敷和备化方联合肝动脉化疗栓塞术治疗肝郁脾虚型原发性肝癌患者的近期疗效及其对血浆血管生成因子水平的影响研究  

Short-term Curative and Plasma Angiogenic Responses to Fuhe Beihua Decoction with Transcatheter Arterial Chemoembolization in Primary Liver Cancer Patients with Liver Depression and Spleen Deficiency Syndrome

作　　者：蒋锐沅 王同彪 满婷婷 覃艳春 洪晓华 荣震[2] 莫春梅[2] JIANG Ruiyuan;WANG Tongbiao;MAN Tingting;QIN Yanchun;HONG Xiaohua;RONG Zhen;MO Chunmei(Guangxi University of Chinese Medicine,Nanning 530200,China;The First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,China)

机构地区：[1]广西中医药大学,广西壮族自治区南宁市530200 [2]广西中医药大学第一附属医院,广西壮族自治区南宁市530023

出　　处：《中国全科医学》2020年第33期4214-4221,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(81760850,81660774);广西医疗卫生适宜技术开发与推广应用项目(S2018046);广西中医药大学第一附属医院院内制剂研究与开发(2018ZJ004)。

摘　　要：背景肝动脉化疗栓塞(TACE)术虽是目前中晚期不可手术的原发性肝癌患者的首选局部治疗措施,但TACE术后仍存在较多问题亟待解决,中医药治疗作为重要的辅助手段,联合TACE术能使原发性肝癌患者获得更大的治疗收益。目的探讨敷和备化方联合TACE术治疗肝郁脾虚型原发性肝癌患者的近期疗效及其对血浆血管生成因子水平的影响。方法选取2018年1—6月广西中医药大学第一附属医院肿瘤科及肝病科收治的肝郁脾虚型原发性肝癌患者90例,采用随机数字表法分为对照组和治疗组,每组45例。在常规对症支持治疗基础上,两组患者均行亚肝段动脉末梢水平TACE术,治疗组患者连续服用敷和备化方12周。比较两组患者近期(治疗12周后)疗效、无进展生存时间(PFS)及治疗前后血清甲胎蛋白水平、Karnofsky(KPS)评分、中医症候积分、血浆血管生成因子〔包括血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、血小板衍生生长因子(PDGF)〕,并观察两组患者毒副作用和/或并发症发生情况。TACE术后当天开始进行电话随访,随访截止时间为患者出现疾病进展或完成整个疗程(12周)。结果两组患者均完成整个疗程及随访,无一例脱落或失访。两组患者总有效率(ORR)、疾病控制率(DCR)比较,差异无统计学意义(P>0.05)。平均随访(207.5±28.4)d,两组患者PFS的Kaplan-Meier生存曲线比较,差异有统计学意义(P<0.05)。治疗组患者治疗后血清甲胎蛋白水平,腹痛腹胀、纳呆食少、情志抑郁、恶心呕吐、神疲乏力、口苦咽干评分及中医症候积分,血浆VEGF、bFGF、PDGF水平均低于对照组,而KPS评分高于对照组(P<0.05)。两组患者毒副作用和/或并发症发生率比较,差异无统计学意义(P>0.05)。结论敷和备化方联合TACE术能在一定程度上延长肝郁脾虚型原发性肝癌患者PFS,同时能有效改善患者临床症状及肿瘤相关血管微�Background Although transcatheter arterial chemoembolization(TACE)is the preferred local treatment for inoperable intermediate and advanced primary liver cancer at present,there are many problems which demands prompt solution after TACE.To improve the treatment benefits from TACE,TCM treatment may be used as an appropriate adjuvant therapy.Objective To investigate the short-term curative and plasma angiogenic responses to Fuhe Beihua Decoction with TACE in primary liver cancer patients with liver depression and spleen deficiency syndrome.Methods From January to June 2018,90 primary liver cancer patients with liver depression and spleen deficiency syndrome were selected from Oncology Department and Liver Disease Department,the First Affiliated Hospital of Guangxi University of Chinese Medicine,and were equally divided into control group and treatment group by random number table method.Both groups underwent TACE at the distal portion of the subsegmental hepatic artery plus routine symptomatic and supportive therapies.The treatment group additionally received Fuhe Beihua Decoction for 12 consecutive weeks(started on the completion day of TACE).Short-term(12 weeks after treatment)curative response,progression-free survival(PFS),pre-and post-treatment serum alpha-fetoprotein(AFP)level,Karnofsky(KPS)score,TCM syndrome score,plasma angiogenesis factors〔including vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),platelet-derived growth factor(PDGF)〕were compared between the two groups.Toxic and side effects and/or complications occurred in both groups were also compared.Patients in the two groups were followed up by telephone after TACE until to the occurrence of progress of disease or the end of course of treatment(12 weeks).Results All the patients completed the whole course of treatment and follow-up with complete data.The overall response rate and disease control rate were not significantly different between the two groups(P>0.05).At average of(207.5±28.4)d of follow-up,Kaplan-Meier

关 键 词：肝肿瘤 肝动脉 化学栓塞 治疗性 敷和备化方 肝气郁结 脾虚 血管生成因子 治疗结果 

分 类 号：R735.7[医药卫生—肿瘤]