苦参素辅助治疗乙型肝炎相关原发性肝癌的疗效观察

Clinical efficacy and safety of oxymatrine auxiliary treatment for hepatitis B viral hepatitis related primary Hvercancer

目的探讨苦参素辅助治疗乙型肝炎（HBV）相关原发性肝癌（PHC）的临床疗效和安全性。方法将345例已确诊患者采用随机数字表法分组，治疗组174例，对照组171例，对照组行肝动脉化疗栓塞术（TACE）治疗；观察组加用苦参素，比较实体瘤近期疗效、患者免疫功能、肝功能、生存质量的改善情况变化，并观察是否出现不良反应。结果在KPS评分方面，治疗组疗效更佳（z=-3．296，P〈0．05）；实体瘤近期疗效方面治疗组更显著（x2=4．676，P〈0．01）；治疗组免疫功能得到显著改善（组内：t（治疗组CD3）=2．544，t（治疗组：CD4）=2．446，t（治疗组：CD8）=2．745，t（治疗组CD4／CD8）=2．873，t（治疗组：NK）=2．542，t（对照组：CD3）=2．614，t（对照组：CD4）=2．337，t（对照组：CD8）=2．545，t（对照组：CD4／CD8）=2．336，t（对照组：NK）=2．672，P〈0．05；组间：t（治疗后：CD3）=2．947，t（治疗后：CD4）=2．846，t（治疗后：CD8）=2．943，t（治疗后：CD4／CD8）=2．879，t（治疗后：NK）=2．798，P〈0．01）。治疗组在ALT、HBV-DNA、AFP改善方面，疗效均更显著（组内：t（治疗组：ALT）=2．676，t（治疗组．HBV-DNA）=2．682，t（治疗组：AFP）=2．611，P〈0．01，t（对照组：ALT）=2．556，t（对照组：AFP）=2．523，P〈0．05，t（对照组：HBV-DNA）=1．216，P〉0．05；组间：t（治疗后：ALT）=2．417，t（治疗后：AFP）=2．432，P〈0．05，t（治疗后：HBV-DNA）=2．674，P〈0．01）。两组均出现化疗后不良反应，均为消化系统及造血系统异常，治疗组不良事件发生率低于对照组（x2白细胞下降：46．969，x2疼痛=46.977，x2发热=22．499，x2恶心、呕吐=88．749，P〈0．05）。结论苦参素辅助治疗HBV相关PHC疗效确切，安全可靠，能显著改善患者生活质量，值得推广。

Objective To study the clinical efficacy and safety of oxymatrine in auxiliary treatment of hepati- tis B virus （HBV） related primary hepatocellular carcinoma （PHC）. Methods 345 patients were divided into treat- ment group （174 cases） and control group （171 cases）. The control group was given hepatic artery chemoembolization therapy. The treatment group added with oxymatrine. The near future curative effect of solid tumor and patients immune function, liver function, the improvement of the quality of life change, and adverse reaction were observed. Results KPS score of the treatment group was better （ Z = - 3. 296, P 〈 0.05 ）, more significant in the near future curative effect of solid tumor （ X2 = 4. 676, P 〈 0. 01 ）. The immune function of the treatment group was significantly improved [ Within group： t（treatment group,：CD3） = 2. 544, t（treatmentgroup：CD4） = 2. 446, t（treatmentgroup：CDs） = 2. 745, t（treatment, group：CD4/CD8） = 2. 873, t（treatment group：NK） = 2. 542, t（control group：CD3） = 2.614, t （control group：CD4） = 2.337, t（control group：CD8） = 2. 545, t（control group：CD4/CDs） = 2. 336, t〈control group,NK） = 2. 672, P 〈 0. 05 ; Between groups ： t（after treatment：CD3） = 2. 947, t（after trestment, CD4） = 2. 846, t（after treatment,CD8） = 2. 943, t（after treatment,CD4/CD8） = 2. 879, t（after treatment：NK） = 2. 798, P 〈 0.01 ]. In the treatment group, the effect was more significant in the improvement of ALT, HBV - DNA, AFP [ Within group： t（treatment group：ALT） = 2. 676, t（treatment group：HBV-DNA） = 2. 682, t（treatment group：AFP） = 2. 611, P 〈 0. 01, t（control group：ALT） = 2. 556, t（control group：AFP） =2. 523 ,P 〈 0.05, t（control group,HBV-DNA〉 = 1. 216,P 〉 0.05 ; Between groups： t（after treatment：ALT） = 2. 417, t（after treatment：AFP） = 2. 432, P 〈 0.05, t（after treatment ：HBV-DNA） = 2. 674, P 〈 0.01 ], Two groups appeared adverse reaction after chemotherapy,digestive system and hematopoietic system anomaly,the incidence rates of adverse events in the treatment group were lower than those in the control group （ X2 white blood cells decreased = 46.969 2 2 , X2the pain = 46. 977, X2hesting= 2 22. 499, X2nsusea,vomiting = 88. 749, P 〈 0.05 ）. Conclusion The oxymatrine auxiliary treatment for HBV related PHC hascurative effect, safe and reliable, and can significantly improve the patients quality of life, it is worth promoting.