龙胆泻肝汤加减治疗原发性肝癌TACE术后栓塞综合征湿热内阻证患者的临床效果

Clinical effect of modified Longdan Xiegan decoction on patients with dampness-heat internal obstruction syndrome of embolism syndrome after TACE operation for primary liver cancer

目的观察龙胆泻肝汤加减治疗原发性肝癌(PLC)肝动脉化疗栓塞(TACE)术后栓塞综合征湿热内阻证患者的临床效果。方法选取2020年10月—2022年4月于南方医科大学顺德医院和南方医科大学中西医结合医院确诊为PLC,经TACE治疗后出现栓塞综合征的湿热内阻证患者82例,根据随机数字表法分为观察组和对照组,每组41例。对照组行常规西药治疗,观察组在对照组基础上行龙胆泻肝汤加减治疗,2组均治疗3周。比较2组临床效果,治疗前后中医证候评分、栓塞综合征症状持续时间、肿瘤患者生活质量评分表(QOL)评分和ECOG体力状况评分,甲胎蛋白(AFP)以及肝功能指标[总胆红素(TBil)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)]水平。结果观察组治疗总有效率为73.17%,高于对照组的31.71%(χ^(2)=14.131,P<0.01)。观察组恶心呕吐、发热、腹胀腹泻、肝区疼痛持续时间均短于对照组(P<0.01)。治疗3周后,2组中医证候评分均低于治疗前,且观察组低于对照组(P<0.01);2组QOL评分均高于治疗前,ECOG评分均低于治疗前,且观察组高/低于对照组(P<0.05或P<0.01);2组AFP水平低于治疗前,且观察组低于对照组(P<0.01);2组TBil、ALP、ALT、AST水平均低于治疗前,且观察组低于对照组(P<0.01)。结论龙胆泻肝汤加减治疗TACE术后栓塞综合征湿热内阻证患者的临床效果较好,根据中医辨证论治既能明显改善栓塞综合征症状,进而改善患者生活质量,又能改善患者肝功能。

Objective To observe the clinical effect of modified Longdan Xiegan decoction on patients with dampness-heat internal obstruction syndrome of embolization syndrome after TACE operation for primary liver cancer(PLC).Methods A total of 82 patients diagnosed with PLC in Shunde Hospital of Southern Medical University and Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine from October 2020 to April 2022 who developed dampness-heat internal obstruction syndrome of embolism syndrome after TACE treatment were selected and divided into observation group and control group according to random number table method,with 41 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with modified Longdan Xiegan decoction on the basis of the control group.Both groups were treated for 3 weeks.The clinical effect,symptom duration of embolism syndrome,and TCM syndrome score,QOL score and ECOG physical status score of tumor patients,Alpha-fetoprotein(AFP) and liver function indicators(TBil,ALP,ALT,AST) levels before and after treatment were compared between the two groups.Results The total effective rate of the observation group was 73.17%,which was higher than 31.71% of the control group(χ^(2)=14.131,P<0.01).The duration of nausea,vomiting,fever,abdominal distension,diarrhea and hepatic pain in the observation group were shorter than those in control group(P<0.01).After 3 weeks of treatment,the TCM syndrome scores in two groups were lower than before treatment,and that in observation group was lower than the control group(P<0.01).QOL scores of two groups were higher than before treatment,ECOG scores were lower than before treatment,and those in observation group were higher/lower than control group(P<0.05 or P<0.01).The AFP levels in two groups were lower than before treatment,and that in observation group was lower than control group(P<0.01).The levels of TBil,ALP,ALT and AST in two groups were lower than before treatment,and those in observation group were lower than control group(P<0.01).Conclusion The clinical effect of modified Longdan Xiegan decoction in the treatment of embolic syndrome patients with dampness-heat internal obstruction syndrome after TACE operation is good.The treatment based on TCM syndrome differentiation can significantly improve the symptoms of embolic syndrome,but also improve the quality of life and liver function of patients.