加味芍药甘草汤联合硫酸吗啡缓释片治疗气血两虚证癌性疼痛疗效及对患者疼痛介质、炎症因子的影响

Clinical Efficacy of Modified Shaoyao Gancao Tang Combined with Morphine Sulfate Sustained Release Tablet for Cancer Pain with Qi and Blood Deficiency Syndrome and Effect on Pain Mediators and Inflammatory Factors

目的:探讨气血两虚证癌性疼痛(癌痛)应用加味芍药甘草汤联合硫酸吗啡缓释片治疗的临床效果。方法:选取2017年1月至2018年1月本院收治的128例癌痛患者,运用随机数字表法将这128例患者随机分成观察组与对照组,各64例。对照组口服硫酸吗啡缓释片治疗,观察组联合口服加味甘草芍药汤治疗。记录比较两组疼痛缓解临床疗效,治疗前后疼痛介质5-羟色胺(5-hydroxytryptamine,5-HT),前列腺素E2(prostaglandin E2,PGE2),内皮素-1 (endothelin-1,ET-1),P物质(substance P,SP),炎症因子肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α),白细胞介素-1β(interleukin 1β,IL-1β),白细胞介素-2(interleuki-2,IL-2),白细胞介素-6(interleuki-6,IL-6)水平变化,不良反应发生情况。结果:治疗4周后,观察组总有效率为90. 6%,较对照组(76. 6%)明显升高(P <0. 05)。与本组治疗前比较,两组治疗后各疼痛介质(5-HT,PGE2,ET-1,SP)血清含量及血清TNF-α,IL-1β,IL-6浓度均明显减少(P <0. 05),血清IL-2浓度均明显增高(P <0. 05);且观察组改善更明显(P <0. 05)。观察组不良反应率为15. 6%(10/64)较对照组23. 4%(15/64)略低,但差异无统计学意义。结论:气血两虚证癌痛应用加味芍药甘草汤联合硫酸吗啡缓释片治疗能明显缓解患者疼痛症状,降低外周疼痛介质水平,调节炎性细胞因子表达,疗效显著,患者耐受性良好。

Objective:To explore the clinical efficacy of modified Shaoyao Gancao Tang and morphine sulfate sustained release tablet for cancer pain with Qi and blood deficiency syndrome.Method:The I28cases with caner pain in our hospital from January 2017to January 2018were selected as research objectives,and divided into observation group (64cases)and control group (64cases)randomly.Morphine sulfate sustained release tablets were given to both group for oral treatment,and modified Shaoyao Gancao Tang was additionally given to observation group.The clinical efficacy for pain relief between two groups,the changes in pain mediators [serotonin 5-hydroxytryptamine (5-HT),prostaglandin E2(PGE2),endothelin-1(ET-1),substance P (SP)] and inflammatory factors [tumor necrosis factor (TNF)-α,interleukin (IL)-1β,IL-2,IL-6]after treatment and incidence of adverse reactions were recorded and compared.Result:After 4weeks treatment,the overall effective rate was 90.6%in observation group,significant higher than 76.6%in control group (P <0.05).Compared withthose before treatment,the serum levels of pain mediators (5-HT,PGE2,ET-1,SP),TNF-α,IL-lβ and IL-6 were decreased significantly in both groups after treatment (P <0.05),and IL-2level in serum was increased significantly (P <0.05);in addition,the improvement was more obvious in observation group (P <0.05).The incidence of adverse reactions was 15.6%(10/64)in observation group,slightly lower than 23.4%(15/64)in the control group,with no statistically significant difference between two groups.Conclusion:Modified Shaoyao Gancao Tang combined with morphine sulfate sustained release tablet could significantly relieve the pain symptoms, reduce the level of peripheral pain mediators,regulate the expression of inflammatory factors with significant effect in the treatment of cancer pain with qi and blood deficiency syndrome,showing good patient tolerance.