健脾益肾法改善晚期大肠癌患者癌因性疲乏的疗效及机制分析

Effect and Mechanism of Jianpi Yishen Method on Improving Cancer-related Fatigue in Patients with Advanced Colorectal Cancer

目的:探讨健脾益肾法对晚期肠癌患者癌因性疲乏症状的改善效果并初步探讨其作用机制,为中医药治疗癌因性疲乏提供客观依据。方法:选取肠癌脾肾亏虚型患者150例,采用数字表法随机分为中药治疗组和对照组,治疗前后分别填写脾肾亏虚型症状分级量表,Piper疲乏量表和功能状态评分(Karnofsky,KPS评分),检测血清细胞因子的含量,探讨细胞因子与癌因性疲乏的关系并比较两组患者治疗前后疲乏程度、中医临床症状、生活质量、血清细胞因子的变化及不良反应的程度。结果:患者的疲乏积分和症状积分呈显著正相关性,且两者均与血清干扰素-γ(IFN-γ),白细胞介素-2(IL-2)及Th1/Th2水平呈负相关性,与IL-4和IL-5则呈正相关性(P<0.05);两组患者在治疗期间未出现明显不良反应且中药治疗组的患者疲乏程度及生活质量的改善均明显优于对照组(P<0.05);两组患者治疗后的血清IFN-γ,IL-2及Th1/Th2水平均明显升高,但中药治疗组升高程度较对照组大(P<0.05);而血清IL-4和IL-5则降低且中药治疗组降低程度更大(P<0.05)。结论:健脾益肾法可纠正Th1/Th2的失衡,有效改善晚期大肠癌患者癌因性疲乏的症状,提高患者的生活质量。

Objective： To investigate the effect and mechanism of Jianpi Yishen method on improving the cancer-related fatigue in patients with advanced colorectal cancer,and to provide objective evidence for the traditional Chinese medicine（ TCM） treatment of cancer-related fatigue. Method： Totally 150 cases of colorectal cancer patients with the spleen and kidney deficiency were collected and randomly divided into Chinese medicine treatment group and control group by using random number table method. They were asked to fill out a spleen and kidney deficiency symptoms rating table, Piper Fatigue Scale and Karnofsky（ KPS） scale before and after treatment. The serum cytokines content was detected, then the relationship between cytokines and the cancerrelated fatigue was investigated. The degree of fatigue,TCM clinical symptoms,quality of life,serum cytokines changes,and the degree of adverse reactions were compared between the two groups before and after treatment.Result： There were significantly positive correlations between the fatigue scores and symptom scores,and these two items were negatively correlated to the levels of interferon-γ（ IFN-γ）,interleukin-2（ IL-2）,and Th1 / Th2 in serum,but were positively correlated to IL-4 and IL-5 levels in colorectal cancer patients（ P〈0. 05）. No obvious adverse reactions were found in patients of both groups during the treatment,and the improvement in fatigue and the quality of life in the Chinese medicine treatment group was significantly better than that in the control group（ P〈0. 05）. The levels of Th1 /Th2,IL-2 and IFN-γ in serum were significantly increased after treatment in two groups,and the increase degree in the Chinese medicine treatment group was higher than that in the control group（ P〈0. 05）; however the levels of IL-4 and IL-5 in serum were significantly decreased after treatment in both groups and the decrease degree in Chinese medicine treatment group was more obvious than that in the control group（ P〈0. 05）. Conclusion： The Jianpi Yishen method can redress the imbalance of Th1 /Th2,and effectively improve the symptoms and the quality of life in the patients with advanced colorectal cancer.