养肺消积解郁方治疗晚期非小细胞肺癌并发抑郁的临床研究

Clinical Research on Yangfei Xiaoji Jieyu Decoction for Advanced Non-Small Cell Lung Cancer Patients with Depression

目的:观察养肺消积解郁方对非小细胞肺癌化疗并发抑郁的临床疗效。方法:纳入NSCLC伴有抑郁情绪的患者38例,随机分为中药组及对照组,两组均以化疗为基础治疗。观察用药4周后抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)及Karnofsky评分变化,并对其中26例伴有睡眠障碍患者用匹斯堡睡眠指数(PSQI)进行睡眠质量评估,观察治疗前后PSQI变化。同时观察患者中位无疾病进展生存期。结果:用药4周后中药组的SDS及HAMD得分分别为(48.88±7.44)和(8.12±2.89),明显低于对照组(54.24±3.71)和(11.62±1.89)(均P<0.05);中药组抑郁治疗有效率82.4%,明显高于对照组42.8%的有效率(P=0.017);中药组治疗后PSQI总分(10.21±1.58),明显低于治疗前(15.36±5.05)(P=0.001);治疗组生活质量改善率为88.3%,对照组为57.1%,治疗组优于对照组(P=0.036);治疗组中位疾病PFS为(8±0.69)个月,对照组(5±0.67)个月,治疗组优于对照组(P=0.01)。结论:抑郁情绪状态影响NSCLC患者的生活质量,并可能缩短了晚期NSCLC的中位PFS,促进了NSCLC患者的化疗耐药。养肺消积解郁方能够有效缓解NSCLC患者的抑郁情绪,提高睡眠质量,改善患者的生活质量,减轻或缓解抑郁情绪对PFS的影响或延缓抑郁可能导致的过早化疗耐药。

Objective： To study the effect of Yangfei Xiaoji Jieyu Decoction for advanced non-small cell lung cancer patients with depression. Methods： Thirty-eight cases of advanced NSCLC-related depression were randomized into 2 groups： Chinese medicine group and control group. Patients accepted based chemotherapy and were assessed by self-rating depression scale（ SDS） and Hemilton depression rating scale（ HAMD） scores after treatment for four weeks. Sleep quality of 26 patients with sleep disorders were assessed by Pittsburgh Sleep Quality Index（ PSQI） to observe PSQI changes before and after the treatment.Quality of life（ QOL） of 38 patients was assessed by Karnofsky score before and after the treatment. Progression-free survival（ PFS） was observed according to 2 years follow-up. Results： Before and after treatment,the SDS and HAMD scores of Chinese medicine group were 48. 88 ± 7. 44 and 8. 12 ± 2. 89,significantly lower than those of the control group 54. 24 ± 3. 71 and 11. 62± 1. 89（ P〈0. 05）. PSQI score of Chinese medicine group was 10. 21 ± 1. 58 after treatment,significantly lower than 15. 36 ± 5.05 before treatment（ P = 0. 001）. The improvement rate of QOL was 88. 3% and 57. 1% in the Chinese medicine group and the control group respectively with significant difference（ P = 0. 036）. The median PFS was 8 ± 0. 69 and 5 ± 0. 67 months in the Chinese medicine group and the control group respectively with significant difference（ P = 0. 01）. Conclusion： Depressive state affects the life quality of NSCLC and may shorten the median PFS of advanced NSCLC patients and promotes resistance to chemotherapy.Yangfei Xiaoji Jieyu Decoction can effectively relieve depression in patients with NSCLC,improve sleep quality and quality of life and reduce the effects of depression on PFS and may delay premature resistance to chemotherapy caused by depression.