二仙升白汤联合黄芪鳝鱼汤治疗化疗后白细胞减少症及对免疫功能的调节作用  

Effect of Erxian Shengbai Decoction Combined with Huangqi Huanagshan Soup on Leukopenia After Chemotherapy and Regulatory Effect on Immunity

作　　者：杨淑艳[1] 吴茂林[1] 吴昕[2] YANG Shu-yan;WU Mao-lin;WU Xin(Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China;West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]成都中医药大学附属医院,成都610072 [2]四川大学华西医院,成都610041

出　　处：《中国实验方剂学杂志》2020年第16期125-130,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：四川省中医药管理局应用研究项目(2015YS016)。

摘　　要：目的:观察二仙升白汤联合黄芪鳝鱼汤治疗化疗后白细胞减少症(脾肾气虚证)的临床疗效及对免疫功能和细胞因子的调节作用。方法:将150例患者按随机数字表法分为对照组和观察组各75例。对照组口服鲨肝醇片,60 mg/次,3次/d,连续服用6周;Ⅲ度,Ⅳ度者,加用重组人粒细胞集落刺激因子注射液(rhG-CSF),2~5μg·kg^-1·d^-1,皮下注射,至中性粒细胞恢复至5. 0×10^9个/L(白细胞计数10. 0×10^9个/L)停药。对照组口服升白康颗粒,1袋/次,3次/d;观察组服用二仙升白汤和黄芪鳝鱼汤,1剂/d;连续服用6周。记录外周血白细胞(WBC)和中性粒细胞(NEUT)数量和恢复正常时间;记录感染次数和抗生素的使用时间;记录rhG-CSF使用量和时间;记录红细胞计数(RBC),血红蛋白(Hb),血小板计数(PLT)和完成化疗率;进行治疗前后中医证候评分和生活质量(KPS)评分,检测治疗前后T淋巴细胞亚群(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)和自然杀伤细胞(NK)水平;检测治疗前后白细胞介素-2(IL-2),IL-6,肿瘤坏死因子-α(TNF-α)。结果:经秩和检验分析,两组患者白细胞减少症的疗效,观察组疗效好于对照组(Z=2. 057,P<0. 05);观察组WBC,NEUT,RBC,Hb和PLT水平均高于对照组(P<0. 01);观察组WBC和NEUT恢复正常时间均短于对照组(P<0. 01);观察组感染次数少于对照组,抗生素使用时间短于对照组(P<0. 01),rhG-CSF使用量少于对照组和使用时间短于对照组(P<0. 01);治疗后观察组WBC,NEUT复常率和完成化疗率分别为76. 12%(51/67),73. 13%(49/67)和92. 54%(62/67),分别高于对照组的57. 35%(39/68),52. 94%(36/68)和79. 41%(54/68)(P<0. 05);观察组NK,CD3^+,CD4+和CD4^+/CD8^+水平均高于对照组,CD8^+低于对照组(P<0. 05);观察组患者IL-2水平高于对照组,IL-6和TNF-α水平均低于对照组。结论:二仙升白汤联合黄芪鳝鱼汤治疗化疗后白细胞减少症(脾肾气虚证)患者,可促进WBC,NEUT复常,还能稳定患者免疫功能,调节细胞因子,改Objective: To observe the clinical efficacy of Erxian Shengbai decoction combined with Huangqi Huang soup for leucopenia(deficiency of spleen and kidney Qi)after chemotherapy,and to investigate the regulatory effect on immune function and cytokines. Method: One hundred and fifty patients were randomly divided into control group(75 cases)and observation group(75 cases)by random number table. Patients in group got batilol tablets by oral administration for 6 weeks,60 mg/time,3 times/day. And the patients at stageⅢ or Ⅳ additionally received recombinant human granulocyte colony stimulating factor injection(rhG-CSF)for subcutaneous injection,2-5 μg·kg^-1·d^-1,until the count of neutrophils recovered to 5. 0×10^9个/L(10. 0×10^9个/L for white blood cell). In the control group shengbaikang granules were taken orally,1 bag/time,3 times/day.Patients in observation group additionally received Erxian Shengbai decoction combined with Huangqi Huangshan soup for 6 weeks,1 doses/day. Number of peripheral blood leukocytes(WBC)and neutrophils(NEUT),time to recovery,number of infections,duration of using antibiotics,dose and duration of rhG-CSF,red blood cell(RBC)count,hemoglobin(Hb),platelets(PLT)and rate of completed chemotherapy were recorded. Scores of traditional Chinese medicine(TCM)syndrome and karnofsky performance scale(KPS)were graded before and after treatment. Levels of T lymphocyte subsets(CD3^+,CD4^+,CD8^+and CD4^+/CD8^+),natural killer cell(NK),interleukin-2(IL-2),IL-6,and tumor necrosis factor-α(TNF-α)were all detected.Result: In the analysis of rank sum test,to the efficacy for leucopenia in observation group was better than that in control group(Z=2. 057,P<0. 05). Levels of WBC,NEUT,RBC,Hb and PLT were higher than those in control group(P<0. 01). Time to recovery,number of infections and duration of using antibiotics,dose and duration of rhG-CSF were all less than those in control group(P<0. 01). After treatment,the recovery rate of WBC and NEUT as well as completed chemotherapy were 76. 12%(51/67),7

关 键 词：化疗 白细胞减少症 脾肾气虚证 二仙升白汤 黄芪鳝鱼汤 免疫功能 细胞因子 

分 类 号：R289.5[医药卫生—方剂学] R5[医药卫生—中药学]