丹栀逍遥散防治肝郁脾虚型原发性肝癌肝动脉化疗栓塞术后栓塞综合征的临床观察  

Clinical Observation of Danzhi Xiaoyao Powder for Preventing and Treating Embolism Syndrome After Transcatheter Hepatic Arterial Chemoembolization in Primary liver Carcinoma Patients Differentiated as Liver Depression and Spleen Deficiency Type

作　　者：陈学武[1] 姜靖雯[1] 张永杰[1] 邱晓堂[1] 曾江正[2] 金桂云[3] 孙刚 CHEN Xue-Wu;JIANG Jing-Wen;ZHANG Yong-Jie;QIU Xiao-Tang;ZENG Jiang-Zheng;JIN Gui-Yun;SUN Gang(Oncology Dept.,Chinese Medicine Hospital of Hainan Province,Haikou 570203 Hainan,China;Oncology Dept.,the First Affiliated Hospital of Hainan Medical College,Haikou 570301 Hainan,China;Interventional Therapy Dept.,the First Affiliated Hospital of Hainan Medical College,Haikou 570301 Hainan,China)

机构地区：[1]海南省中医院肿瘤科,海南海口570203 [2]海南医学院附属第一医院肿瘤科,海南海口570301 [3]海南医学院附属第一医院介入治疗科,海南海口570301

出　　处：《广州中医药大学学报》2021年第8期1564-1570,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81960549);海南省卫健委科研项目(编号:16036030A2001);2019-2021年省级中医重点专科建设项目(肿瘤科)(编号:S100111.401);国家中医药管理局“第六批全国老中医药专家学术经验继承工作”项目(编号:国中医药人教发[2017]29号、琼财社[2019]252)。

摘　　要：【目的】观察丹栀逍遥散防治肝郁脾虚型原发性肝癌患者肝动脉化疗栓塞术(TACE)后栓塞综合征的临床疗效。【方法】将80例中医辨证属于肝郁脾虚型,符合TACE治疗适应症的原发性肝癌患者随机分为治疗组和对照组,每组各40例。2组患者均接受TACE治疗,对照组给予术后常规西医对症支持治疗,治疗组在对照组的基础上加用丹栀逍遥散口服治疗。1周后观察2组患者的主观整体营养状况评价量表(PG-SGA)评分及免疫功能指标[T淋巴细胞亚群CD4^(+)/CD8^(+)比值、自然杀伤(NK)细胞]和肝功能指标[谷丙转氨酶(ALT)、总胆红素(TB)]的变化情况,评估2组患者的中医证候疗效、生活质量疗效、栓塞综合征主要症状及心理痛苦程度,4周后评估2组患者的实体瘤疗效。【结果】(1)治疗后,治疗组的实体瘤疗效、中医证候疗效、生活质量疗效分别为70.0%(28/40)、90.0%(36/40)和75.0%(30/40),对照组分别为65.0%(26/40)、65.0%(26/40)和55.0%(22/40);组间比较,治疗组的中医证候疗效和生活质量疗效均明显优于对照组(P<0.05),而2组的实体瘤疗效相当,差异无统计学意义(P>0.05)。(2)经TACE治疗1周后,治疗组的发热严重程度和腹痛严重程度均较对照组减轻(P<0.05),而2组的恶心呕吐严重程度比较,差异无统计学意义(P>0.05)。(3)治疗1周后,治疗组的PG-SGA评分对比治疗前无明显变化(P>0.05),而对照组的PG-SGA评分较治疗前明显升高(P<0.05);组间比较,治疗组的PG-SGA评分明显低于对照组(P<0.05)。(4)治疗1周后,对照组的CD4^(+)/CD8^(+)、NK细胞水平均较治疗前明显下降(P<0.01),治疗组的CD4^(+)/CD8^(+)、NK细胞水平均较治疗前明显升高(P<0.05);组间比较,治疗组的CD4^(+)/CD8^(+)、NK细胞水平均明显高于对照组(P<0.05或P<0.01)。(5)TACE治疗1周后,治疗组的心理痛苦程度明显低于对照组,差异有统计学意义(P<0.05)。(6)治疗前和治疗后,2组患者的ALT、TB等肝功能指�Objective To investigate the clinical effect of Danzhi Xiaoyao Powder on preventing and treating embolism syndrome after transcatheter hepatic arterial chemoembolization(TACE)in primary liver carcinoma patients differentiated as liver depression and spleen deficiency type. Methods Eighty primary liver carcinoma patients having the indications of TACE and differentiated as the syndrome of liver depression and spleen deficiency were randomly divided into treatment group and control group,and each group had 40 patients. Both groups received TACE,and then the control group was given routine symptomatic treatment,and the treatment group was given oral use of Danzhi Xiaoyao Powder combined with the symptomatic treatment. The intervention with the medicine covered two weeks. After treatment for one week,we observed the changes in the scores of PatientGenerated Subjective Global Assessment(PG-SGA),immune function indicators of T lymphocyte subset CD4^(+)/CD8^(+)ratio and natural killer(NK)cell count,and hepatic function indicators of alanine transaminase(ALT)and total bilirubin(TB)in the two groups. Meanwhile,the efficacy for traditional Chinese medicine(TCM)syndrome,efficacy for quality of life, and the efficacy for relieving the primary symptoms of embolism syndrome and psychological distress in the two groups were also observed. Four weeks after TACE,the efficacy for solid tumor in the two groups was evaluated. Results(1)After treatment,the effective rates for reducing solid tumor,relieving TCM syndrome,and improving quality of life in the treatment group were 70.0%(28/40),90.0%(36/40)and75.0%(30/40)respectively,and those in the control group were 65.0%(26/40),65.0%(26/40)and 55.0%(22/40)respectively. The intergroup comparison showed that the treatment group had stronger efficacy for improving TCM syndrome and quality of life than the control group(P<0.05),while the efficacy on reducing the solid tumor in the treatment group was similar to that in the control group(P>0.05).(2)One week after TACE,the severity of fever

关 键 词：丹栀逍遥散 原发性肝癌 肝动脉化疗栓塞术 栓塞综合征 肝郁脾虚型 

分 类 号：R273.357[医药卫生—中西医结合]