黄芪注射液穴位注射联合艾灸对胃癌化疗所致骨髓抑制效果观察

Observation on the Effect of Acupoint Injection of Astragalus Injection Combined with Moxibustion on Bone Marrow Suppression Induced by Chemotherapy in Gastric Cancer

目的探讨黄芪注射液穴位注射联合艾灸对胃癌化疗所致骨髓抑制的治疗效果。方法选取濮阳市中医医院2019年6月至2022年12月收治的232例初诊晚期胃癌患者开展前瞻性随机对照研究,按照随机数字表法分为A、B、C、D四组,每组各58例。A组给予常规治疗,B组在A组的基础上给予黄芪注射液穴位注射治疗,C组在A组的基础上给予艾灸治疗,D组在A组的基础上给予黄芪注射液穴位注射联合艾灸治疗,四组患者均治疗42 d。比较四组患者治疗前后的中医症候积分,血常规指标,免疫功能相关指标(血细胞簇分化抗原CD3^(+)、CD4^(+)、CD8^(+))以及化疗期间升白细胞药物及升血小板药物治疗情况,骨髓抑制发生率,化疗不良反应发生率。结果四组化疗期间使用升白细胞药物、升血小板药物治疗患者例数比较差异无统计学意义(P>0.05)。四组患者中医证候积分经重复测量方差分析均差异有统计学意义(P<0.05),四组患者治疗1周时、治疗42 d后中医证候积分均高于治疗前(P<0.05),治疗42 d后中医证候积分均低于治疗1周时(P<0.05);B、C、D组治疗1周时、治疗42 d后中医证候积分均低于A组(P<0.05),D组均低于A、B、C组(P<0.05)。治疗42 d后四组患者中性粒细胞计数降低(P<0.05),且D组高于A、B、C组(P<0.05);治疗42 d后四组白细胞计数、血小板计数、血红蛋白水平均降低(P<0.05),且B、C、D组均高于A组(P<0.05),D组白细胞计数、血小板计数高于B、C组(P<0.05),C、D组血红蛋白水平均高于B组(P<0.05);治疗42 d后四组CD3^(+)、CD4^(+)均降低(P<0.05),但B、C、D组均高于A组(P<0.05),D组高于B、C组(P<0.05);治疗42 d后四组CD8^(+)均升高(P<0.05),但B、C、D组均低于A组(P<0.05),D组低于C组(P<0.05);D组骨髓抑制发生率及恶心呕吐、便秘发生率均低于A组(P<0.05)。结论黄芪注射液穴位注射联合艾灸可有效改善胃癌化疗患者临床症状,提高免疫功能,降低骨髓抑制和不良反应发生率,具有较好的临床疗效。

Objective To investigate the therapeutic effect of acupoint injection of astragalus injection combined with moxibustion on bone marrow suppression caused by chemotherapy ingastric cancer.Methods A prospective randomized controlled study was conducted on 232 patients with newly diagnosed advanced gastric cancer admitted to Puyang Hospital of Traditional Chinese Medicine from June 2019 to December 2022 were selected and divided into A,B,C and D groups according to the random number table method,with 58 cases in each group.Group A was given routine treatment,group B was given acupoint injection of astragalus injection on the basis of group A,group C was given moxibustion on the basis of group A,while group D was given acupoint injection of astragalus injection combined with moxibustion on the basis of group A.All four groups were treated for 42 days.The traditional Chinese medicine symptom scores,blood routine indexes,immune function related indexes(blood cell cluster differentiation antigen CD3^(+),CD4^(+),CD8^(+))before and after treatment and the treatment status of leukocyte-increasing drugs and platelet-increasing drugs during chemotherapy,the incidences of bone marrow suppression,and the incidences of adverse reactions of chemotherapy were compared among the four groups.Results There were no significant differences in the numbers of patients treated with leukocyte-enhancing drugs and platelet-enhancing drugs during the chemotherapy among the four groups(P>0.05).After 42 days of treatment,the scores of traditional Chinese medicine syndromes in the four groups were significantly different by repeated measures analysis of variance(P<0.05).The scores of traditional Chinese medicine syndromes in the four groups after 1 week and 42 days of treatment were higher than those before treatment(P<0.05),and the scores of traditional Chinese medicine syndromes after 42 days of treatment were lower than those after 1 week of treatment(P<0.05).The scores of traditional Chinese medicine syndromes in group B,C and D were lower than that in group A after 1 week and 42 days of treatment(P<0.05),and those in group D were lower than those in group A,B and C(P<0.05).After 42 days of treatment,the neutrophil count in the four groups decreased(P<0.05),and that in group D was higher than that in groups A,B and C(P<0.05).After 42 days of treatment,the white blood cell count,platelet count and hemoglobin level in the four groups decreased(P<0.05),and those in groups B,C and D were higher than those in group A(P<0.05),and the white blood cell count and platelet count in group D were higher than those in groups B and C(P<0.05),and the hemoglobin levels in groups C and D were higher than that in group B(P<0.05).After 42 days of treatment,CD3^(+)and CD4^(+)in the four groups were decreased(P<0.05),but those in groups B,C and D were higher than those in group A(P<0.05),and those in group D were higher than those in groups B and C(P<0.05).After 42 days of treatment,CD8^(+)in the four groups increased(P<0.05),but those in groups B,C and D were lower than that in group A(P<0.05),and that in group D was lower than that in group C(P<0.05).The incidences of myelosuppression,nausea and vomiting,and constipation in group D were lower than those in group A(P<0.05).Conclusion Acupoint injection of astragalus injection combined with moxibustion can effectively improve the clinical symptoms of patients with gastric cancer chemotherapy,improve immune function,reduce the incidence of bone marrow suppression and adverse reactions,and has good clinical efficacy.