蛭龙活血通瘀胶囊配合调强放疗对局部晚期非小细胞肺癌患者凝血指标的影响

Effect of Zhilong Huoxue Tongyu Capsules Combined with Intensity Modulated Radiotherapy on Coagulation Index in Patients with Local Advanced Non-small Cell Lung Cancer

目的:探讨该院自主研制的中药产品蛭龙活血通瘀胶囊配合适形调强放射治疗(intensity modulated radiotherapy,IMRT)对局部晚期非小细胞肺癌患者凝血指标的影响。方法:随机将患者分为治疗组和对照组,每组各30例。对照组采用6MV直线加速器IMRT,1.8~2.0Gy/次,5次/周,总剂量60~64Gy。治疗组在对照组的基础上加用蛭龙活血通瘀胶囊,放疗当天开始服用,1.6g/次,3次/d,直至放疗结束。两组患者在治疗前后检查凝血指标,包括血小板(PLT)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)及D-二聚体(D-D)。比较放疗前和放疗后肺癌患者凝血指标的变化。结果:治疗组治疗前和治疗后PLT、PT、APTT、FIB及D-D分别为(202.6±83.2)×10^(9)/L和(180.5±89.3)×10^(9)/L、(9.91±1.42)sec和(14.04±0.80)sec、(29.35±2.80)sec和(38.18±3.69)sec、(5.58±0.55)g/L和(2.57±0.43)g/L、(0.56±0.13)mg/L和(0.18±0.09);对照组治疗前和治疗后PLT、PT、APTT、FIB及D-D分别为(205.5±84.6)×10^(9)/L和(184.2±90.8)×10^(9)/L、(9.85±1.24)sec和(11.22±1.01)sec、(31.10±3.65)sec和(35.53±3.74)sec、(5.49±0.67)g/L和(4.63±0.87)g/L、(0.58±0.15)mg/L和(0.41±0.11),两组治疗前、后PT、FIB和D-D差异有统计学意义(P<0.05);PLT和APTT差异无统计学意义(P>0.05)。治疗组和对照组患者治疗后中医症状积分缓解率分别为76.67%(23/30)和30%(9/30),差异有统计学意义(P<0.05)。放射性肺炎、食管炎和白细胞减少等毒副反应均主要为1~2级,均无统计学差异。结论:蛭龙活血通瘀胶囊配合IMRT可以改善局部晚期非小细胞肺癌患者的高凝状态,值得临床推广应用。

Objective:To explore the effect of the hospital’s self-developed traditional Chinese medicine product,Hirudinon Huoxuetongyu capsules,combined with conformal intensity modulated radiotherapy(intensity modulated radiotherapy,IMRT)on blood coagulation indicators in patients with locally advanced non-small cell lung cancer.Methods:The patients were randomly divided into treatment group and control group,with 30 cases in each group.The control group used 6MV linear accelerator IMRT,1.8-2.0Gy/time,5 times/week,with a total dose of 60-64Gy.The treatment group was added Zhilong Huoxue Tongyu Capsules on the basis of the control group,and started taking it on the day of radiotherapy,1.6g/time,3 times/d,until the end of the radiotherapy.The two groups of patients were checked for coagulation indicators before and after treatment,including platelets(PLT),plasma prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)and D-dimer(D-D).Compare the changes of coagulation indexes in lung cancer patients before and after radiotherapy.Results:The PLT,PT,APTT,FIB and DD of the treatment group before and after treatment were(202.6±83.2)×10^(9)/L and(180.5±89.3)×10^(9)/L,(9.91±1.42)sec and(14.04±0.80)sec,(29.35±2.80)sec and(38.18±3.69)sec,(5.58±0.55)g/L and(2.57±0.43)g/L,(0.56±0.13)mg/L and(0.18±0.09);PLT,PT,APTT,FIB and DD before and after treatment in the control group were(205.5±84.6)×10^(9)/L and(184.2±90.8)×10^(9)/L,(9.85±1.24)sec and(11.22±1.01),respectively)sec,(31.10±3.65)sec and(35.53±3.74)sec,(5.49±0.67)g/L and(4.63±0.87)g/L,(0.58±0.15)mg/L and(0.41±0.11)The differences in PT,FIB and D-D before and after treatment between the two groups were statistically significant(P<0.05);the differences in PLT and APTT were not statistically significant(P>0.05).The TCM symptom score relief rate of patients in the treatment group and control group after treatment was 76.67%(23/30)and 30%(9/30),respectively,and the difference was statistically significant(P<0.05).Toxic side effects such as radiation pneumonia,esophagitis and leukopenia were mainly grade 1 to 2,and there was no statistical difference.Conclusion:Zhilong Huoxue Tongyu Capsules combined with IMRT can improve the hypercoagulable state of patients with locally advanced non-small cell lung cancer,which is worthy of clinical application.