穴位埋线联合健脾清肺汤对化疗后脾肺气虚证非小细胞肺癌患者的效果

Effect of acupoint thread embedding combined with Jianpi Qingfei Decoction on non-small cell lung cancer patients with spleen-lung Qi deficiency syndrome after chemotherapy

目的探究穴位埋线联合健脾清肺汤对化疗后脾肺气虚证非小细胞肺癌患者中医证候及预后的影响。方法选取2022年5月至2024年1月陕西省中医医院收治的140例化疗后脾肺气虚证非小细胞肺癌患者,以抽签法随机分为两组,每组70例。研究组中男45例,女25例;年龄(59.26±5.00)岁;肿瘤分期Ⅲ期25例、Ⅳ期45例;鳞癌30例、腺癌40例。对照组中男47例,女23例;年龄(60.14±5.06)岁;肿瘤分期Ⅲ期27例、Ⅳ期43例;鳞癌33例、腺癌37例。对照组患者应用健脾清肺汤治疗(400 ml分早晚两次温服),21 d为1个周期,共治疗3个周期;研究组患者联合穴位埋线治疗,每10 d治疗1次,3次为1个疗程,共治疗2个疗程。比较两组治疗前、治疗63 d后的中医证候积分、免疫细胞因子、肿瘤标志物水平及治疗期间不良反应。采用t检验、χ^(2)检验进行统计学分析。结果治疗后两组中医证候积分均降低,且研究组均低于对照组[咳嗽痰多:(2.11±0.46)分比(2.95±0.53)分,神疲乏力:(2.26±0.16)分比(3.31±0.57)分,气短:(2.11±0.36)分比(2.89±0.24)分,便溏:(1.25±0.43)分比(1.60±0.51)分,纳呆:(2.03±0.41)分比(3.26±0.53)分],差异均有统计学意义(均P<0.05)。研究组治疗后的鳞癌相关抗原(SCC-Ag)、胃泌素释放肽前体(ProGRP)、癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)水平均低于对照组[(0.94±0.20)μg/L比(1.33±0.24)μg/L、(56.24±8.41)ng/L比(71.03±10.81)ng/L、(3.21±1.05)μg/L比(4.01±1.13)μg/L、(2.03±0.47)μg/L比(2.97±0.34)μg/L],差异均有统计学意义(均P<0.05)。研究组治疗后的CD4+/CD8+、CD16+CD56+、干扰素(IFN)-γ水平均高于对照组,白细胞介素(IL)-10水平低于对照组,差异均有统计学意义(均P<0.05)。研究组的不良反应发生率为8.57%(6/70),低于对照组的22.86%(16/70),差异有统计学意义(χ^(2)=5.393,P=0.020)。结论在化疗后脾肺气虚证非小细胞肺癌患者中,应用穴位埋线联合健脾清肺汤可减轻中医证候,改善免疫功能,降低肿瘤标志物水平,且不良反应较少,可在临床推广。

Objective To explore the influence of acupoint thread embedding combined with Jianpi Qingfei Decoction on traditional Chinese medicine(TCM)syndrome and prognosis of non-small cell lung cancer patients with spleen-lung Qi deficiency syndrome after chemotherapy.Method A total of 140 non-small cell lung cancer patients with spleen-lung Qi deficiency syndrome after chemotherapy in Shaanxi Provincial Hospital of Traditional Chinese Medicine from May 2022 to January 2024 were selected and were randomly divided into two groups by drawing lots,with 70 cases in each group.There were 45 males and 25 females in the study group,aged(59.26±5.00)years;there were 25 cases of stage Ⅲ and 45 cases of stage Ⅳ;there were 30 cases of squamous cell carcinoma and 40 cases of adenocarcinoma.In the control group,there were 47 males and 23 females,aged(60.14±5.06)years;there were 27 cases of stage Ⅲ and 43 cases of stage Ⅳ;there were 33 cases of squamous cell carcinoma and 37 cases of adenocarcinoma.The control group was treated with Jianpi Qingfei Decoction(400 ml taken warmly twice in the morning and evening),21 days as 1 cycle,a total of 3 cycles;the study group was treated with acupoint thread embedding on the basis of the control group,once every 10 days,3 times as a course of treatment,a total of 2 courses of treatment.The TCM syndrome scores,immune cytokines,and tumor markers before and after 63 days of treatment and adverse reactions during treatment were compared between the two groups.t test and χ^(2) test were used for statistical analysis.Results After treatment,the TCM syndrome scores of both groups were decreased,and those in the study group were lower than those in the control group[cough and phlegm accumulation:(2.11±0.46)points vs.(2.95±0.53)points,fatigue:(2.26±0.16)points vs.(3.31±0.57)points,shortness of breath:(2.11±0.36)points vs.(2.89±0.24)points,loose stools:(1.25±0.43)points vs.(1.60±0.51)points,restlessness:(2.03±0.41)points vs.(3.26±0.53)points],with statistically significant differences(all P<0.05).The levels of squamous cell carcinoma associated antigen(SCC-Ag),gastrin-releasing peptide precursor(ProGRP),carcinoembryonic antigen(CEA),and cytokeratin 19 fragment(CYFRA21-1)in the study group after treatment were lower than those in the control group[(0.94±0.20)μg/L vs.(1.33±0.24)μg/L,(56.24±8.41)ng/L vs.(71.03±10.81)ng/L,(3.21±1.05)μg/L vs.(4.01±1.13)μg/L,(2.03±0.47)μg/L vs.(2.97±0.34)μg/L],with statistically significant differences(all P<0.05).After treatment,the levels of CD4+/CD8+,CD16+CD56+,and interferon(IFN)-γin the study group were higher than those in the control group,and the level of interleukin-10 was lower than that in the control group,with statistically significant differences(all P<0.05).The incidence of adverse reactions in the study group was 8.57%(6/70),which was lower than that in the control group[22.86%(16/70)],with a statistically significant difference(χ^(2)=5.393,P=0.020).Conclusion In the treatment of non-small cell lung cancer patients with spleen-lung Qi deficiency syndrome after chemotherapy,acupoint thread embedding combined with Jianpi Qingfei Decoction can alleviate the TCM syndromes,improve the immune function,lower the levels of tumor markers,and has fewer adverse reactions,which can be promoted in clinical practice.