骨痛灵方联合唑来膦酸治疗支气管肺癌骨转移伴中重度疼痛37例临床观察  

Clinical Observation on Gutongling Formula(骨痛灵方) Combined with Zoledronic Acid in Treatment of 37 Cases of Bone Metastatic Pain of Lung Cancer

作　　者：罗琴琴 徐振晔[2] 薛莎[1] LUO Qinqin;XU Zhenye;XUE Sha(l.Wuhan Hospital of Integrated Chinese and Western Medicine,Wuhan 43000;Longhua Hospital Affiliated to Shanghai Univer-sity of Chinese Medicine)

机构地区：[1]武汉市中西医结合医院 [2]上海中医药大学附属龙华医院

出　　处：《中医杂志》2018年第21期1853-1857,共5页Journal of Traditional Chinese Medicine

摘　　要：目的探讨骨痛灵方联合唑来膦酸治疗支气管肺癌骨转移伴中重度疼痛临床疗效和可能作用机制。方法将73例支气管肺癌骨转移伴中重度患者随机分为对照组(36例)和治疗组(37例)。两组均给予止痛和中药基础方治疗,对照组在基础治疗同时予以唑来膦酸静脉滴注,每4周1次,治疗组在对照组治疗的基础上在基础中药方中加入骨痛灵方口服,每日1剂,两组疗程均为8周。观察治疗前后两组患者数字疼痛评分(NRS评分),并比较镇痛疗效;检测治疗前后两组患者骨代谢指标[血清钙(Ca^(2+))、碱性磷酸酶(ALP)、Ⅰ型胶原氨基端延长肽(P1NP)和β-Ⅰ型胶原羧基端肽(β-CTx)含量];通过直线回归分析NRS评分与骨代谢指标的相关性。结果治疗组镇痛疗效总有效率72. 97%,对照组为44. 44%,两组比较差异有统计学意义(P <0. 05)。治疗后,治疗组血清ALP、P1NP、β-CTx含量均较治疗前有所降低(P <0. 05),且与对照组比较降低更为明显(P <0. 05);血清Ca2+两组间比较差异无统计学意义(P> 0. 05)。相关性分析显示,治疗组中血清β-CTx含量的降低与患者NRS评分的降低呈正相关(r=0. 187,P <0. 01)。结论骨痛灵方联合唑来膦酸是治疗支气管肺癌骨转移伴中重度疼痛的有效疗法,其作用机制可能与抑制破骨细胞活性有关。Objective To investigate the clinical efficacy and possible mechanism of Chinese Medicine Gutongling Formula（ 骨痛灵方,GTL） combined with Zoledronic Acid（ ZA） in the treatment of bone metastatic pain of lung cancer. Method A total of 73 patients with lung cancer bone metastasis who were suffering from moderate to severe pain were selected and randomly divided into control group（ 36 cases） and treatment group（ 37 cases）. The patients in both groups received analgesic and traditional Chinese medicine basic treatment,and the control group was additionally given intravenous infusion of zoledronic acid once 4 weeks. On the basis of the same treatment in control group,the treatment group was given oral GTL 1 dose each day,8 weeks as a course for both groups. Before and after the treatment,the numeric rating Scale（ NRS） was recorded to value the analgesia and the serum bone metablic markers serum calcium（ Ca2 ＋）,alkaline phosphatase（ ALP）,total procollagen type 1 N-terminal propeptide（ P1 NP） and β-isomerized C-terminal telopeptides（ β-CTx） were tested. The relevance of the linear of NRS and the reduce of serum bone metablic markers were analyzed. Results The total effective rate of analgesia in the treatment group and the control group was 72. 97% and 44. 44% respectively,and the differences between groups was significant（ P〈 0. 05）. After treatment,serum ALP,P1 NP,β-CTx indexes of the treatment group decreased significantly（ P〈 0. 05）,and the decrease was more than that of the control group（ P〈 0. 05）. There was no significant of serum Ca2 ＋in both groups（ P〉 0. 05）. According to the correlation analysis,the decrease of serum β-CTx was positively related to the reduction of NRS in the treatment group（ r = 0. 187,P 0. 01）. Conclusion The prescription Gutongling Formula combined with ZA was an effective therapy for lung cancer bone metastasis with moderate to severe pain patients,and its mechanism may be related with the suppression of the osteo

关 键 词：支气管肺癌 骨转移 疼痛 骨痛灵方 唑来膦酸 破骨细胞 

分 类 号：R734.2[医药卫生—肿瘤]