复方苦参注射液联合西黄丸对晚期结直肠癌姑息治疗患者癌性疼痛和疲乏中位生存期及并发症发生率影响

Effects of Compound Matrine Injection Combined with Xihuang Pill on Cancer Pain and Fatigue Median Survival and Complication Rate in Patients with Advanced Colorectal Cancer Undergoing Palliative Care

目的:探讨复方苦参注射液联合西黄丸对晚期结直肠癌姑息治疗患者癌性疼痛和疲乏、中位生存期及并发症发生率影响。方法:将2020年1月至2021年5月成都医学院第一附属医院收治的153例晚期结直肠癌患者随机分为对照组(常规姑息治疗)、单药组(常规姑息治疗+西黄丸)、联合组(常规姑息治疗+西黄丸+复方苦参注射液),各51例。比较三组治疗前、治疗1个周期及治疗3个周期后癌性疼痛[疼痛数字分级法(NRS)]、癌因性疲乏[Piper疲乏修订量表(PFS-R)]、生存情况[功能状态评分(KPS)]评分、炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、IL-8、IL-1β]、免疫功能(总T淋巴细胞、总B淋巴细胞、NK细胞),并比较三组肿瘤控制效果、并发症、毒副反应及中位生存期。结果:联合组肿瘤稳定占比高于对照组、单药组,且单药组高于对照组,进展患者占比低于单药组、对照组,且单药组低于对照组(P<0.05);联合组治疗1个、3个周期后NRS评分、PFS-R评分低于单药组、对照组,且单药组低于对照组,KPS评分高于单药组、对照组,且单药组高于对照组(P<0.05);联合组治疗1个、3个周期后总T淋巴细胞、总B淋巴细胞、NK细胞高于单药组、对照组,且单药组高于对照组(P<0.05);联合组治疗1个、3个周期后IL-6、CRP、IL-8、IL-1β低于单药组、对照组,且单药组低于对照组(P<0.05);联合组便秘、失眠、肠梗阻、肠出血、低热、感染发生率低于单药组、对照组,单药组便秘、失眠、肠梗阻、低热、感染发生率低于对照组(P<0.05);联合组恶心呕吐、骨髓抑制发生率低于单药组、对照组,且单药组低于对照组(P<0.05);随访2年,均失访2例,联合组死亡7例,单药组死亡20例,对照组死亡34例。联合组、单药组、对照组中位生存期分别为18、14、13个月,联合组中位生存期长于单药组、对照组(P<0.05)。结论:复方苦参注射液联合西黄丸可有效减轻晚期结直肠癌姑息治疗患者癌性疼痛和疲乏,改善患者生存质量,提高免疫功能,降低炎症反应及并发症发生率。

Objective:To investigate the effects of compound Kushin injection combined with Xihuang Pill on cancer pain and fatigue,median survival and complication rate in patients with advanced colorectal cancer receiving palliative care.Methods:A total of 153 patients with advanced colorectal cancer treated in The First Affiliated Hospital of Chengdu Medical College from January 2020 to May 2021 were randomly divided into control group(conventional palliative care),monotherapy group(conventional palliative care+Xihuang pill)and combination group(conventional palliative care+Xihuang pill+compound matrine injection),with 51 cases in each group.Cancer pain[numerical pain scale(NRS)],cancer fatigue[Piper Revised Fatigue Scale(PFS-R)],survival[Functional status score(KPS)],inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP),and IL-8,IL-1β],immune function(total T lymphocytes,total B lymphocytes,NK cells)were compared between the 3 groups before treatment,1 cycle and 3 cycles after treatment,and the tumor control effect,complications,toxicity and median survival of the 3 groups were compared.Results:The proportion of stable tumor in combination group was higher than that in control group and monotherapy group,and the proportion of progressive patients was lower than that in monotherapy group and control group,and the proportion of patients in monotherapy group was lower than that in control group(P<0.05).After 1 and 3 cycles of treatment,the NRS score and PFS-R score in combination group were lower than those in monotherapy group and control group,and the monotherapy group was lower than that in control group,and the KPS score was higher than that in monotherapy group and control group,and the monotherapy group was higher than that in control group(P<0.05).After 1 and 3 cycles of treatment,the total T lymphocytes,total B lymphocytes and NK cells in combination group were higher than those in monotherapy group and control group,and monotherapy group was higher than control group(P<0.05).The levels of IL-6,CRP,IL-8 and IL-1βin combination group were lower than those in monotherapy group and control group after 1 and 3 cycles of treatment,and those in monotherapy group were lower than those in control group(P<0.05).The incidence of constipation,insomnia,intestinal obstruction,intestinal bleeding,hypothermia and infection in combination group was lower than that in monotherapy group and control group,and the incidence of constipation,insomnia,intestinal obstruction,hypothermia and infection in drug group was lower than that in control group(P<0.05).The incidence of nausea,vomiting and myelosuppression in combination group was lower than that in monotherapy group and control group,and the incidence in monotherapy group was lower than that in control group(P<0.05).After 2 years of follow-up,2 cases were lost to follow-up,7 cases died in the combination group,20 cases died in the monotherapy group,and 34 cases died in the control group.The median survival time of combination group,single drug group and control group was 18,14 and 13 months,respectively,and the median survival time of combination group was longer than that of monotherapy group and control group(P<0.05).Conclusion:Compound matrine injection combined with Xihuang Pill effectively alleviated cancer pain and fatigue,improve the quality of life,enhance immune function,reduce inflammatory response and complication rate in patients with advanced colorectal cancer in palliative care.