肺癌Ⅳ号方联合化疗治疗老年非小细胞肺癌患者的病例对照研究

Lung cancer 1V recipe combined with chemotherapy in treating non-small cell lung cancer in the elderly： a case-control study

目的观察肺癌Ⅳ号方配合化疗对兼具“热毒”表现的中晚期老年非小细胞肺癌（NSCLC）患者的临床疗效观察。方法选取我科2013年4月至2014年10月收治的70岁以上中晚期NSCLC并兼具“热毒”表现的患者77例，随机分为化疗组39例，化疗＋中药组38例，脱落13例（对照组5例，中药组8例），两组患者均给予化疗的基础上，观察患者加用中药后卡氏评分、有效率、中医主症，及治疗前、后第1、56天超敏C反应蛋白（hs-CRP）及肿瘤标志物中癌胚抗原（CEA）、烯醇化酶（NSE）、肿瘤相关物质检测（TSGF）的变化。结果两组患者治疗后治疗有效率分别为20．0％、23．5％，两组比较差异无统计学意义（P〉o．05）。但加用中药组卡氏评分、中医主症明显改善，分别为36．7％比26．5％和80．0％比58．8％，组间比较差异皆有统计学意义（χ2=2．721、6．731，P〈0．05）。hs-CRP、CEA、NSE、TSGF水平在用药前后两组组问比较差异无统计学意义（P〉0．05），但hs-CRP水平两组自身比较皆较治疗前降低，中药组降低更加明显分别为51．47％、23．77％，且差异有统计学意义（χ2=19．713，P〈0．05）。结论肺癌Ⅳ号方可改善兼具“热毒”症候的老年肺癌患者的主要临床症状，提高其生活质量，且老年肺癌患者的化疗耐受性可。并发现中医“热毒”症候与患者hs—CRP水平具有相关性，推测其可能为该症候的物质基础。

Objective To explore the therapeutic effect of lung cancer IV recipe combined with chemotherapy on treating middle and advanced stages of non-small cell lung cancer （NSCLC） in the elderly. Methods A total of 77 NSCLC patients in middle and advanced stages aged 70 years and over who had heat-toxin syndrome in traditional Chinese medicine （TCM） were selected from Apr. 2013 to Oct. 2014 in our hospital. Patients were randomly divided into chemotherapy group （n= 39） and chemotherapy ＋ herbs group （n= 38）. Karnofsky assessment scale （KPS）, effective rate, symptom and sign in traditional Chinese medicine, changes in the levels of high-sensitivity c-reactive protein （hs-CRP）, carcino-embryonic antigen （CEA）, neuron specific enolase （NSE）, tumor special growth factor （TSGF） were observed before and 1 and 56 days after treatment. Results There was no significant difference in effective rate between the two groups （P〉0.05）. The KPS and symptom and sign in TCM were improved significantly in chemotherapy ＋ herbs group as compared with chemotherapy group （36.7% vs 26.5%, 80.0% vs 58.8%, respectively （χ2 =2. 721,6. 731,both P〈0.05）. There were no significant differences in hs-CRP, NSE, CEA, TSGF levels between two groups before and after treatment （P〉0.05）, but hs-CRP level in both groups was decreased after treatment as compared to pre-treatment and the decvease was more obvious in chemotherapy ＋herbs group （51.47% vs. 23.77%, χ2 = 19. 713, P〈0.05）. Conclusions Lung cancer 1V recipe can improve the main clinical symptoms, quality of life and tolerance to chemotherapy in NSCLC patients with heat-toxin manifestation in TCM. There is a correlation between heat toxin syndrome and hs- CRP level in NSCLC patients, which shows that hs-CRP probably is the material basis of the heat toxin syndrome in TCM.