加味参芪地黄汤对去势后激素敏感性前列腺癌骨转移患者的疗效研究  

Modified Shenqi Dihuang Decoction for bone metastasis of hormone-sensitive prostate cancer after castration

作　　者：顾坚毅[1] 谈鸣岳 葛旻垚[1] 翟新宇[1] 郭冬冬 徐东亮 GU Jian-yi;TAN Ming-yue;GE Min-yao;ZHAI Xing-yu;GUO Dong-dong;XU Dong-liang(Center of Urology,Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院泌尿中心,上海201203

出　　处：《中华男科学杂志》2021年第2期161-166,共6页National Journal of Andrology

基　　金：国家自然科学基金(81972370)。

摘　　要：目的:观察中药加味参芪地黄汤对去势后激素敏感性前列腺癌骨转移患者的临床疗效。方法:将76例去势后激素敏感且伴有骨转移的前列腺癌患者随机分为对照组与加味参芪地黄汤组。对照组予最大限度雄激素阻断治疗,加味参芪地黄汤组在对照组治疗的基础上加服加味参芪地黄汤治疗,比较去势抵抗发生率、观察患者的中医症候评分、骨转移情况、生存质量及不良事件的发生率。结果:最终统计纳入患者64例。加味参芪地黄汤组去势抵抗发生率为28.12%,新发骨及内脏转移病灶为18.75%,治疗后血清碱性磷酸酶(AKP)水平为(318.5±165.8)U/L,均显著低于对照组71.87%、40.63%、(328.5±170.6)U/L(P均<0.05)。加味参芪地黄汤组中医症候评分:尿频尿不畅(1.64±0.66)分、食欲不振(1.41±0.39)分、神疲乏力(1.39±0.58)分、腰酸背痛(1.26±0.38)分、体重减轻(1.26±0.80)分、自我评价(1.54±0.63)分,均明显优于对照组(2.05±0.51)分、(1.95±0.48)分、(2.59±0.68)分、(1.76±0.41)分、(1.88±0.75)分、(1.89±0.58)分,(P均<0.05)。治疗后加味参芪地黄汤组体力状况评分(卡氏评分,KPS)为(79.87±11.23)分,显著高于对照组(70.45±12.16)分(P<0.05)。加味参芪地黄汤组和对照组患者治疗后疼痛数字评分(NRS)及不良事件发生率无明显差异。结论:加味参芪地黄汤对去势后激素敏感性前列腺癌骨转移患者治疗后可有效提高患者的生活质量和中医症候评分,增加现代药物治疗激素敏感性前列腺癌的疗效,降低新发转移病灶发生率,改善患者血清指标并减轻骨转移相关的疼痛,提高患者的生存质量。Objective:To observe the clinical effect of Modified Shenqi Dihuang Decoction(MSDD)on bone metastasis of hormone-sensitive PCa after castration.Methods:Seventy-six hormone-sensitive PCa patients with bone metastasis were randomly divided into a control and an MSDD group of an equal number,the former treated by maximal androgen blockade(MAB)and the latter with MSDD in addition to MAB,both for 6 months.Comparisons were made between the two groups of patients in their TCM symptom scores,quality of life(QOL)scores and the incidence rates of castration resistance,bone metastasis and adverse events.Results:Totally,64 of the patients were included in the statistical analysis.Compared with the controls,the MSDD group showed significantly lower rates of castration resistance(71.87%vs 28.12%,P<0.05)and new bone and visceral metastases(40.63%vs 18.75%,P<0.05)and level of serum alkaline phosphatase after treatment([328.5±170.6]vs[318.5±165.8]U/L,P<0.05),as well as lower scores in the TCM symptoms of frequent micturition(2.05±0.51 vs 1.64±0.66,P<0.05),loss of appetite(1.95±0.48 vs 1.41±0.39,P<0.05),fatigue(2.59±0.68 vs 1.39±0.58,P<0.05),back pain(1.76±0.41 vs 1.26±0.38,P<0.05),weight loss(1.88±0.75 vs 1.26±0.80,P<0.05)and self-evaluation(1.89±0.58 vs 1.54±0.63,P<0.05),but a higher score in the physical status(Karnofsky Performance Scale)(70.45±12.16 vs 79.87±11.23,P<0.05).There were no statistically significant differences in the Numeric Rating Scale for Pain score and the incidence of adverse events between the two groups of patients.Conclusion:Modified Shenqi Dihuang Decoction can effectively improve the QOL and TCM symptom scores of the patients with hormone-sensitive PCa after androgen castration,enhance the efficacy of modern drugs in the treatment of hormone-sensitive PCa,decrease the incidence of metastasis,improve the patient's serum indicators,reduce the pain associated with bone metastasis,and improve the patient's quality of life.

关 键 词：激素敏感性前列腺癌 骨转移 加味参芪地黄汤 中医药 

分 类 号：R737.25[医药卫生—肿瘤]