贞芪八珍汤加味辅助治疗老年ⅢA/ⅢB期非小细胞肺癌气阴两虚证48例临床观察

Clinical observation on 48 cases of stageⅢA/ⅢB non-small cell lung cancer in elderly patients with deficiency of both qi and yin syndrome treated by modified Zhenqi Bazhen Tang(贞芪八珍汤) as adjuvant therapy

目的观察贞芪八珍汤加味辅助治疗老年ⅢA/ⅢB期非小细胞肺癌(NSCLC)气阴两虚证的临床疗效。方法将95例老年ⅢA/ⅢB期NSCLC气阴两虚证患者采用随机数字表法分为对照组和治疗组。对照组47例在保肝、营养支持等常规治疗的基础上予以长春瑞滨+顺铂(NP)化疗方案治疗,治疗组48例在对照组治疗方法的基础上给予贞芪八珍汤加味治疗。2组均以28 d为1个化疗周期,2个周期后比较2组的临床疗效以及治疗前后肿瘤标志物[血清癌胚抗原(CEA)、糖链抗原125(CA125)、细胞角蛋白19片段(CYFRA21-1)]、T淋巴细胞亚群(CD3^(+)、CD8^(+)、CD4^(+))、炎症小体[核苷酸结合寡聚化结构域样受体蛋白(NLRP)3、NLRP12]水平。结果治疗组总有效率为70.83%(34/48),对照组为51.06%(24/47),2组比较差异有统计学意义(P<0.05)。治疗后2组血清CEA、CA125、CYFRA21-1及NLRP3水平均明显降低,血清NLRP12水平均明显升高,与同组治疗前比较差异有统计学意义(P<0.05或P<0.01),且治疗组对各项指标的改善作用更明显,与对照组治疗后比较差异均有统计学意义(P<0.01);治疗后治疗组血清CD3^(+)、CD4^(+)水平均明显升高,CD8^(+)水平明显降低,与同组治疗前比较差异有统计学意义(P<0.01),且治疗组血清CD3^(+)、CD4^(+)水平明显高于对照组,血清CD8^(+)水平明显低于对照组,2组比较差异均有统计学意义(P<0.01)。结论贞芪八珍汤加味辅助治疗老年ⅢA/ⅢB期NSCLC气阴两虚证临床疗效显著,可改善患者血清肿瘤标志物、T淋巴细胞亚群及炎症小体水平。

Objective To observe the clinical efficacy of modified Zhenqi Bazhen Tang(贞芪八珍汤)in adjuvant treatment of stageⅢA/ⅢB non-small cell lung cancer in elderly patients with deficiency of both qi and yin syndrome.Methods 95 elderly patients with stage IIIA/IIIB NSCLC with deficiency of both qi and yin syndrome were divided into control group and treatment group using a random number table.Forty-seven patients in the control group were treated with vinorelbine+cisplatin(NP)chemotherapy on the basis of routine treatment such as liver protection and nutritional support.Forty-eight patients in the treatment group were treated with modified Zhenqi Bazhen Tang(贞芪八珍汤)on the basis of the treatment method of the control group.Two groups were treated with 28 d as 1 chemotherapy cycle,after 2 cycles,the clinical efficacy and the levels of tumor markers[serum carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),cytokeratin 19 fragment(CYFRA21-1)],T lymphocyte subsets(CD3^(+),CD8^(+),CD4^(+)),inflammasome[nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),NLRP12]before and after treatment were compared between the two groups.Results The total effective rate was 70.83%(34/48)in the treatment group and 51.06%(24/47)in the control group,the difference being significant(P<0.05).After treatment,the levels of serum CEA,CA125,CYFRA21-1 and NLRP3 in the two groups were decreased significantly,the levels of serum NLRP12 were increased significantly,and the difference was statistically significant compared with the same group before treatment(P<0.05 or P<0.01),and the improvement effect of the treatment group on each index was more significant,which was statistically significant as compared with that in the control group after treatment(P<0.01).After treatment,the levels of serum CD3^(+)and CD4^(+)in the treatment group were increased significantly,and the level of CD8^(+)was decreased significantly,and the difference was statistically significant in the same group(P<0.01).The levels of serum CD3^(+)and CD4^(+)in the treatment group were significantly higher than those in the control group,and the level of serum CD8^(+)was significantly lower than that in the control group,with significant difference between two groups(P<0.01).Conclusion Modified Zhenqi Bazhen Tang(贞芪八珍汤)has significant clinical efficacy in adjuvant treatment of stage IIIA/IIIB NSCLC in elderly patients with deficiency of qi and yin syndrome,which can improve serum tumor markers,inflammasome levels and T lymphocyte subsets levels.