with decoction of jiaweiwushensiling and powder of zuyin could effectively control pleural effusion of cancer patients,improve patients, immune function and the quality of life and be more efficacious than only cisplatin in treating cancer hydrothorax.