柔肝消毒汤治疗湿热毒蕴型乙型肝炎肝硬化后原发性肝癌的临床观察

Clinical observation of Rougan Xiaodu Decoction in the treatment of primary liver cancer(stageⅣ)after hepatitis B cirrhosis with damp-heat toxin accumulation

目的:观察柔肝消毒汤联合西医常规疗法治疗湿热毒蕴型乙型肝炎肝硬化后原发性肝癌(PHC)Ⅳ期的临床疗效。方法:2021年3月1日至2021年6月30日上海市中医医院肝病科收治乙型肝炎肝硬化后PHC患者62例,将患者分为两组,对照组患者30例,仅施以西医基础疗法;治疗组患者32例,在西医基础治疗的同时,加用柔肝消毒汤治疗。比较两组患者治疗前后瘤体大小、半年生存率、中位生存期、生活质量(KPS评分)、体力状况(ECOG PS评分)、肝功能、甲胎蛋白(AFP)、中医证侯积分等。记录用药的安全性及不良反应。结果:治疗8周后,治疗组患者瘤体控制率、半年生存率、中位生存期、KPS评分有效率、ECOG PS评分、中医证侯积分明显优于对照组(P<0.05),两组患者治疗后肝功能均有进展,但对照组进展更显著(P<0.05)。两组患者AFP与治疗前比较均差异明显(P<0.05)。两组患者安全性差异无统计学意义,均不存在严重不良反应。结论:柔肝消毒汤联合西医常规疗法能延缓湿热毒蕴型乙型肝炎肝硬化后PHC(Ⅳ期)患者的瘤体生长、延长患者生存期限、提高患者的生存质量及体力、减轻中医症状、减慢患者肝功能进展速度,但不能控制AFP进展。

Objective:To observe the clinical curative effect of Rougan Xiaodu Decoction combined with conventional western medicine therapy in the treatment of primary liver cancer(stageⅣ)after hepatitis B cirrhosis caused by damp-heat toxin accumulation.Methods:62 patients with PHC after hepatitis B cirrhosis admitted to the Hepatology Department of Shanghai Hospital of Traditional Chinese Medicine from March 1,2021 to June 30,2021 were divided into two groups.30 patients in the control group were only treated with western medicine basic therapy.32 patients in the treatment group were treated with Rougan Xiaodu Decoction in addition to the basic treatment of western medicine.The tumor size,half-year survival rate,median survival time,quality of life(KPS score),physical status(ECOG PS score),liver function,alpha-fetoprotein(AFP),and TCM syndrome score were compared between the two groups before and after treatment.The safety and adverse reactions were recorded.Results:The tumor control rate,six-month survival rate,median survival time,KPS score effective rate,ECOG PS score,and TCM syndrome score of the treatment group after treatment were significantly better than those of the control group(P<0.05).Both groups had progression in liver function after treatment,but the control group had a more significant progression(P>0.05).There was a significant difference in the comparison of alpha-fetoprotein(AFP)levels before and after treatment in both groups(P<0.05).There were no statistically significant differences in safety between the two groups,and no serious adverse reactions were observed.Conclusion:Rougan Xiaodu Decoction,combined with conventional Western medicine treatment,can delay the tumor growth,prolong the survival period of patients,improve the quality of life and physical strength of patients,and reduce the symptoms of traditional Chinese medicine in patients with primary liver cancer(stageⅣ)after hepatitis B cirrhosis due to damp-heat toxin accumulation.The rate of progression of liver function in chronic patients.But cannot control AFP progression.