增液白虎汤配合切脉针灸对鼻咽癌放疗后吞咽障碍效果及VCA-IgA、Rta-lgG、SA抗体水平影响

Effect of Acupuncture and Moxibustion Combined with Zengye Baihu Decoction Combined with Radiotherapy on Dysphagia after Treatment of Nasopharyngeal Carcinoma and Its Effect on VCA-IgA,Rta-lgG and SA Antibody Levels

目的探讨增液白虎汤配合切脉针灸辅助治疗鼻咽癌(Nasopharyngeal carcinoma,NPC)对患者放疗后吞咽障碍(Swallowing disorders,SD)临床疗效和EB病毒壳抗原免疫球蛋白A(VCA-IgA)、EB病毒Rta蛋白抗体免疫球蛋白G(Rta-lgG)、唾液酸(SA)抗体水平影响。方法选择2015年6月-2017年4月于我院确诊并行治疗的鼻咽癌放疗后SD患者83例,按照随机数字表法将患者分为联合组(n=41)和对照组(n=42)。两组患者均使用增液白虎汤,而联合组在对照组基础上加行切脉针灸治疗,完成全部治疗后对患者进行为期2年的随访。观察两组患者末次随访时吞咽困难症状的疗效,治疗前及末次随访时吞咽功能评价,生活质量评分,血清EB病毒抗体水平及治疗不良反应情况之间的差异。结果联合组患者治疗总有效率90.24%与对照组总有效率71.42%相比显著较高(P<0.05)。联合组末次随访时患者饮水试验平均等级,流质、半流质及固态形态食物吞咽功能评价量表(vadeofluroscopic dysphagia scale,VDS)评分及世界卫生组织生存质量测定量表(World Health Organization Quality of Life instrument-brief,WHOQOLBREF)评分同对照组比较差异显著(P<0.05)。联合组末次随访时VCA-IgA滴度为1∶20及以下人数较对照组显著较高,而血清Rta-lgG及SA含量则显著较低(P<0.05)。两组患者不良反应人数比较无显著差异(P=0.223)。结论在增液汤基础上加用切脉针灸能有效治疗NPC患者放疗后SD,其效果优于单纯使用增液白虎汤治疗。

Objective To investigate the clinical efficacy of Zengye Baihu Decoction combined with acupuncture and moxibustion for the treatment of nasopharyngeal carcinoma(NPC)in patients with dysphagia(SD)and the effects of VCA-IgA,Rta-lgG and SA antibody levels.Methods 84 patients with SD after NPC radiotherapy who were diagnosed concurrently in our hospital from June 2015 to April 2017 were enrolled.Patients were divided into a combination group(n=41)and a control group according to a random number(n=42).The two groups of patients were treated with Zengye Baihu Decoction,while the combined group was treated with acupuncture and moxibustion on the basis of the control group.The patients were followed up for 2 years after completing all treatments.The efficacy of dysphagia symptoms at the last follow-up of the two groups was observed,and the differences in swallowing function evaluation,quality of life score,serum EBV antibody levels,and adverse drug treatment were measured before and at the last follow-up.Results The total effective rate of the combined group was significantly higher than that of the control group(P<0.05).At the last follow-up of the combined group,the average grade of drinking water test,fluid,semi-liquid and solid-state food VDS scores and WHOQOL-BREF scores were significantly different from those of the control group(P<0.05).At the last follow-up of the combined group,the VCAIgA titer of 1∶20 and below was significantly higher than the control group,while the serum Rta-lgG and SA levels were significantly lower(P<0.05).There was no significant difference in the number of adverse events between the two groups(P=0.223).Conclusion Adding acupuncture and moxibustion on the basis of Zengye Baihu Decoction can effectively treat SD in patients with NPC after radiotherapy.The effect is due to the simple treatment of Zengye Baihu Decoction.