补肺化瘀汤辅助治疗非小细胞肺癌的临床疗效及其对血清一氧化氮和血管内皮生长因子水平的影响研究

Clinical and Serological Responses to Bufeihuayu Decoction Adjuvant Therapy in Patients with Non-small Cell Lung Cancer

背景肺癌是当今威胁人类生命健康的第一杀手,而非小细胞肺癌发生率占肺癌的70%~80%,放化疗是治疗非小细胞肺癌的主要措施,但难以获得令人满意的治疗效果。补肺化瘀汤是治疗肺癌的临床经验方,对常见肺部疾病和肺癌均有一定的疗效,但现有研究仅局限于补肺化瘀汤治疗非小细胞肺癌的疗效,对其作用机制的研究鲜见报道。目的观察补肺化瘀汤辅助治疗非小细胞肺癌患者的临床疗效,及其对患者血清一氧化氮(NO)、血管内皮生长因子(VEGF)水平的影响。方法选择2015年1月-2017年12月在广西中医药大学附属瑞康医院进行治疗的非小细胞肺癌患者87例,采用随机平行对照研究,将患者分为对照组(n=43)和观察组(n=44)。对照组采用常规一线化疗方案(长春瑞滨+顺铂)进行化疗,观察组在对照组基础上加用补肺化瘀汤,1剂/d,3周为1个疗程,治疗2个疗程。比较两组患者治疗后的临床疗效,治疗前后血清NO、VEGF水平、外周血T淋巴细胞水平、中医证候评分、生存质量[KPS评分、健康调查简表(SF-36)评分]以及毒副作用发生情况。结果观察组总有效率、稳定率高于对照组(P<0.05)。治疗后观察组血清NO、VEGF水平低于对照组(P<0.05);治疗后观察组外周血CD3^+T淋巴细胞、CD4^+T淋巴细胞、CD4^+/CD8^+水平均高于对照组,CD8^+T淋巴细胞水平低于对照组(P<0.05)。治疗后观察组中医证候评分、KPS评分、SF-36评分高于对照组(P<0.05)。观察组脱发、胃肠道反应、骨髓抑制、腹泻发生率低于对照组(P<0.05)。结论补肺化瘀汤辅助治疗非小细胞肺癌能明显提高临床疗效,下调血清NO、VEGF水平,改善患者细胞免疫功能、生存质量,减轻化疗带来的毒副作用。

Background Lung cancer is the first killer threatening human life and health.The incidence of non-small cell lung cancer(NSCLC)accounts for 70%to 80%of lung cancer.Radiotherapy and chemotherapy are the main measures to treat NSCLC,but it is difficult to obtain satisfactory therapeutic effect.Bufeihuayu Decoction is a clinical experience prescription for the treatment of lung cancer.It has certain curative effect on common lung diseases and lung cancer.However,the existing research is limited to the curative effect of Bufeihuayu Decoction on NSCLC,and its mechanism is rarely reported.Objective To explore NSCLC patients’clinical response and serological response[changes in serological markers of both nitric oxide(NO)and vascular endothelial growth factor(VEGF)]to Bufeihuayu decoction,an adjuvant therapy.Methods This randomized,double-blind study was conducted in 87 cases of NSCLC from Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine from January 2012 to December 2015.Patients were divided into control group(n=43)and observation group(n=44)by randomized parallel control study.Both groups received vinorelbine plus cisplatin,a conventional chemotherapy program as first-line therapy,in addition,the observation group received Bufeihuayu decoction[for 2 courses of treatment(once daily,3 weeks as a course of treatment)].Comparisons were made between the two groups in terms of clinical response[assessed by TCM syndrome score and quality of life evaluated by the Karnofsky Performance Scale(KPS)and SF-36],serological response(evaluated by serum NO and VEGF),immune response(evaluated by peripheral T-lymphocyte subsets)and safety(evaluated by the incidence of toxicity and side effects)during the treatment period.Results After treatment,compared with the control group,the observation group had much higher overall response rate,and rate of achieving stable disease(P<0.05),significantly lower serum NO and VEGF levels(P<0.05),obviously higher levels of peripheral CD3+T cells,CD4+T cells and CD4+/CD8+ratio,and much lower level of CD8+T cells(P<0.05).Moreover,the TCM syndrome score,KPS score and SF-36score in the observation group were significantly better than those in the control group(P<0.05).The incidence of alopecia,gastrointestinal reactions,myelosuppression,and diarrhea was much lower than that of the control group(P<0.05).Conclusion As an adjuvant therapy to first-line chemotherapy for NSCLC,Bufeihuayu decoction can significantly enhance the overall clinical response,down-regulate the levels of serum NO and VEGF,improve the cellular immune function and quality of life,and reduce the side effects caused by chemotherapy.