扶正固本祛邪加减方联合调强放疗治疗Ⅲ~Ⅳ期胃癌的临床效果观察

Observation on clinical effect of Fuzheng Guben Quxie prescription combined with intensity modulated radiotherapy in treatment of StageⅢ-Ⅳgastric cancer

目的 探讨扶正固本祛邪加减方联合调强放疗治疗Ⅲ~Ⅳ期胃癌的临床效果。方法 选取2020年1月至2022年6月空军军医大学第二附属医院中医科收治的Ⅲ~Ⅳ期胃癌患者94例,依据简单随机数字表法分为研究组与对照组,各47例。对照组采用调强放疗,研究组在对照组基础上采用扶正固本祛邪加减方。对比两组肿瘤疗效、血清肿瘤标志物[癌胚抗原(Carcino-embryonic antigen, CEA)、糖链抗原19-9(Glycochain antigen 19-9,CA19-9)、巨噬细胞炎性蛋白3α(Macrophage inflammatory protein 3α,CCL20)]、免疫功能[外周血T淋巴细胞亚群[T细胞表面糖蛋白CD3复合体(T cell surface glycoprotein CD3,CD3^(+))、T细胞表面糖蛋白CD4复合体(T cell surface glycoprotein CD4,CD4^(+))、CD4^(+)/T细胞表面糖蛋白CD8复合体(T cell surface glycoprotein CD8,CD8^(+))]、肿瘤营养评分(Patient-generated subjective global assessment, PG-SGA)、中医证候评分]、生存期限[中位无进展生存期(Median progressionfree survival, PFS)、中位生存期、12个月生存率]。结果 研究组总有效率(57.45%)、疾病控制率(91.49%)均高于对照组(38.30%、70.21%)(P<0.05)。治疗后,两组CEA、CA19-9、CCL20含量均较治疗前下降,且研究组较对照组低(P<0.05)。治疗后,对照组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均较治疗前下降,研究组均较治疗前升高,且研究组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05)。治疗后,两组肿瘤营养评分较治疗前下降,且研究组较对照组低(P<0.05)。治疗后两组中医证候评分均较治疗前下降,且研究组较对照组低(P<0.05)。研究组PFS、中位生存期较对照组长,12个月生存率高于对照组(P均<0.05)。结论 扶正固本祛邪加减方联合调强放疗治疗Ⅲ~Ⅳ期胃癌可提高临床疗效,降低肿瘤标志物含量,改善机体免疫功能,延长患者生存周期,促进疾病良好转归。

Objective To explore the effect and mechanism of Fuzheng Guben Quxie prescription combined with intensity-modulated radiotherapy in treatment of stageⅢ-Ⅳgastric cancer.Methods Select 94 patients with stageⅢtoⅣ[HJ46x]gastric cancer admitted to the hospital from January 2020 to June 2022,and the patients were divided into study group and control group according to simple random number table method,with 47 patients in each group.The control group was treated with intensity-modulated radiotherapy,while the study group was treated with the modified formula of strengthening the body and removing pathogenic factors based on the control group.Tumor efficacy,tumor markers[carcinoembryonic antigen(CEA),gluce-chain median survivalantigen 19-9(CA19-9),macrophage inflammatory protein 3α(CCL20)],immune function indexes(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),tumor nutrition score(PG-SGA),TCM syndrome score and survival time[median progression free survival(PFS),median survival,12-month survival]of the two groups were analyzed.Results The total effective rate(57.45%)and disease control rate(91.49%)of the study group was higher than median survival of the control group(38.30%,70.21%)(P<0.05).After the treatment,the levels of CEA,CA19-9 and CCL20 in the two groups were lower than before the treatment,and the levels in the study group were lower than the median survival in control group(P<0.05).After the treatment,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)was decreased in control group,and it was increased in study group,and the levels of indexes in the study group were higher than the median survivalin control group(P<0.05).After the treatment,the tumor nutrition score of the two groups were lower than that before the treatment,and the study group was lower than control group(P<0.05).After the treatment,TCM syndrome scores of both groups were lower than before the treatment,and the study group was lower than the control group(P<0.05).The median PFS and median survival of the study group was longer than median survival of control group,and 12-month survival rate was higher than that of control group(P<0.05).Conclusion Fuzheng Guben Quxie prescription combined with intensity modulate radiotherapy has a significant effect in the treatment of stageⅢ-Ⅳgastric cancer,which can reduce the content of tumor markers,improve immune function,prolong the survival cycle of the patients and ensure a good outcome of the disease.