清燥救肺汤加减对晚期非小细胞肺癌化疗患者生活质量和生存期的影响

Effect of Modified Qingzao Jiufei Tang on Quality of Life and Survival Period of Patients with Non-small Cell Lung Cancer

目的:探讨清燥救肺汤加减辅助化疗对非小细胞肺癌(NSCLC)生活质量和生存期的影响及对免疫功能和细胞因子的调节作用。方法:将120例患者随机分为对照组和观察组各60例。两组患者均采用紫杉醇+顺铂化疗的综合治疗方案;对照组口服益肺清化颗粒,2袋/次,3次/d。观察组给予清燥救肺汤加减,化疗第1天开始内服,1剂/d,至化疗结束后12周。记录患者6个月和1年的生存率,记录生存期;进行治疗前后肺癌生活质量量表(FACT-L 4.0)评分;进行治疗后安德森症状评估量表(MDASI-C)评分;检测治疗前后白细胞分化抗原(CD)3^+,CD4^+,CD8^+,CD4^+/CD8^+,自然杀伤细胞(NK),细胞角蛋白19片段21-1(CYFRA21-1),鳞状细胞癌抗原(SCC-Ag),神经元特异性烯醇化酶(NSE),血管内皮生长因子(VEGF),核转录因子(NF)-κB,细胞间黏附分子-1(ICAM-1)和转化生长因子-β(1 TGF-β1)水平。结果:观察组6个月生存率为78.33%(47/60),高于对照组的60.00%(36/60)(χ^2=4.728,P<0.05);观察组1年生存率为48.33%(29/60),高于对照组的30.00%(18/60)(χ^2=4.232,P<0.05);观察组生存期为15个月长于对照组的11个月(P<0.01);观察组患者FACT-L总分和各个因子评分均高于对照组(P<0.01);观察组患者疾病症状群、胃肠道症状群、疲乏症状群和情绪症状群评分均低于对照组(P<0.01);症状群对生活乐趣等6个方面日常生活的影响评分也均低于对照组(P<0.01);观察组NK,CD3^+,CD4^+和CD4^+/CD8^+水平均高于对照组(P<0.05),CD8+低于对照组(P<0.05);观察组TGF-β1,NF-κB,ICAM-1和VEGF水平均低于对照组(P<0.01);观察组患者CYFRA21-1,SCC-Ag和NSE水平均低于对照组(P<0.01)。结论:清燥救肺汤辅助用于中晚期NSCLC化疗患者可延长生存期,并提高生存率,减轻了症状群对日常生活的影响,提高了生活质量,并可抑制肿瘤标志和细胞因子表达,稳定了机体免疫功能,对于NSCLC预后的改善具有积极的临床意义。

Objective:To discuss the efficacy of modified Qingzao Jiufei Tang combined with adjuvant chemotherapy on quality of life and survival period of patients with non-small cell lung cancer(NSCLC)and the moderation effect on immune function and cytokines.Method:One hundred and twenty patients were randomly divided into control group(60 cases)and observation group(60 cases)by random number table.Patients in two group got paclitaxel and cisplatin chemotherapy.The control group took Yifei Qinghua granules orally,2 bags/time,3 times/day.In addition to the therapy of control group,patients in observation group were added with modified Qingzao Jiufei Tang from the first day after chemotherapy to the 12th week after chemotherapy,1 dose/day.Six-month and one-year survival rates and survival period were recorded.Before and after treatment,lung cancer quality of life scale(FACT-L 4.0)and M.D.Anderson Symptom Inventory(MDASI-C)were scored.And levels of CD3^+,CD4^+,CD8^+and CD4^+/CD8^+,natural killer cells(NK),cytokeratin 19 fragment 21-1(CYFRA21-1),squamous cell carcinoma antigen(SCC-Ag),neuron-specific enolase(NSE),vascular endothelial growth factor(VEGF),nuclear transcription factor-κB(NF-κB),intercellular adhesion molecule 1(ICAM-1),transforming growth factor(TGF)-β1 were all detected.Result:The 6-month survival rate of in observation group was 78.33%(47/60),which was higher than 60.00%(36/60)in control group(χ^2=4.728,P<0.05).The one-year survival rate in observation group was 48.33%(29/60),which was higher than 30.00%(18/60)in control group(χ^2=4.232,P<0.05).And the survival period in observation group was 15 months,which was longer than 11 months in control group(P<0.01).And scores of FACT-L and various factors were all higher than those in control group(P<0.01).Scores of disease symptoms,gastrointestinal symptoms,fatigue symptoms and emotional symptoms were all lower than those in control group(P<0.01),and scores of effect of symptoms on daily life in six aspects,such as enjoyment of life,were all lower than those in control group(P<0.01).And levels of NK,CD3^+,CD4^+and CD4^+/CD8^+were higher than those in control group(P<0.05),while levels of CD8^+,TGF-β1,NF-κB,ICAM-1,VEGF,CYFRA21-1,SCC-Ag and NSE were all lower than those in control group(P<0.01).Conclusion:Modified Qingzao Jiufei Tang combined with adjuvant chemotherapy can prolong the survival time,improve the survival rate,alleviate the effect of symptoms on daily life,improve the quality of life,inhibit the expression of tumor markers and cytokines,and stabilize the immune function of the body,with a positive clinical significance in improving the prognosis of NSCLC.