扶正清鼻方辅助放疗治疗鼻咽癌40例

Adjuvant Radiotherapy Treatment of Fuzheng Qingbi Decoction on Nasal Pharyngeal Cancer with 40 Cases

目的:探讨扶正清鼻方辅助放疗治疗鼻咽癌(NPC)放射性口腔黏膜损伤及对血浆脱氧核糖核酸(EBV-DNA),血清EB病毒衣壳抗原抗体(VCA-IgA)和早期抗原抗体(EA-IgA)的影响。方法:将80例NPC患者随机按入诊前后顺序分为对照组和观察组各40例。对照组进行放疗+对症支持治疗。观察组在对照组治疗的基础上加服扶正清鼻方,1剂/d。两组疗程均为12周。观察放射性口腔黏膜损伤出现时间及程度,于第3,7周进行生活质量评分;采用聚合酶链式反应法(PCR)检测血浆EBV-DNA水平;采用酶联免疫吸附剂测定(ELISA)检测血清VCA-IgA和EA-IgA水平。结果:治疗后第3周,观察组放射性口腔黏膜损伤Ⅲ级反应发生率为40%,对照组为57.5%,差异无统计学意义;观察组Ⅳ级反应发生率为2.5%,对照组为17.5%,差异有统计学意义(P<0.05);治疗后第7周,观察组Ⅲ级反应发生率为55%,对照组为70%;治疗组Ⅳ级反应发生率为7.5%,对照组为25%,差异有统计学意义(P<0.05);对照组出现放射性口腔黏膜反应时间为(18.5±2.8)d,观察组为(15.5±2.7)d,观察组晚于对照组(P<0.01);治疗后观察组血浆EBV-DNA水平低于对照组(P<0.01);治疗后观察组血清VCA-IgA和EA-IgA水平低于对照组(P<0.01)。结论:扶正清鼻方能减轻鼻咽癌放射性口腔黏膜损伤,并能抑制咽癌血清EB病毒,降低血清病毒抗体水平,这可能对NPC复发或转移抑制作用。

Objective： Discuss adjuvant radiotherapy treatment of Fuzheng Qingbi decoction in treating oral mucosa injury of nasal pharyngeal cancer （NPC） and influence to epstein-barr virus-deoxyribonucleic acid （EBV-DNA） in plasma, serous EB virus capsid antigen （VCA-IgA） and early antigen antibody （EA-IgA）. Method： Eighty patients with NPC were randomly divided into control group （40 cases） and observation group （40 cases ） according to the order of admission. Patients in the control group received radiotherapy and symptomatic and supportive treatment. Based on the control group, patients in the observation group added Fuzheng Qingbi decoction, and Fuzheng Qingbi decoction, 1 dose/day, Course of treatment in two groups were 12 weeks. The time and degree of oral mucosa injury were observed, quality of life was graded at the third and seventh week after treatment. The level of EBV-DNA in plasma was detected by polymerase chain reaction （PCR）. And the level of serous VCA-IgA and EA-IgA were detected by enzyme-linked immuno sorbent assay （ELISA）. Result： At the third week after treatment, incidence rate of Ⅲ level oral mucosa injury in observation group was 40% which was 57.5% in control group, statistical significance from the differences between two groups. Incidence rate of Ⅳ level in observation group was 2.5% which was 17.5% in control group, which means a statistical significance from the differences between two groups （P 〈 0.05）. At the seventh week after treatment, incidence rate of Ⅲ level oral mucosa injury in observation group was 55% which was 70% in control group. And incidence rate of Ⅳ level in observation group was 7.5% which was 25% in control group, statistical significance from the differences between two groups （P 〈 0.05）. The time of oral mucosa injury in control group were （18.5 ± 2.8） d which were （15.5 ±2.7） d observation group later than the control group, incidence time observation group was later than in control group （P 〈 0.01 ）. After treatment, level of EBV-DNA in plasma in observation group was lower than in control group （P 〈0.01 ）. And the level of serous VCA-IgA and EA-IgA in observation group were lower than those in control group （P 〈 0.01 ）. Conclusion： Fuzheng Qingbi decoction can relieve oral mucosa injury of nasal pharyngeal cancer, restrain EB virus in plasma of pharyngeal cancer and reduce level of serous virus antibody, it may have the inhibiting effect to relapse or transfer of NCP.