中西医结合治疗化疗所致外周神经毒性的临床应用

Clinical application of combined traditional Chinese and Western medicine treatment in chemotherapy-induced peripheral neurotoxicity

目的:探索口服维生素B6、度洛西汀联合黄芪桂枝五物汤辅以针灸的中西医结合疗法治疗化疗所致外周神经病变(CIPN)的临床效果。方法:收集2021年5月~2022年11月在弋矶山医院化疗后出现Ⅲ级以上CIPN的33例恶性肿瘤患者资料,予以口服维生素B6、度洛西汀联合黄芪桂枝五物汤、针灸的中西医结合疗法联合治疗。评估治疗后疗效,对比患者的活动自理能力评分,明确影响治疗效果的临床特征。结果:中西医结合疗法治疗Ⅲ级以上CIPN的有效率为75.8%(25/33),平均起效时间(14.96±1.00)d。有效组患者的治疗前基线卡劳夫斯基(KPS)评分[(72.80±9.36)分]高于无效组患者[(61.25±3.54)分](P<0.01),治疗后33例患者KPS评分[(83.64±8.22)分]均较治疗前[(70.00±9.68)分]升高(P<0.001)。多因素Logistic回归分析显示,治疗前KPS评分高是患者治疗有效的保护因素(P<0.05)。结论:中西医联合治疗策略能显著改善化疗引起的周围神经毒性和患者的KPS评分,有临床进一步推广的价值。

Objective:To investigate the efficacies of integrated traditional Chinese and Western medicine[oral vitamin B6,duloxetine and Huangqi Guizhi Wuwu Decoction(HGWD)combined with acupuncture]in the treatment of chemotherapy-induced peripheral neuropathy(CIPN).Methods:Thirty-three tumor patients with grade 3 CIPN in our hospital were included from May 2021 to October 2022,and integrally treated with oral vitamin B6,duloxetine,HGWD and acupuncture.The treatment efficacies were evaluated by the patents′Karnofsky Performance Status(KPS),and the scoring of the patients on self-care activities was compared to identify the clinical features that influenced the treatment outcome.Results:The response rate of combined traditional Chinese and Western medicine in the treatment of gradeⅢCIPN was 75.8%(25/33),and median time to onset of symptom relief was(14.96±1.00)days.The baseline KPS score in patients of the effective group was significantly higher before treatment than that of those of ineffective group(72.80±9.36 vs.61.25±3.54;P<0.05).The KPS score was improved in 33 patients after treatment(83.64±8.22 vs.70.00±9.68;P<0.001).Multivariate analysis showed that a high preoperative KPS score was a protective factor for effective treatment in such patients(P<0.05).Conclusion:Integrated traditional Chinese and Western medicine regimen can produce a beneficial therapeutic effect on grade 3 CIPN,which may serve as a promising strategy in clinical practice.