柴胡化积方改善原发性肝癌TACE术后综合征的临床观察

Clinical Observation on Chaihu Huaji Decoction in Improving Postembolization Syndrome of Hepatocellular Carcinoma following Transcatheter Arterial Chemoembolization

目的观察柴胡化积方改善原发性肝癌肝动脉化疗栓塞术(TACE)后综合征的疗效。方法选取100例患者,先根据肝癌临床分期进行分层,分为Ⅰb期、Ⅱa期、Ⅱb期、Ⅲa期亚组,然后在各亚组内按照随机数字表法分为治疗组与对照组,最后将4个亚组中所有的治疗组与对照组相应合并,形成本研究最终的治疗组和对照组。治疗组采用基础治疗联合柴胡化积方,对照组仅采用基础治疗,治疗周期均为7 d。最终,治疗组与对照组各完成50例有效病例。比较两组治疗前后中医证候评分、肝功能、甲胎蛋白(AFP)、血常规、肾功能、电解质,并对各个亚组的中医证候评分进行分层分析。结果治疗组中医证候总有效率明显高于对照组(P<0.05)。两组间比较,治疗后治疗组发热、恶心呕吐、口干、口苦、大便稀溏、纳差的证候评分以及证候总评分明显低于对照组(P<0.05);术后7 d,治疗组谷丙转氨酶(ALT)、谷草转氨酶(AST)明显低于同时期对照组(P<0.05);术后28 d,治疗组TBIL明显低于同时期对照组(P<0.05);两组术后28 d AFP无显著性差异(P>0.05);两组各时期血红蛋白(HGB)、红细胞计数(RBC)、白细胞计数(WBC)、血小板计数(PLT)、血清肌酐(CR)、血清钾(K^(+))、血清钠(Na^(+))均无显著性差异(P>0.05)。治疗后,治疗组各分期中医证候总评分明显低于相同分期的对照组(P<0.05),治疗组Ⅲa期的中医证候总评分下降最明显,治疗组Ⅰb期有显著性改善的症状数量最多。结论柴胡化积方治疗原发性肝癌TACE术后综合征疗效确切,可明显改善中医证候和肝功能,Ⅰb期改善症状的数量最多,Ⅲa期改善症状的程度最明显。

Objective:To evaluate the efficacy of Chaihu Huaji Decoction in improving postembolization syn⁃drome of hepatocellular carcinoma following transcatheter arterial chemoembolization(TACE).Methods:Patients who met the enrollment requirements were selected.They were firstly stratified according to the clinical stages of liver cancer,and were divided into stageⅠb,stageⅡa,stageⅡb and stageⅢa subgroups,and then randomly di⁃vided into the treatment group and control group according to random number table method.Finally,all the treat⁃ment groups in the four subgroups were combined with the control group to form the final treatment group and con⁃trol group in this study.The treatment group was treated with basic treatment combined with Chaihu Huaji Decoc⁃tion,while the control group was treated with basic treatment only,and the treatment cycle was 7 days.There were 50 effective cases in the treatment group and the control group respectively.The TCM pattern scores,liver func⁃tion,alpha-fetoprotein(AFP),blood routine,renal function and electrolytes were compared between the two groups before and after treatment,and the TCM pattern scores of each subgroup were analyzed in stratified ways.Re⁃sults:The total effective rate of TCM syndrome in the treatment group was significantly higher than that in the control group(P<0.05).Compared between the two groups,the pattern scores and total pattern scores of fever,nau⁃sea and vomiting,dry mouth,bitter mouth,loose stool,and poor appetite in the treatment group were significantly lower than those in the control group(P<0.05).On the 7th day after surgery,the levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the treatment group were significantly lower than those in the con⁃trol group(P<0.05).On the 28th day after operation,the TBIL in the treatment group was significantly lower than that in the control group(P<0.05).There was no obvious difference in AFP between two group(P>0.05).There were no significant differences in hemoglobin(HGB),red blood cell count(RBC),white blood cell count(WBC),platelet count(PLT),serum creatinine(CR),serum potassium(K^(+))and serum sodium(Na^(+))between the two groups significantly lower than that of the control group at the same stage(P<0.05),and the total score of TCM syndrome in stageⅢa of the treatment group decreased the most obvious,and the number of symptoms with significant im⁃provement in stageⅠb in the treatment group was the most.Conclusion:Chaihu Huaji Decoction has a definite effect on the treatment of postembolization syndrome of hepatocellular carcinoma following TACE,and can signifi⁃cantly improve TCM syndromes and liver function.The number of symptoms improved in stageⅠb is the most,and the degree of improvement in stageⅢa is the most obvious.