黄芪建中汤加减联合化疗治疗Ⅲb~Ⅳ期胃癌临床研究

Clinical Study on Modified Huangqi Jianzhong Decoction Combined with Chemotherapy for Stomach Cancer in Stage Ⅲb to Ⅳ

目的:观察黄芪建中汤加减联合化疗治疗脾胃虚寒型Ⅲb~Ⅳ期胃癌的临床疗效,以及对肿瘤标志物[癌胚抗原(CEA)、糖类抗原199 (CA199)、糖类抗原724 (CA724)]、血管内皮生长因子(VEGF)、白细胞介素-6 (IL-6)水平的影响。方法:选取82例脾胃虚寒型Ⅲb~Ⅳ期胃癌患者,按照患者入院编号单双数分成观察组与对照组各41例。对照组给予奥沙利铂联合氟尿嘧啶进行化疗,观察组在对照组基础上给予黄芪建中汤加减治疗。3周为1个疗程,2组均治疗2个疗程。比较2组临床疗效,生活质量,血清CEA、CA199、CA724、VEGF、IL-6、CD4^(+)、CD8^(+)水平,CD4^(+)/CD8^(+)值及不良反应发生率。结果:治疗后,观察组临床疗效总有效率82.93%,高于对照组58.54%(P<0.05)。2组血清CEA、CA199、CA724、VEGF、IL-6水平均较治疗前降低(P<0.05),观察组血清CEA、CA199、CA724、VEGF、IL-6水平均低于对照组(P<0.05)。2组血清CD4^(+)水平及CD4^(+)/CD8^(+)值均较治疗前降低(P<0.05),血清CD8^(+)水平均较治疗前升高(P<0.05);观察组血清CD4^(+)水平及CD4^(+)/CD8^(+)值均高于对照组(P<0.05),血清CD8^(+)水平低于对照组(P<0.05)。观察组生活质量改善率75.61%,高于对照组48.78%(P<0.05)。治疗期间,观察组胃肠道反应、中性粒细胞减少、周围神经毒性发生率均低于对照组(P<0.05)。结论:在化疗基础上给予黄芪建中汤加减治疗脾胃虚寒型Ⅲb~Ⅳ期胃癌,能够降低肿瘤标志物、VEGF及IL-6水平,改善患者的免疫功能和生活质量,减轻不良反应。

Objective:To observe the clinical effect of modified Huangqi Jianzhong Decoction combined with chemotherapy for stomach cancer in stage Ⅲb to Ⅳ of the spleen-stomach deficiency-cold type and its effects on the levels of tumor markers [carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),carbohydrate antigen 724(CA724)],vascular endothelial growth factor(VEGF),and interleukin-6(IL-6).Methods:A total of 82 cases of patients with stomach cancer in stage Ⅲb to Ⅳ of the spleenstomach deficiency-cold type were selected and divided into the observation group and the control group according to their hospital admission sequence(odd or even numbers),with 41 cases in each group.The control group was treated with chemotherapy with Oxaliplatin combined with 5-Fluorouracil,and the observation group was additionally treated with modified Huangqi Jianzhong Decoction based on the treatment of the control group.Both groups were treated for 2 treatment courses,with 3 weeks being1 course.Clinical effects,quality of life,the levels of CEA,CA199,CA724,VEGF,IL-6,CD4^(+) ,CD8^(+) ,CD4^(+) /CD8^(+) ratio,and the incidence of adverse reactions were compared between the two groups.Results:After treatment,the total clinical effective rate was 82.93% in the observation group,higher than that of 58.54% in the control group(P<0.05).The levels of CEA,CA199,CA724,VEGF,and IL-6 in serum in the two groups were decreased when compared with those before treatment(P<0.05),and the levels of CEA,CA199,CA724,VEGF,and IL-6 in the observation group were lower than those in the control group(P<0.05).The levels of CD4^(+) and CD4^(+) /CD8^(+) ratio in serum in the two groups were decreased when compared with those before treatment(P<0.05),and the levels of CD8^(+) were increased when compared with those before treatment(P<0.05);the levels of CD4^(+) and CD4^(+) /CD8^(+) ratio in serum in the observation group were higher than those in the control group(P<0.05),and the level of CD8^(+) in serum in the observation group was lower than that in the control group(P<0.05).The improvement rate of quality of life was 75.61% in the observation group,higher than that of 48.78% in the control group(P<0.05).During the treatment,the incidence of gastrointestinal reactions,neutropenia,and peripheral neurotoxicity in the observation group were lower than those in the control group(P<0.05).Conclusion:Modified Huangqi Jianzhong Decoction combined with chemotherapy for stomach cancer in stage Ⅲb to Ⅳ of the spleenstomach deficiency-cold type can reduce the levels of tumor markers,VEGF,and IL-6,improve the immune function and quality of life of patients,and alleviate adverse reactions.