温阳行气利水方联合顺铂、恩度腹腔灌注治疗脾肾阳虚型恶性腹水的临床观察

Clinical Observation of Wenyang Xingqi Lishui Decoction Combined with Cisplatin and Endostatin Intraperitoneal Perfusion in theTreatment of Malignant Ascites with Spleen-kidney Yang Deficiency Type

目的探讨温阳行气利水方联合顺铂、重组人血管内皮抑制素(恩度)腹腔灌注治疗对脾肾阳虚型恶性腹水的临床疗效。方法选取住院病人70例,按随机数表法分成对照组和观察组,各35例。对照组接受顺铂、恩度腹腔灌注治疗,观察组在对照组的基础上口服温阳行气利水方。观察2组治疗前后Karnofsky功能状态评分(KPS评分)、中医证候评分(腹部胀满、食少纳呆、下肢浮肿、小便短少、畏寒肢冷)、腹水最大深度、腹水糖类抗原125(CA125)、腹水糖类抗原199(CA199)、腹水癌胚抗原(CEA)、血清血管内皮生长因子(VEGF)的变化和不良反应发生情况。结果(1)研究过程中,对照组脱落2例,观察组脱落1例,共67例完成实验。(2)治疗前,2组KPS评分、患者中医证候积分、腹水最大深度、腹水肿瘤标志物水平和血清VEGF含量相当(P>0.05),治疗后2组患者评分均有改善,观察组患者评分优于对照组(P<0.05);2组患者不良反应发生率相当(P>0.05)。结论温阳行气利水方对脾肾阳虚证恶性腹水的病人疗效可靠,可以改善患者的临床症状,提高患者的生活质量;同时其也可以降低恶性腹水中CA125、CA153和CEA的水平和血清VEGF含量,减少恶性腹水生成;同时温阳行气利水方的不良反应较少,安全性良好,可以在临床中应用。

Objective:To study the clinical effect of Wenyang Xingqili Lishui Decoction combined with cisplatin and recombinant human endostatin(Endo)in the treatment of malignant ascites with spleen-kidney yang deficiency.Methods:70 inpatients were selected and divided into control group and observation group according to random number table method,35 cases each group.The control group received cisplatin and Endo intraperitoneal perfusion treatment and the observation group took Wenyang Xingqili Lishui Decoction orally on the basis of the control group.The changes and adverse reactions of Karnofsky performance status score(KPS score),TCM syndrome score(abdominal distension,undereating and anorexia,edema of lower extremities,short urination,chilly sensation and cold limbs),maximum depth of ascites,ascites carbohydrate antigen 125(CA125),ascites carbohydrate antigen 199(CA199),ascites carcinoembryonic antigen(CEA)and serum vascular endothelial growth factor(VEGF)of the 2 groups were observed before and after treatment.Results:(1)During the study,2 cases fell off in the control group and 1 case fell off in the observation group.67 cases completed the experiment.(2)Before treatment,KPS score,TCM syndrome score,maximum ascites depth,ascites tumor marker level and serum VEGF content of the 2 groups were similar(P>0.05).After treatment,the scores of the 2 groups were improved,and the scores of the observation group were better than those of the control group(P<0.05).The incidence of adverse reactions in the 2 groups was similar(P>0.05).Conclusion:Wenyang Xingqi Lishui Decoction has a reliable effect on malignant ascites patients with spleen-kidney yang deficiency syndrome and can improve the clinical symptoms and improve the quality of life of patients.At the same time,it can also reduce the levels of CA125,CA153 and CEA in malignant ascites and serum VEGF content,and decrease the formation of malignant ascites.The side effects of Wenyang Xingqi Lishui Docoction are less,and its safety is good,which can be used in clinical practice.