温补脾肾汤对肺脾肾气虚型慢性阻塞性肺疾病合并肺癌患者疗效和血清免疫球蛋白及血浆和肽素的影响研究

Influence of Wenbupishen Decoction on the Effect and Serum Immunoglobulin and Plasma Copeptin of Lung Spleen Kidney Qi Deficiency Chronic Obstructive Pulmonary Disease Patients Complicated with Lung Cancer

背景相对于一般的肺癌患者,合并慢性阻塞性肺疾病(COPD)患者的临床症状控制难度更大,患者治疗后的生存质量也较差。为此,积极寻找合适的治疗方式来改善COPD合并肺癌患者的治疗效果及生存质量尤为重要。而目前关于中医药治疗COPD合并肺癌患者的研究尚少。目的探究并分析温补脾肾汤对肺脾肾气虚型COPD合并肺癌患者疗效及血清免疫球蛋白(Ig)、血浆和肽素(Copeptin)的影响。方法选取2016年10月—2019年10月新疆医科大学附属中医医院收治的肺脾肾气虚型COPD合并肺癌患者300例为研究对象。按照随机数字表法将患者分为对照组(150例)和观察组(150例)。对照组仅采取常规西医治疗,观察组在常规西医治疗的基础上给予温补脾肾汤。收集并比较两组患者一般资料,治疗前、治疗后1个月、治疗后3个月COPD评估测试(CAT)积分,临床疗效,治疗前及治疗后3个月免疫炎性指标(包括血清IgG、IgA、IgM及血浆Copeptin),治疗前、治疗后1个月、治疗后3个月生存质量评分,不良反应发生情况。结果治疗方法与时间在CAT积分上存在交互作用(P<0.05);治疗方法、时间在CAT积分上主效应显著(P<0.05)。观察组治疗后1个月、治疗后3个月CAT积分低于对照组(P<0.05)。对照组、观察组治疗后1个月、治疗后3个月CAT积分分别低于本组治疗前,治疗后3个月CAT积分分别低于本组治疗后1个月(P<0.05)。观察组临床疗效优于对照组(P<0.05)。治疗后3个月,观察组血清IgG、IgA高于对照组,血清IgM、血浆Copeptin低于对照组(P<0.05)。对照组、观察组治疗后3个月血清IgG、IgA分别高于本组治疗前,血清IgM、血浆Copeptin分别低于本组治疗前(P<0.05)。治疗方法与时间在生存质量评分上存在交互作用(P<0.05);治疗方法、时间在生存质量评分上主效应显著(P<0.05)。观察组治疗后1个月、治疗后3个月生存质量评分高于对照组(P<0.05)。对照组、观察组治疗后1个月、治疗后3个月生存质量评分分别高于本组治疗前,治疗后3个月生存质量评分分别高于本组治疗后1个月(P<0.05)。两组患者均未出现严重的不可逆性不良反应。两组不良反应发生率比较,差异无统计学意义(P>0.05)。两组患者调整药物剂量后不良反应均得到明显改善。结论温补脾肾汤能有效提高肺脾肾气虚型COPD合并肺癌患者疗效并改善患者血清Ig、血浆Copeptin,提高患者生存质量,值得临床推广。

Background Compared with the general lung cancer patients,patients with chronic obstructive pulmonary disease(COPD)are more difficult to control clinical symptoms,and their quality of life after treatment is also poor.Therefore,it is very important to find the appropriate treatment to improve the treatment effect and quality of life of COPD patients with lung cancer.However,there are few studies about the treatment of COPD with lung cancer by TCM.Objective To explore and analyze the influence of Wenbupishen Decoction on the effect and serum immunoglobulin(Ig),plasma Copeptin of Lung Spleen Kidney Qi Deficiency COPD patients complicated with lung cancer.Methods From October 2016 to October 2019,300 COPD patients complicated with lung cancer who were admitted to Chinese Medicine Hospital Affiliated to Xinjiang Medical University were selected as the research objects.According to the random number table method,the patients were divided into control group(150 cases)and observation group(150 cases).The control group was only given conventional western medicine treatment,while the observation group was given Wenbupishen Decoction on the basis of conventional western medicine treatment.The general data,COPD assessment test(CAT)score before treatment,1 month after treatment and 3 months after treatment,curative effect,immune inflammatory indexes(including serum IgG,IgA,IgM and plasma Copeptin)before treatment and 3 months after treatment,quality of life scores before treatment,1 month after treatment and 3 months after treatment,and incidence of adverse reactions of the two groups were collected and compared.Results There was interaction between treatment method and time on CAT score(P<0.05);the main effect of treatment method and time on CAT score was significant(P<0.05).The CAT score of the observation group was lower than that of the control group at 1 month and 3 months after treatment(P<0.05).The CAT scores of the control group and the observation group at 1 month and 3 months after treatment were lower than those before treatment,and the CAT scores of the control group and the observation group at 3 months after treatment were lower than those 1 month after treatment(P<0.05).The clinical curative effect of the observation group was better than that of the control group(P<0.05).Three months after treatment,the serum IgG and IgA of the observation group were higher than those of the control group,and the serum IgM and plasma Copeptin were lower than those of the control group(P<0.05).The serum IgG and IgA 3 months after treatment in the control group and the observation group were higher than those before treatment,and the serum IgM and plasma Copeptin were lower than those before treatment(P<0.05).There was interaction between treatment method and time in quality of life score(P<0.05),and the main effect of treatment method and time on quality of life score was significant(P<0.05).The scores of quality of life in the observation group at 1 month and 3 months after treatment were higher than those in the control group(P<0.05).The quality of life scores of the control group and the observation group at 1 month and 3 months after treatment were higher than those before treatment,and the quality of life scores of the control group and the observation group at 3 months after treatment were higher than those at 1 month after treatment(P<0.05).No serious irreversible adverse reactions occurred in both groups.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).The adverse reactions of the two groups were significantly improved after adjusting the drug dosage.Conclusion Wenbupishen Decoction can effectively improve the curative effect of Lung Spleen Kidney Qi Deficiency COPD patients complicated with lung cancer,improve the serum Ig and plasma Copeptin,and improve the quality of life of patients,which is worthy of clinical promotion.