针药并用治疗结直肠癌术后癌因性疲乏的疗效观察

Observations on Efficacy of Combined Acupuncture and Medicine for Cancer-related Fatigue After Colorectal Cancer Surgery

目的观察针药并用治疗结直肠癌术后癌因性疲乏的临床疗效。方法纳入96例结直肠癌术后癌因性疲乏患者为研究对象,按照随机数字表法将患者分为研究组和对照组,每组48例。对照组采用FOLFOX6化疗方案联合温阳健脾益肠方治疗,研究组在对照组基础上予八髎穴烧山火针刺治疗。观察两组治疗前后血清粒细胞-巨噬细胞集落刺激因子(GM-CSF)、白细胞介素(IL)-8、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、二胺氧化酶值(DAO)、D-乳酸(D-LA)、肠型脂肪酸结合蛋白(I-FABP)、转铁蛋白(TRF)、前白蛋白(PA)、血清白蛋白(ALB)和T淋巴细胞亚群CD4、CD3^(﹢)、CD8^(﹢)水平的变化。观察两组治疗前后简短疲劳量表(BFI)评分和生存质量量表(QLQ-C30)评分的变化。比较两组临床疗效及不良反应发生情况。结果治疗后,研究组血清IL-8、GM-CSF、TNF-α、hs-CRP水平均低于对照组(P<0.05),研究组T淋巴细胞亚群及CD4^(﹢)/CD8^(﹢)水平高于对照组(P<0.05),研究组DAO、D-LA、I-FABP水平低于对照组(P<0.05),研究组TRF、PA、ALB水平低于对照组(P<0.05),研究组BFI评分低于对照组(P<0.05),研究组QLQ-C30评分高于对照组(P<0.05),研究组总有效率高于对照组(P<0.05),研究组不良反应发生率低于对照组(P<0.05)。结论烧山火法针刺八髎穴联合温阳健脾益肠方治疗结直肠癌术后癌因性疲乏可抑制炎症反应,调节肠道屏障应激,改善肠道屏障功能、营养指标和细胞免疫状态,缓解躯体疲乏症状,提升患者生活质量及临床疗效,减少不良反应。

Objective To investigate the clinical efficacy of combined acupuncture and medicine for cancer-related fatigue after colorectal cancer surgery.Method Ninety-six patients with cancer-related fatigue after colorectal cancer surgery were enrolled as subjects and allocated,using a random number table,to a study group and a control group,with 48 cases in each group.The control group received FOLFOX6 chemotherapy protocol plus yang-warming,spleen-replenishing and intestine-reinforcing prescription and the study group,acupuncture at Baliao points by mountain-burning fire manipulation in addition.Serum granulocyte-macrophage colony stimulating factor(GM-CSF),interleukin-8(IL-8),hypersensitive C-reactive protein(hs CRP),tumor necrosis factor-α(TNF-α),diamine oxidase(DAO),D-lactic acid(D-LA),intestinal fatty acid binding protein(I-FABP),transferrin(TRF),prealbumin(PA),serum albumin(ALB)and T lymphocyte subsets CD4^(﹢),CD3^(﹢) and CD8^(﹢) levels were measured in the two groups before and after treatment.the brief fatigue inventory(BFI)score and the quality of life questionnaire core 30(QLQ-C30)score were recorded in the two groups before and after treatment.The clinical therapeutic effects and the incidences of adverse reactions were compared between the two groups.Result After treatment,serum IL-8,GM-CSF,TNF-αand hs-CRP levels were lower in the study group than in the control group(P<0.05);T lymphocyte subsets and CD4^(﹢)/CD8^(﹢) levels were higher in the study group than in the control group(P<0.05);DAO,D-LA and I-FABP levels were lower in the study group than in the control group(P<0.05);TRF,PA and ALB levels were lower in the study group than in the control group(P<0.05);the BFI score was lower in the study group than in the control group(P<0.05);the QLQ-C30 score was higher in the study group than in the control group(P<0.05);the efficacy rate was higher in the study group than in the control group(P<0.05);the incidence of adverse reactions was lower in the study group than in the control group(P<0.05).Conclusion Acupuncture at Baliao points by mountain-burning fire manipulation plus yang-warming,spleen-replenishing and intestine-reinforcing prescription can inhibit inflammatory reactions,regulate intestinal barrier stress,ameliorate intestinal barrier function,nutritional indicators and cellular immune status,relieve the symptoms of physical fatigue,improve the quality of life and clinical efficacy and reduce adverse reactions in patients with cancer-related fatigue after colorectal cancer surgery.