益气除痰中医药不同时点干预对ⅢB或ⅣB期非小细胞肺癌生存期的影响  

Effects of Replenishing Qi and Removing Phlegm TCM Interventions at Different Time-Points on Survival Time of Non-small Cell Lung Cancer in StageⅢB orⅣB

作　　者：陈虹宇 林洁涛[2] 王文萍[2] 林晓彤 王思斯 孙哲[2] 曹洋[2] CHEN Hongyu;LIN Jietao;WANG Wenping;LIN Xiaotong;WANG Sisi;SUN Zhe;CAO Yang(The First Clinical Medical School,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一临床医学院,广州510405 [2]广州中医药大学第一附属医院肿瘤中心,广州510405

出　　处：《医药导报》2022年第8期1147-1152,共6页Herald of Medicine

基　　金：国家自然科学基金面上项目(81973815);重大疑难疾病中西医临床协作试点建设项目(2019XZZX-ZL0001);广东省中医药局面上项目(20201095);广东省自然科学基金项目(2017A030313886);广州中医药大学第一附属医院“创新强院”项目(2017TD01)。

摘　　要：目的以中西医结合治疗策略为支点,立足于益气除痰治法在肺癌防治中的优势,探讨益气除痰中医药不同时点干预对ⅢB或ⅣB期非小细胞肺癌(NSCLC)生存期的影响。方法采用回顾性队列研究分析广州中医药大学第一附属医院肿瘤中心肺癌随访系统中符合纳排标准的初治时间为2017年1月1日—2018年12月31日的ⅢB或ⅣB期肺脾气虚型NSCLC患者,将入选病例按益气除痰中医药干预时点分为始于一线、晚于一线两个组,进行总生存时间的差异性分析,并采用多因素回归分析筛选出可能影响预后的其他因素。结果始于一线(97例)、晚于一线(21例)两组患者的基线特征及治疗特征差异无统计学意义,具有良好的可比性。晚于一线组(AFLT)的中位生存时间比始于一线组(FLT)少172 d[332 d vs 504 d,P=0.021,HR=1.88,95%CI(1.08,3.25)]。多因素COX回归分析结果显示,酪氨酸激酶抑制剂(TKIs)治疗是独立的预后影响因子,使用TKI可以降低死亡风险[HR=0.48,95%CI(0.28,0.82)]。回溯患者的一线无进展生存时间,益气除痰法晚于一线组较始于一线组短173 d(103 d vs 276 d,P<0.01),且与一线方案无关。结论一线治疗期间联合益气除痰中医药可延长ⅢB或ⅣB期肺脾气虚型NSCLC患者的总生存时间,即益气除痰中医药干预时点越早越好。Objective Taking the treatment strategy of integrated traditional Chinese and Western medicine,based on the advantages of replenishing qi and removing phlegm(Yiqi Chutan)in lung cancer prevention and treatment,the effect of different time point interventions of Yiqi Chutan on the survival time of stageⅢB orⅣB non-small cell lung cancer(NSCLC)was discussed.Methods A retrospective cohort study was performed among patients diagnosed with stageⅢB orⅣB NSCLC with qi deficiency of lung and spleen syndrome in the First Affiliated Hospital of Guangzhou University of Chinese Medicine Data were collected from the patients who met the criteria via an electronic medical record system or telephone follow-up from Jan.2017 to Dec.2018.According to the intervention at different time-points through Yiqi Chutan,we divided patients into first-line treatment group(FLT group)and after-first-line treatment group(AFLT group).The difference analysis of the total survival time was carried out,and the multivariate regression analysis was used to screen out other factors that may affect the prognosis.Results This study included data from 118 patients:97 patients(82.2%)for the FLT group and 21 patients(17.8%)for the AFLT group.There were no significant differences in baseline characteristics and treatment characteristics between the two groups of patients.The median survival time of the AFLT group was 172 days less than that of the FLT group[332 days vs 504 days,P=0.021,HR=1.88,95%CI(1.08,3.25)].Multifactorial COX regression analysis revealed that the treatment of the tyrosine kinase inhibitor(TKIs)was an independent prognostic factor.TKIs can reduce the risk of death[HR=0.48,95%CI(0.28,0.82)].While backtracking the patient's first-line progression-free survival time,that the AFLT group was 173 days shorter than the FLT group(103 days vs 276 days,P<0.01),independent of the first-line regimens.Conclusion During the first-line treatment period,combined with Yiqi Chutan,the total survival time of patients with stageⅢB orⅣB NSCLC an

关 键 词：中药复方 益气除痰法 非小细胞肺癌 干预时点 生存时间 

分 类 号：R979.1[医药卫生—药品] R734.2[医药卫生—药学]