复方苦参注射液联合化学治疗和调强适形放射治疗中晚期宫颈癌疗效观察

Effect of Fufang Kushen Zhusheye combined with chemotherapy and intensity modulated radiation therapy in treatment of advanced cervical cancer

目的探讨复方苦参注射液联合化学治疗和调强适形放射治疗中晚期宫颈癌的临床效果。方法选择2014年6月至2017年8月西安交通大学第二附属医院收治的中晚期宫颈癌患者90例为研究对象,根据随机数字表法将患者分为观察组和对照组,每组45例。2组患者均给予顺铂、多西他赛化学治疗(DP化学治疗方案)和调强适形放射治疗;在此基础上,观察组患者给予复方苦参注射液治疗。2组患者治疗12周后进行疗效判定及生活质量评估,并观察2组患者治疗期间不良反应发生情况;分别于治疗前及治疗12周后检测血清基质金属蛋白酶-9(MMP-9)、骨桥蛋白(OPN)、白细胞介素-2(IL-2)、γ干扰素(IFN-γ)、白细胞介素-6(IL-6)、白细胞介素-4(IL-4)水平;所有患者治疗后随访2 a,统计患者1、2 a生存率。结果观察组和对照组患者总有效率分别为64.44%(29/45)、42.22%(19/45),观察组患者总有效率显著高于对照组(χ2=4.464,P<0.05)。治疗12周后,观察组患者生活质量显著高于对照组(χ2=2.065,P<0.05)。治疗前2组患者血清MMP-9、OPN水平比较差异无统计学意义(P>0.05),2组患者治疗12周后血清MMP-9、OPN水平显著低于治疗前(P<0.05);治疗12周后,观察组患者血清MMP-9、OPN水平显著低于对照组(P<0.05)。治疗前2组患者血清IL-6、IL-4、IL-2、IFN-γ水平比较差异无统计学意义(P>0.05);2组患者治疗12周后血清IL-6、IL-4水平显著低于治疗前,血清IL-2、IFN-γ水平显著高于治疗前(P<0.05);治疗12周后,观察组血清IL-6、IL-4水平显著低于对照组,血清IL-2、IFN-γ水平显著高于对照组(P<0.05)。观察组患者肝肾损害、胃肠道反应、骨髓抑制、皮肤黏膜反应发生率显著低于对照组(P<0.05)。在2 a的随访期间,观察组患者脱落1例,对照组患者脱落2例。观察组患者1、2 a生存率分别为88.64%(39/44)、77.27%(34/44),对照组患者1、2 a生存率分别为74.42%(32/43)、55.81%(24/43);2组患者1 a生存率比较差异无统计学意义(χ2=2.929,P>0.05);观察组患者2 a生存率显著高于对照组(χ2=4.506,P<0.05)。结论调强适形放射治疗联合DP化学治疗方案治疗中晚期宫颈癌的疗效肯定,联合应用复方苦参注射液可有效提高治疗效果,增强机体免疫功能,减少不良反应,改善患者预后。

Objective To investigate the clinical effect of Fufang Kushen Zhusheye combined with chemotherapy and intensity modulated radiation therapy in the treatment of advanced cervical cancer.Methods Ninety patients with advanced cervical cancer admitted to the Second Affiliated Hospital of Xi′an Jiaotong University from June 2014 to August 2017 were selected as the research subjects.The patients were divided into observation group and control group according to the random number table method,with 45 cases in each group.The patients in the two groups were treated with chemotherapy(cisplatin and docetaxel,DP chemotherapy)and intensity modulated radiation therapy.On this basis,the patients in the observation group were treated with Fufang Kushen Zhusheye.The curative effect and quality of life of the patients in the two groups were evaluated after 12 weeks of treatment,and the incidence of adverse reactions was observed during treatment.The levels of serum matrix metalloproteinase-9(MMP-9),osteopontin(OPN),interleukin-2(IL-2),interferon-γ(IFN-γ),interleukin-6(IL-6)and interleukin-4(IL-4)were detected before and after 12 weeks of treatment.All patients were followed up for two years after treatment,and the 1-and 2-year survival rates were observed.Results The total effective rate in the observation group and the control group was 64.44%(29/45)and 42.22%(19/45),respectively.The total effective rate in the observation group was significantly higher than that in the control group(χ2=4.464,P<0.05).The quality of life of the patients in the observation group was significantly higher than that in the control group after 12 weeks of treatment(χ2=2.065,P<0.05).There was no significant difference in serum MMP-9 and OPN levels between the two groups before treatment(P>0.05).The levels of serum MMP-9 and OPN after 12 weeks of treatment were significantly lower than those before treatment in the two groups(P<0.05).After 12 weeks of treatment,the levels of serum MMP-9 and OPN in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the levels of serum IL-6,IL-4,IL-2 and IFN-γbetween the two groups before treatment(P>0.05).Compared with before treatment,the levels of serum IL-6 and IL-4 decreased,and the levels of serum IL-2 and IFN-γincreased after 12 weeks of treatment(P<0.05).After 12 weeks of treatment,the levels of serum IL-6 and IL-4 in the observation group were significantly lower than those in the control group,and the levels of serum IL-2 and IFN-γin the observation group were significantly higher than those in the control group(P<0.05).The incidences of liver injury,kidney damage,gastrointestinal reaction,bone marrow suppression and skin mucosal reaction in the observation group were significantly lower than those in the control group(P<0.05).During the 2-year follow-up period,one case in the observation group and two cases in the control group lost to follow-up.The 1-and 2-year survival rates in the observation group were 88.64%(39/44)and 77.27%(34/44),respectively;the 1-and 2-year survival rates in the control group were 74.42%(32/43)and 55.81%(24/43),respectively.There was no significant difference in the 1-year survival rate between the two groups(χ2=2.929,P>0.05).The 2-year survival rate in the observation group was significantly higher than that in the control group(χ2=4.506,P<0.05).Conclusion Intensity modulated radiation therapy combined with DP chemotherapy is effective in the treatment of advanced cervical cancer.Fufang Kushen Zhusheye can effectively increase the therapeutic effect,enhance the immune function,reduce the adverse reactions and improve the prognosis of patients.