健脾清肠法改善化疗致结直肠癌患者肠屏障功能障碍的临床观察  

Clinical Observation on Therapeutic Effects of Strengthening Spleen and Clearing Intestinal Treatment on Intestinal Barrier Dysfunction in Patients after Chemotherapy with Colorectal Cancer

作　　者：付晓伶[1] 张彦博[1] 周荣耀[1] 王文海[1] 

机构地区：[1]上海中医药大学附属曙光医院,上海201203

出　　处：《云南中医学院学报》2014年第3期51-56,共6页Journal of Yunnan University of Traditional Chinese Medicine

基　　金：上海市卫生局科研项目(20139173);上海市教委科研项目(2013JW045)

摘　　要：目的观察健脾清肠法改善化疗致结直肠癌患者肠黏膜屏障功能障碍的临床疗效,并探讨可能作用机制。方法采用随机同期对照原则,将82例患者分成空白对照组26例(予单纯化疗)、培菲康组26例(予培菲康联合化疗)和中药组30例(予健脾清肠方药联合化疗),经治疗2个月,分别于治疗前后对结直肠癌患者予KPS行为状态评分,中医证侯总积分和单项症状积分,并检测血浆内毒素含量和尿乳果糖/甘露醇排泄率。结果中药组治疗后患者KPS评分显著高于对照组(P<0.05),其改善脾虚湿热证有效率为83.33%,显著高于对照组(P<0.05)。健脾清肠方药对"大便溏薄"、"腹痛"、"纳呆"、"肠鸣"、"倦怠乏力"、"面色萎黄"症状改善明显(P<0.05),而空白对照组和培菲康组症状出现不同程度加重。对"大便溏薄"、症状改善与培菲康组作用相近(P>0.05),中药组治疗后血浆内毒素含量、尿乳果糖/甘露醇排泄率均显著降低(P<0.05);且与培菲康组作用相近(P>0.05)。结论具有健脾清肠功效的中药能修复结直肠癌患者肠黏膜屏障损伤和改善脾虚湿热证的临床症状,提高生活质量。其可能机制主要是通过降低血内毒素含量和尿乳果糖/甘露醇比值,从而减少肠黏膜屏障通透性改变,改善肠屏障功能障碍。Objective To observe the clinical effects of＂strengthening spleen and clearing intestinal treatment ＂on intestinal barrier dysfunction in patients after chemotherapy with colorectal cancer,and its mechanism. Methods 82 cases of intestinal barrier dysfunction in patients after chemotherapy with colorectal cancer were divided into three groups,the blank control group in which 26cases were treated by single chemotherapy,the control group of Bifico in which 26 cases were treated by Bifico,while the treatment group of traditional Chinese medicine were given strengthening spleen and clearing intestinal decoction. Before and after the treatment for two mouths,KPS score,overall accumulate points and single point of TCM symptoms were all aberserved,the blood endotoxin concentration and the ratio of urine lactulose to mannitol（L/M）were also detected. Results Treatment group can raise scores on the quality of life（P〈0.05）. The efficiency of treatment group which can improve significantly clinical symptoms of spleen deficiency and damp-heat accumulation in patients is 83. 33%（P〈0.05）,which is higher than the other groups. This decoction can significantly improve symptoms of ＂loose stool,abdomen pain,poor appetite,borborygmus,tiredness,yellow complexion＂（P0.05）. The blank control group and the Bifico control group can make some symptoms aggravating in different degree. It can also produce the same effect with Bifico for ＂loose stool ＂.（P〉0.05）Strengthening spleen and clearing intestinal decoction and Bifico can all decrease significantly endotoxin,urine lactulose / mannitol ratio（P〈0.05）. Conclusion Strengthening spleen and clearing intestinal decoction can significantly ameliorate intestinal barrier dysfunction in patients with colorectal cancer,improve clinical symptoms of spleen deficiency and damp-heat accumulation

关 键 词：健脾清肠法 肠屏障功能障碍 脾虚湿热证 结直肠癌 化疗 

分 类 号：R273[医药卫生—中西医结合]