蒿芩清胆汤合当归补血汤防治胃癌化疗后胃肠道反应及骨髓抑制的临床观察

Clinical Observation of Haoqin Qingdan Decoction Combined with Danggui Buxue Decoction in Preventing Gastrointestinal Reaction and Myelosuppression after Gastric Cancer Chemotherapy

目的观察蒿芩清胆汤合用当归补血汤防治胃癌化疗后症状改善、胃肠道反应、骨髓抑制、增强免疫功能的作用并分析其机理。方法观察胃癌化疗患者56例,随机分为两组,对照组予为含奥沙利铂的中度致吐性方案化疗,每21 d为1个治疗周期,观察1个周期。治疗组在对照组基础上予蒿芩清胆汤合当归补血汤治疗,疗程为3周,观察两组治疗前后的中医证候积分、胃肠道反应情况及胃肠激素水平、骨髓抑制发生情况,血淋巴细胞百分比。结果治疗后中医证候积分比较,治疗组治疗3周后(11.53±3.45)分低于对照组治疗3周后(17.07±2.45)分(P<0.05);两组治疗后治疗组恶心呕吐、腹泻、便秘、腹胀发生率明显低于对照组,其中恶心呕吐发生率治疗组(28.6%,8/28)低于对照组(67.9%,19/28),差异具有统计学意义(P<0.05);两组治疗后胃肠激素含量均较治疗前有变化,治疗3周后治疗组的胃动素(MOT)为(477.21±26.9) ng/L,胃泌素(GAS)为(107.88±18.56) ng/L,优于治疗3周后对照组的MOT(413.79±23.7) ng/L、GAS(123.79±22.30) ng/L;治疗组化疗后Ⅱ度以上骨髓抑制发生率为14.29%(4/28),优于对照组的32.14%(9/28);对照组化疗后CD4/CD8下降明显,差异有统计学意义(P<0.05),而治疗组上述细胞水平变化不大,差异无统计学意义(P>0.05)。结论蒿芩清胆汤与当归补血汤联合应用于胃癌化疗患者,可调节胃肠激素,改善中医证候,减轻胃肠道反应,改善骨髓抑制,增强免疫功能。

Objective To observe the effect of Haoqin Qingdan Decoction combined with Danggui Buxue Decoction on prevention and treatment of gastric cancer after chemotherapy,gastrointestinal reaction,myelosuppression and enhancement of immune function andanalyze its mechanism.Methods A total of 56 patients with gastric cancer chemotherapy were enrolled.They were randomly divided into two groups.The control group was treated with moderate vomiting regimen containing oxaliplatin.One treatment cycle was 21 days,and one cycle was observed.On the basis of the control group,the treatment group was treated with Haoqin Qingdan Decoction combined with Danggui Buxue Decoction for 3 weeks.The TCM syndrome scores,gastrointestinal reactions,gastrointestinal hormone levels and myelosuppression in the two groups were observed before and after treatment.And we counted the percentage of blood lymphocytes.Results After treatment,the scores of TCM syndromes were compared.After 3 weeks of treatment,the score was(11.53 ± 3.45) points in the treatment group and was lower than the control group’s(17.07 ± 2.45) points(P<0.05).After treatment,the incidence of constipation,abdominal distension,nausea,vomiting and diarrhea in the treatment group was significantly lower than that of the control group.The incidence of nausea and vomiting was lower in the treatment group(28.6%,8/28) than that in the control group(67.9%,19/28),and the difference was statistically significant(P<0.05).There were changes before treatment.After 3 weeks of treatment,the motilin(MOT) of the treatment group was(477.21 ± 26.9)ng/L,and the gastrin(GAS) was(107.88 ± 18.56) ng/L,which was better than those before treatment.After 3 weeks,the control group’s MOT was(413.79 ± 23.7) ng/L and GAS(123.79 ± 22.30) ng/L.The myelosuppression rate of II degree or higher in the treatment group was 14.29%(4/28),which was better than that of the control group(32.14%,9/28).After CD4/CD8 decreased significantly,the difference was statistically significant(P<0.05),but the level of the above cells in the treatment group did not change much,and the difference was not statistically significant(P>0.05).Conclusion Haoqin Qingdan Decoction combined with Danggui Buxue Decoction can be used in gastric cancer chemotherapy patients to regulate gastrointestinal hormones,thereby improving TCM syndromes,reducing gastrointestinal reactions,improving bone marrow suppression and enhancing immune function.