加减阳和汤改善晚期宫颈癌免疫相关性甲状腺功能减退的临床观察

Clinical Observation on Improvement of Immune Hypothyroidism in Advanced Cervical Cancer with Modified Yanghe Decoction(加减阳和汤)

目的探讨加减阳和汤改善晚期宫颈癌免疫相关性甲状腺功能减退的临床疗效。方法选取2022年1月—2023年6月该院肿瘤科收治的晚期宫颈癌患者60例,入组采用“免疫检查点抑制剂(ICIs)+化疗”方案治疗晚期宫颈癌,针对出现免疫性甲状腺功能减退[促甲状腺素(TSH)>4.2 mIU/mL]的患者,随机分为对照组及试验组,对照组予以左甲状腺素钠片,试验组在对照组的基础上予以加减阳和汤水煎服。两组患者均治疗3个月。对比两组临床疗效、中医证候疗效、甲状腺激素水平、T细胞亚群水平、并发症与生存率。结果治疗后,与对照组相比,试验组治疗总有效率较高(P<0.05),试验组中医症状总有效率较高(P<0.05)。经治疗,与治疗前相比,治疗后两组CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)增高,差异有统计学意义(P<0.05);与对照组比较,试验组CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)较高,差异有统计学意义(P<0.05)。经治疗,两组血清TSH水平显著较治疗前降低,T4、FT4水平较治疗前升高;试验组血清TSH水平显著低于对照组,T4、FT4水平高于对照组(P<0.05)。两组不良反应总发生率相比差异无统计学意义(P>0.05)。与对照组比较,试验组PFS率较高(P<0.05)。结论加减阳和汤应用于晚期宫颈癌免疫相关性甲状腺功能减退能够有效改善症状体征,调节机体甲状腺激素与T细胞亚群水平,值得临床推广。

Objective To investigate the clinical efficacy of Modified Yanghe Decoction(加减阳和汤)to improve immune hypothyroidism in advanced cervical cancer.Methods Sixty patients with advanced cervical cancer admitted to the oncology department from January 2022 to June 2023 were selected and treated with“immune checkpoint inhibitor(ICI)+chemotherapy”regimen for immune hypothyroidism in advanced cervical cancer(thyroid stimulating hormone(TSH)>4.2 mIU/mL).The control group was given levothyroxine sodium tablets,while the experimental group was treated with Yanghe Decoction on the basis of the control group.The clinical efficacy,TCM symptom efficacy,thyroid hormone level,T-cell subpopulation level,complications and survival rate of the two groups were compared.Result After treatment,compared with that of the control group,the total effective rate of treatment group was higher(P<0.05),and the total effective rate of TCM symptoms in the experimental group was higher(P<0.05).After treatment,the levels of CD_(4)^(+),CD_(8)^(+) and CD_(4)^(+)/CD_(8)^(+) were increased in the two groups after treatment compared with those before treatment,and the difference was statistically significant(P<0.05).Compared with those in the control group,the values of CD_(4)^(+),CD_(8)^(+) and CD_(4)^(+)/CD_(8)^(+) in the experimental group were higher,and the difference was statistically significant(P<0.05).After treatment,serum TSH levels in two groups were significantly lower than those before treatment and the levels of free triiodothyronine(FT3)and free thyroxine(FT4)were higher than those before treatment.Serum TSH level in the experimental group was significantly lower than that in the control group.The levels of FT3 and FT4 were higher than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Compared with that in the control group,the progression-free survival(PFS)rate in the experimental group was higher(P<0.05).Conclusion The application of Modified Yanghe Decoction in immune hypothyroidism in advanced cervical cancer can effectively improve the symptoms and signs and regulate the levels of thyroid hormones and T-cell subsets in the body,which is worthy of clinical promotion.