艾灸联合温阳利水方辅助治疗卵巢恶性肿瘤腹腔积液临床观察

Adjuvant therapy of moxibustion combined with Wenyang Lishui formula for peritoneal effusion of ovarian malignant tumors

目的:观察艾灸联合温阳利水方辅助治疗卵巢恶性肿瘤腹腔积液的临床疗效。方法:将60例卵巢恶性肿瘤腹腔积液患者随机分为观察组和对照组,每组30例。对照组给予紫杉醇脂质体第1天静脉滴注+顺铂第2~4天静脉滴注化疗,21d为一疗程,共治疗4个疗程。观察组在对照组治疗基础上予以艾灸联合温阳利水方辅助治疗,选取命门、脾俞、肾俞、神阙、关元、子宫配合腹部任脉四穴(中脘、水分、气海、中极)施灸,每穴灸30 min,每日1次,持续12周;温阳利水方内服,每日1剂,分2次服用,2周为一疗程,治疗6个疗程。检测两组患者治疗前后外周血CD3^+、CD4^+、CD8^+和CD4^+/CD8^+水平,比较两组患者治疗前后腹腔积液量和Karnofsky功能状态(KPS)评分变化情况,并评定两组临床疗效。结果:观察组患者病情控制率为96.7%(29/30),总体有效率为86.7%(26/30),均显著高于对照组的80.0%(24/30)和56.7%(17/30,P<0.05)。治疗后观察组患者外周血CD3^+、CD4^+和CD4^+/CD8^+水平均明显升高(P<0.01),对照组治疗前后比较差异无统计学意义(P>0.05),观察组治疗后CD3^+、CD4^+、CD4^+/CD8^+的增幅显著高于对照组(P<0.05);治疗后两组患者腹腔积液量均减少(P<0.01),观察组腹腔积液量降幅大于对照组(P<0.05);与治疗前比较,两组患者治疗后KPS评分均明显升高(P<0.01),观察组升幅大于对照组(P<0.05);观察组不良反应发生率低于对照组[23.3%(7/30)vs 53.3%(16/30),P<0.05]。结论:艾灸联合温阳利水方可有效提高卵巢恶性肿瘤腹腔积液患者免疫功能,减少腹腔积液量,提高病情控制率和总体有效率,改善患者生活质量,降低患者化疗过程中不良反应发生率。

Objective To observe the clinical efficacy of adjuvant therapy of moxibustion combined with Wenyang Lishui formula for peritoneal effusion of ovarian malignant tumors. Methods Sixty patients with peritoneal effusion of ovarian malignant tumors were randomly divided into an observation group and a control group, 30 cases in each group. The patients in the control group were treated with intravenous infusion of paclitaxel liposome at the first day and cisplatin at the 2 nd to 4 th day, 21 days as a course of treatment, and 4 courses were given. Based on the treatment of the control group, the patients in the observation group were treated by moxibustion combined with Wenyang Lishui formula. Moxibustion was applied at Mingmen(GV 4), Pishu(BL 20), Shenshu(BL 23), Shenque(CV 8), Guanyuan(CV 4), Zigong(EX-CA 1), Zhongwan(CV 12), Shuifen(CV 9), Qihai(CV 6) and Zhongji(CV 3), each acupoint for 30 min, once a day for 12 weeks.Wenyang Lishui formula was taken twice orally, one dose a day, 2 weeks as a course of treatment, and 6 courses were given. The levels of CD3^+, CD4^+, CD8^+ and CD4^+/CD8^+ in peripheral blood were measured before and after 12-week treatment in the two groups. The changes of peritoneal effusion volume and Karnofsky performance status scale(KPS) score before and after treatment were compared between the two groups, and the clinical efficacy of the two groups was evaluated. Results The symptom improvement rate was 96.7%(29/30) and overall effective rate was 86.7%(26/30) in the observation group, which were significantly superior to those in the control group [80.0%(24/30) and 56.7%(17/30), P<0.05]. After treatment, the levels of CD3^+, CD4^+ and CD4^+/CD8^+ in peripheral blood were significantly increased in the observation group(P<0.01), there was no significant difference in the control group before and after treatment(P>0.05), and the increase in the observation group was significantly higher than that in the control group(P<0.05). After treatment, the volume of peritoneal effusion in the two groups was decreased(P<0.01), and the reduced volume in the observation group was higher than that in the control group(P<0.05). After treatment, KPS scores were increased significantly in both two groups(P<0.01),and the increase in the observation group was higher than that in the control group(P<0.05). The incidence rate of adverse reactions in the observation group was lower than that in the control group [23.3%(7/30) vs 53.3%(16/30), P<0.05]. Conclusion Moxibustion combined with Wenyang Lishui formula could effectively improve the immune function, reduce the volume of peritoneal effusion, improve the symptom improvement rate, overall effective rate and the quality of life, and reduce the incidence of adverse reactions in chemotherapy of patients with peritoneal effusion of ovarian malignant tumors.