桂枝茯苓汤对卵巢癌术后患者外周血T淋巴细胞亚群、血清肿瘤标志物及凝血水平变化的影响

Effects of Guizhi Fuling Decoction on Peripheral Blood T Lymphocyte Subsets,Serum Tumor Markers in Patients with Ovarian Cancer after Operation and Coagulation Level Change

目的:探究桂枝茯苓汤对卵巢癌术后患者外周血T淋巴细胞亚群及血清肿瘤标志物水平的影响。方法:选取2017年3月至2018年3月海南省肿瘤医院收治的卵巢癌术后患者88例作为研究对象,按照随机数字表分为对照组和观察组,每组44例,对照组肿瘤细胞减灭术并配合紫杉醇、卡铂化疗,化疗6个周期,观察组加用桂枝茯苓汤治疗6周期。观察2组治疗前、治疗后肿瘤标志物:人附睾分泌蛋白(HE4)、糖类抗原125(CA125)、糖类抗原199(CA199)、T淋巴细胞亚群和免疫球蛋白含量,血小板(PLT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、全血高切黏度、全血低切黏度、SF-36生命质量评分变化并比较;治疗过程中进行不良反应监测,包括胃肠道反应、肝肾功能损害、骨髓抑制、皮疹等;治疗后进行疗效比较。结果:治疗后2组CA125、CA199、HE4较治疗前均显著下降,差异有统计学意义(P<0.05),且观察组患者以上指标均显著低于对照组,差异有统计学意义(P<0.05)。对照组治疗前、治疗后PLT、PT、APTT、TT、FIB、全血高切黏度、全血低切黏度比较,差异无统计学意义(P>0.05),观察组治疗后PLT、FIB、全血高切黏度、全血低切黏度较治疗前显著下降,PT、APTT、TT则显著升高,且PT、APTT、TT显著高于对照组,PLT、FIB、全血高切黏度、全血低切黏度显著低于对照组,差异有统计学意义(P<0.05)。治疗后2组患者生理职能、生理功能、社会功能、心理健康、情感职能、躯体疼痛、活力维度评分均较治疗前均显著升高,差异有统计学意义(P<0.05),且观察组各维度评分均显著高于对照组,差异有统计学意义(P<0.05)。治疗后2组CD3+、CD4+、CD4+/CD8+、IgA、IgM较治疗前均显著升高,CD8+较治疗前显著下降(P<0.05),且观察组CD8+显著低于对照组,余均显著高于对照组,差异有统计学意义(P<0.05)。观察组药物不良反应率显著低于对照组,差异有统计学意义(P<0.05)。结论:桂枝茯苓汤能改善卵巢癌术后患者外周血T淋巴细胞亚群,提高免疫力,抑制肿瘤标志物,改善高凝状态,从而提高疗效,改善生命质量,不良反应发生率低。

Objective: To explore the effects of Guizhi Fuling Decoction on T lymphocyte subsets and serum tumor markers in patients with ovarian cancer after operation. Methods: A total of 88 patients with ovarian cancer after operation were enrolled in Hainan Tumor Hospital from March 2017 to March 2018.They were randomly divided into a control group(44 cases)and an observation group(44 cases)according to random number table.The control group received cytoreductive surgery combined with paclitaxel and carboplatin chemotherapy for 6 cycles.The observation group was treated with Guizhi Fuling Decoction for 6 cycles.Tumor markers:human epididymal secretory protein(HE4),carbohydrate antigen 125(CA125),carbohydrate antigen 199(CA199),T lymphocyte subsets and immunoglobulin content platelet(PLT),prothrombin time(PT),partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),whole blood high and low cutting viscosity,SF-36 life quality score changes were observed before and after treatment.In the course of treatment,adverse reactions were monitored,including gastrointestinal reactions,liver and kidney function damage,bone marrow suppression,rash,etc.The curative effects were compared after treatment. Results: After treatment,CA125,CA199 and HE4 in the 2 groups were significantly lower than those before treatment( P <0.05),and the above indexes in the observation group were significantly lower than those in the control group( P <0.05). 2)There was no significant difference in PLT,PT,APTT,TT,FIB,whole blood high cutting viscosity and whole blood low cutting viscosity before and after treatment in the control group( P >0.05).PLT,FIB,whole blood high cutting viscosity and whole blood low cutting viscosity in the observation group decreased significantly after treatment,while PT,APTT and TT increased significantly.PT,APTT and TT were significantly higher than those in the control group,PLT,FIB and whole blood low cutting viscosity were significantly higher than those before treatment.The high cutting viscosity and low cutting viscosity of whole blood were significantly lower than those of the control group( P <0.05). 3)After treatment,the scores of physiological function,physiological function,social function,mental health,emotional function,physical pain and vitality of the 2 groups were significantly increased than those before treatment( P <0.05),and the scores of each dimension of the observation group were significantly higher than those of the control group( P <0.05). 4)After treatment,the levels of CD3 +,CD4 +,CD4 +/CD8 +,IgA and IgM in the 2 groups were significantly increased than those before treatment,and the levels of CD8 + in the observation group were significantly lower than those in the control group( P <0.05),and the rest were significantly higher than those in the control group( P <0.05). 5)The rate of adverse drug reactions in the observation group was significantly lower than that in the control group( P <0.05). Conclusion: Guizhi Fuling Decoction can improve T lymphocyte subsets in peripheral blood of patients with ovarian cancer after operation,improve immunity,inhibit tumor markers and improve hypercoagulable state,thereby improving curative effect,improving quality of life with low incidence of adverse reactions.