健脾固肠方改善Ⅲ、Ⅳ期肿瘤化疗患者肠道屏障功能的临床观察  

Clinical Observation of “Jianpi Guchang Decoction” on Intestinal Barrier Function of Chemotherapy Patients with Cancer at Stage Ⅲ and Ⅳ

作　　者：吴婷婷[1] 沈伟[2] 钟薏[1] 张士强[1] 杨蕴[1] 蒋海燕[1] 夏晓婷[1] 吕俊强[1] 付淑娟[1] 周张杰 

机构地区：[1]上海中医药大学附属市中西医结合医院肿瘤科,上海200082 [2]上海交通大学医学院附属新华医院肛肠外科,上海200092

出　　处：《上海中医药大学学报》2017年第2期27-32,共6页Academic Journal of Shanghai University of Traditional Chinese Medicine

基　　金：上海市科委中医引导类项目(15401930300);上海市自然科学基金资助项目(15ZR14387);上海市虹口区卫计委医学科研基金资助项目(虹卫1502-01)

摘　　要：目的:观察健脾固肠方对Ⅲ、Ⅳ期脾虚证恶性肿瘤化疗患者肠道屏障功能的影响。方法:纳入Ⅲ、Ⅳ期脾虚证恶性肿瘤化疗患者60例,随机分为中药干预组和单纯化疗组,每组30例,另将30例健康体检者作为健康对照组。所有患者均给予化疗治疗,中药干预组患者在化疗基础上给予健脾固肠方治疗,观察周期为6周。治疗前后检测并比较两组患者的外周血二胺氧化酶(DAO)、D-乳酸(D-LA)、肠型脂肪酸结合蛋白(IFABP)、内毒素(ET)、肠黏膜分泌型免疫球蛋白A(s Ig A)、白介素2(IL-2)、肿瘤坏死因子-β(TNF-β)、转化生长因子-β(TGF-β)、干扰素-γ(IFN-γ)水平,评估两组患者的中医证候评分及疗效,采用Karnofsky行为表现量表评估两组患者的生存质量,比较两组患者的化疗毒副反应(包括体质量和消化道毒副反应)。结果:(1)治疗前后两组患者的DAO、D-LA、IFABP、IL-2、TNF-β水平均显著高于健康对照组(P<0.05);治疗后,中药干预组患者的DAO水平较治疗前显著降低(P<0.01),单纯化疗组患者的D-LA水平较治疗前显著升高(P<0.05),中药干预组患者的DAO、D-LA水平显著低于单纯化疗组(P<0.05)。(2)治疗后,中药干预组患者的中医证候评分较治疗前明显降低(P<0.05),单纯化疗组患者的评分显著升高(P<0.05),且中药干预组患者的评分明显低于单纯化疗组(P<0.01);经治疗后,中药干预组的中医证候疗效总有效率为63.33%,单纯化疗组为30.00%,中药干预组的中医证候疗效优于单纯化疗组(P<0.01)。(3)治疗后,中药干预组患者的卡氏(KPS)评分明显升高(P<0.01),且明显高于单纯化疗组(P<0.05);经治疗后,中药干预组患者的KPS评分改善总有效率为73.33%,单纯化疗组为43.33%,中药干预组患者的KPS评分改善情况优于单纯化疗组(P<0.05)。(4)在稳定化疗患者体质量、改善恶心呕吐和腹泻等症状方面,中药干预组优于单纯化疗组(P<0.05)。结论:健脾固肠方�Objective： To observe the effect of ＂Jianpi Guchang Decoction＂ on the intestinal barrier function of chemotherapy patients with malignant cancer at stage Ⅲ and Ⅳ of spleen-deficiency syndrome. Methods： A total of 60 chemotherapy patients with malignant cancer at stage Ⅲ and Ⅳ of spleen-deficiency syndrome were selected and randomly divided into the Chinese medicine group and the chemotherapy group with 30 cases in each group, meanwhile 30 healthy volunteers were included as the healthy control group. All the patients were treated with chemotherapy and the patients in the Chinese medicine group were treated with ＂Jianpi Guchang Decoction＂ additionally, with a course of 6 weeks. Before and after treatment, the levels of serum diamine oxidase （ DAO ）, D-lactate （ D-LA）, intestinal fatty acid binding protein （ IFABP）, endotoxin（ET） , intestinal mucosa secretory immunoglobulin A （sIgA） , interleukin （IL-2 ）, tumor necrosis factor （TNF）-β, transforming growth factor（TGF） -β, interferon（IFN） -γ were detected, the scores and effect of Chinese medical syndrome were evaluated, the quality of life was assessed by Karnofsky performance scale （ KPS ）, and the toxic and adverse reactions including body wight and gastrointestinal side effects were compared. Results： （1）The levels of DAO, D-LA, IFABP, IL-2 and TNF-β in both groups before and after treatment were significantly higher than those in the healthy control group （ P 〈 0.05 ） ; after treatment, the level of DAO of the Chinese medicine group was markedly decreased （P 〈0.01 ）, the level of D-LA of the chemotherapy group was markedly increased （ P 〈 0.05 ）, and the levels of DAO and D-LA of the Chinese medicine group were significantly lower than those of the chemotherapy group （P 〈 0.05 ）. （2）After treatment, the scores of Chinese medical syndrome of the Chinese medicine group were obviously decreased （ P 〈 0.05 ）, the scores of the chemotherapy group were markedly incr

关 键 词：健脾固肠方 肠道屏障功能 脾虚证 化疗 恶性肿瘤 

分 类 号：R273[医药卫生—中西医结合]