清肺益气汤联合GP方案治疗晚期非小细胞肺癌的疗效观察

Clinical efficiency of Qingfeiyiqi decoction combined with GP scheme in treatment of advanced non-small cell lung cancer

目的观察清肺益气汤联合GP(吉西他滨+顺铂)方案治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法2013年3月至2019年4月收治的56例晚期NSCLC患者随机分为对照组和观察组,每组28例。患者均接受水化、止吐药+地塞米松治疗,对照组第1天给予吉西他滨1000 mg/m2,第1~3天予以顺铂注射液30 mg/m2,3周重复。观察组在对照组基础上加用清肺益气汤200 ml。以上方案每3周为1个疗程,完成2个疗程后,观察2组患者临床疗效、临床症状改善情况、T细胞免疫功能、凝血功能、毒副反应、治疗前后肿瘤标志物CEA水平、生活质量及生存时间。结果观察组总有效率为64.3%明显高于对照组的32.0%,差异有统计学意义(P<0.05)。观察组咳嗽、乏力、纳差症状改善情况明显高于对照组(P<0.05)。治疗前2组患者T细胞免疫功能及凝血状态差异无统计学意义(P>0.05);治疗后观察组患者CD+8水平显著下降,CD+3、CD+4、CD+4/CD+8水平显著升高;纤维蛋白原(FIB)、D-二聚体(D-D)水平均显著低于治疗前和对照组,差异有统计学意义(P<0.05)。治疗前,白细胞、血小板和血红蛋白2组间差异无统计学意义(P>0.05);对照组治疗后白细胞、血小板和血红蛋白均较治疗前明显降低(P<0.01)。治疗后观察组白细胞、血小板及血红蛋白均无明显变化与治疗前比较差异无统计学意义(P>0.05)。观察组出现消化道反应(呕吐)9例,出现Ⅱ度呕吐1例,对照组出现(呕吐)23例,其中出现Ⅱ度及以上呕吐患者10例,2组差异有统计学意义(P<0.05);观察组肝功能损害3例,其中Ⅰ度损害2例,Ⅱ度损害1例,对照组患者出现肝功能损害4例,Ⅰ度损害2例,Ⅱ度损害1例,Ⅲ度损害1例;2组差异无统计学意义(P>0.05);观察组肾功能不全2例,Ⅰ度损害1例,Ⅱ度损害1例,对照组肾功能不全3例,Ⅰ度损害1例,Ⅱ度损害2例,2组差异无统计学意义(P>0.05)。2组患者治疗前后CEA水平差异无统计学意义(P>0.05)。治疗后观察组CEA水平较治疗前显著降低,差异有统计学意义(P<0.01),对照组CEA水平较治疗前也有降低,差异有统计学意义(P<0.05)。2组治疗前生活质量评分差异无统计学意义(P>0.05);治疗后观察组生活质量评分明显低于对照组(P<0.05)。观察组中位生存期为10.2个月明显长于对照组的7.6个月,差异有统计学意义(P<0.05)。结论清肺益气汤联合GP方案可显著提高晚期NSCLC患者的临床疗效,明显改善晚期NSCLC患者的临床症状,免疫功能和凝血状态,减少化疗药物的毒副反应,提高患者的生活质量,延长生存期。

Objective To observe the clinical efficiency of Qingfeiyiqi decoction combined with GP(Gemcitabine+Cisplatin)scheme in treatment of advanced non-small cell lung cancer(NSCLC).Methods Fifty-five patients with advanced NSCLC were randomly divided into control group(n=28)and observation group(n=28).All patients were treated with hydration,antiemetic and dexamethasone after admission.The patients in control group were given 1,000mg/m2 of gemcitabine on the first day and 30mg/m2 of cisplatin injection on the first 1~3 days,with three weeks as a period.The patients in observation group were,on the basis of the control group,treated with Qingfei Yiqi Decoction,with three weeks as a period.After two periods,the clinical efficacy,clinical symptoms,T cell immune function,coagulation function,side effects,the level of tumor markers CEA before and after treatment,life quality and survival time of patients were observed and compared between the two groups.Results Before treatment,there were no significant differences in T cell immune function,coagulation status and life quality scores between the two groups(P>0.05)and there were no significant differences in white blood cells,platelets and hemoglobin was found between the two groups(P>0.05).After treatment,the total effective rate in observation group was 64.3%,which was significantly higher than that(32.0%)in control group(P<0.05).The improvementrate of clinical symptoms including cough,fatigue andanorexia in observation group was significantly higherthan that of control group(P<0.05).The levels ofCD+8 were significantly decreased,while the levelsof CD+3,CD+4 and CD+4/CD+8 were significantlyincreased in observation group.The levels ofproprotein(FIB)and dimmer(DD)in observation group were significantly lower than those before treatment and those in control group(P>0.05).Moreover,the white blood cells,platelets and hemoglobin in control group were significantly decreased(P<0.01),but there were no significant changes in white blood cells,platelets and hemoglobin in observation group(P>0.05).Furthermore,there were one case of gradeⅡvomiting and 9 cases of gastrointestinal reaction in observation group,however,there were 10 cases of gradeⅡ/above vomiting and 23 cases of gastrointestinal reaction in control group(P<0.05).There were 3 cases of liver function damage(1case of gradeⅠand 2 cases of gradeⅡ)in observation group and 4 cases of liver function damage(2 cases of gradeⅠ,one case of gradeⅡand one cases of gradeⅢ)in control group(P>0.05).There were 2 cases of renal insufficiency(one case of gradeI and one case of gradeⅡ)in observation group and 3 cases of renal insufficiency(one case of gradeI and 2 cases of gradeⅡ)in control group(P>0.05).In addition,the levels of CEA in both groups were significantly decreased(P<0.05).There were no significant differences in the levels of CEA before and after treatment(P>0.05).Before treatment,there were no significant differences in life quality scores between the two groups(P>0.05),however,after treatment the life quality scores in observation group were significantly lower than those in control group(P<0.05).The median survival time in observation group(10.2 months)was significantly longer than that(7.6 months)in control group(P<0.05).Conclusion Qingfeiyiqi decoction combined with GP scheme can significantly improve the clinical efficacy in treatment of advanced NSCLC,improve the clinical symptoms,immune function and coagulation status of patients,reduce the side effects of chemotherapy drugs,improve the life quality of patients and prolong survival time.