补阳还五汤化裁治疗气虚血瘀型手足综合征

Treatment of Hand and Foot Syndrome of Qi Deficiency and Blood Stasis Type with Modified Buyang Huanwu Decoction

目的:观察补阳还五汤化裁治疗气虚血瘀型手足综合征(hand-foot syndrome,HFS)的临床疗效。方法:选取口服盐酸安罗替尼胶囊靶向治疗后出现手足综合征的肺癌患者60例,随机分为治疗组30例、对照组30例。对照组给予口服维生素B6及尿素维E软膏治疗;治疗组在对照组治疗基础上给予补阳还五汤化裁内服及外用。比较两组患者治疗后临床HFS分级,治疗前后临床症状、生活质量总积分及各个维度积分,血小板(platelet,PLT)、血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、白细胞(white blood cell,WBC)、中性粒细胞(neutrophil,N)、血红蛋白(hemoglobin,HGB)、淋巴细胞(lymphocyte number,LY)水平,正中神经、桡神经、腓肠神经、腓浅神经的感觉传导速度(sensory nerve conduction velocity,SNCV)。结果:(1)治疗组有效率为90.00%,对照组有效率为53.33%,两组有效率比较,差异有统计学意义(P<0.05)。(2)治疗后,治疗组患者手足综合征0级比例明显高于对照组,差异有统计学意义(P<0.05)。(3)治疗后,两组患者中医证候积分均显著降低,差异有统计学意义(P<0.05);治疗组在改善手和(或)足麻木、手足刺痛、水肿方面优于对照组(P<0.05)。(4)治疗组在改善患者生活质量方面显著优于对照组(P<0.05或P<0.01)。(5)治疗后,两组患者PLT、PLR均显著降低(P<0.05),WBC、N、HGB均显著升高;且治疗组WBC、N、HGB高于同期对照组(P<0.05),治疗组PLR低于同期对照组(P<0.05)。(6)两组患者治疗后正中神经、桡神经、腓肠神经、腓浅神经SNCV均显著升高(P<0.01);治疗组正中神经、桡神经、腓肠神经、腓浅神经SNCV均高于同期对照组,差异均有统计学意义(P<0.05)。结论:补阳还五汤化裁内服及外用治疗气虚血瘀型HFS临床疗效显著,可明显改善患者手足综合征临床症状,升高WBC、N、HGB水平,降低PLR,提高正中神经、桡神经、腓肠神经、腓浅神经SNCV。

Objective:To observe the clinical efficacy of Buyang Huanwu Decoction in treating hand foot syndrome(HFS)of Qi deficiency and blood stasis type.Method:Sixty lung cancer patients who developed hand foot syndrome after targeted treatment with oral arotinib hydrochloride capsules were randomly divided into a treatment group of 30 cases and a control group of 30 cases.The control group was treated with oral vitamin B6 and urea vitamin E ointment;The treatment group was treated with Buyang Huanwu Decoction orally and externally on the basis of the control group.The clinical HFS grades,clinical symptoms,total scores of life quality and scores of each dimension,platelet(PLT),platelet to lymphocyte ratio(PLR),white blood cell(WBC),neutrophil(N),hemoglobin(HGB),lymphocyte number(LY)levels,median nerve,radial nerve,sural nerve The sensory nerve conduction velocity(SNCV)of the superficial peroneal nerve.Result:(1)The effective rate of the treatment group was 90.00%,while the effective rate of the control group was 53.33%.The difference in effective rates between the two groups was statistically significant(P<0.05).(2)After treatment,the proportion of patients with grade 0 hand and foot syndrome in the treatment group was significantly higher than that in the control group,with a statistically significant difference(P<0.05).(3)After treatment,the TCM syndrome scores of both groups of patients significantly decreased,with a statistically significant difference(P<0.05).The treatment group was superior to the control group in improving hand and/or foot numbness,hand and foot tingling,and edema(P<0.05).(4)The treatment group significantly improved the quality of life of patients compared to the control group(P<0.05 or P<0.01).(5)After treatment,PLT and PLR in both groups of patients were significantly reduced(P<0.05),while WBC,N,and HGB were significantly increased;And the WBC,N,and HGB in the treatment group were higher than those in the control group during the same period(P<0.05),while the PLR in the treatment group was lower than that in the control group during the same period(P<0.05).(6)After treatment,the SNCV of median nerve,radial nerve,sural nerve and superficial peroneal nerve were significantly increased in both groups(P<0.01);The SNCVs of median nerve,radial nerve,sural nerve and superficial peroneal nerve in the treatment group were higher than those in the control group at the same time,and the difference was statistically significant(P<0.05).Conclusion:Buyang Huanwu Decoction has significant clinical efficacy in treating HFS of qi deficiency and blood stasis type,which can significantly improve the clinical symptoms of hand foot syndrome,increase the levels of WBC,N,HGB,reduce PLR,and increase the SNCV of median nerve,radial nerve,sural nerve,and superficial peroneal nerve.