百合固金汤联合卡瑞利珠单抗及PP方案治疗气阴两虚型晚期非鳞非小细胞肺癌的疗效观察  

Clinical Efficacy of Baihe Gujin Decoction Combined with Karelizumab and PP Regimen in the Treatment of Advanced Non-scale Non-small Cell Lung Cancer with Deficiency of Both Qi and Yin

作　　者：甄雄严 张淑平 赵娇 李卿 李晓靖 韩文峰 周红梅 肖敬 ZHEN Xiong-yan;ZHANG Shu-ping;ZHAO Jiao(Surgical II,the Second Affiliated Hospital of Hebei School of Traditional Chinese Medicine,Ding zhou(073000),China)

机构地区：[1]河北中医学院第二附属医院外二科,河北定州073000 [2]河北中医学院第二附属医院肿瘤科,河北定州073000 [3]河北中医学院第二附属医院脾胃病科,河北定州073000 [4]河北中医学院第二附属医院肺病科,河北定州073000

出　　处：《中国中西医结合外科杂志》2022年第4期501-506,共6页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：河北省中医药管理局科研计划项目(2022398)。

摘　　要：目的:探讨百合固金汤联合卡瑞利珠单抗及PP方案(培美曲塞+顺铂)治疗气阴两虚型晚期非鳞非小细胞肺癌(NSCLC)的临床疗效以及其对患者外周血T淋巴细胞亚群水平和血清糖类抗原125(CA125)、微小核糖核酸-19b(miR-19b)、巨噬细胞炎性蛋白-3α(MIP-3α)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)水平的影响。方法:选择我院2018年6月—2021年8月收治的80例气阴两虚型晚期非鳞NSCLC患者作为研究对象,采用随机数字表法分成观察组与对照组各40例。对照组给予PP方案联合卡瑞利珠单抗治疗,在此基础上,观察组联合百合固金汤内服治疗,所有对象均以21 d为1个疗程。连续治疗6个疗程后观察两组疗效及安全性。比较治疗前后两组中医证候积分、外周血T淋巴细胞亚群水平及血清CA125、miR-19b、MIP-3α、β-CTX水平。结果:观察组客观有效率(ORR)、中医疗效总有效率比对照组(分别为75.0%vs 50.0%、90.0%vs 65.0%)均显著提高,差异有统计学意义(P<0.05)。与治疗前相比,两组治疗后各项主症(咳嗽、咯痰、气短喘粗、口干咽燥、神疲乏力)积分和血清CA125、miR-19b、MIP-3α浓度均显著下降(P<0.05),外周血CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)水平均显著升高(P<0.05);且观察组改善更显著(P<0.05)。两组治疗前后血清β-CTX水平组内及组间比较差异均无统计学意义(P>0.05)。观察组白细胞减少、恶心呕吐的发生率比对照组[分别为52.5%(21/40)vs 75.0%(30/40)、42.5%(17/40)vs 70.0%(28/40)]均显著降低,差异有统计学意义(P<0.05)。结论:百合固金汤联合卡瑞利珠单抗及PP方案治疗气阴两虚型晚期非鳞NSCLC能有效缓解患者的临床症状体征,改善细胞免疫功能,提高临床疗效,并能减轻化疗药物引起的不良反应。Objective To explore the clinical efficacy of Baihe Gujin Decoction combined with Karelizumab and PP regimen(pemetrexed+cisplatin)in the treatment of advanced non-scale non-small cell lung cancer(NSCLC)with deficiency of both Qi and Yin,and its effects on peripheral blood T lymphocyte subsets,carbohydrate antigen 125(CA125),microRNA-19b(miR-19b),macrophage inflammatory protein-3α(MIR-3α)and Type I collagen carboxy-terminal peptideβspecial sequence(β-CTX)in serum.Methods 80 patients with advanced nonscale NSCLC with deficiency of both Qi and Yin in our hospital from June 2018 to August 2021 were selected and randomly divided into observation group and control group,with 40 cases in each group.The patients in control group were treated with PP regimen combined with carilizumab.On this basis,the patients in observation group were combined with treatment of Baihe Gujin Decoction.All subjects were treated with 21 days as a course of treatment.After 6 consecutive courses,the curative effect and safety of the two groups were evaluated.Before and after treatment,TCM syndromes scores and the levels of T lymphocyte subsets in peripheral blood and CA 125,miR-19 b,MIP-3αandβ-CTX in serum of the two groups were compared.Results ORR in the observation group was significantly higher than that in the control group[75.0%(30/40)vs 50.0%(20/40)](P<0.05).The total effective rate of TCM in observation group[90.0%(36/40)]was significantly higher than that in control group[65.0%(26/40)](P<0.05).After treatment,the scores of the main symptoms(cough,expectoration,shortness of breath,dryness of mouth and throat,fatigue)and CA125,mi R-19 b,MIP-3αin serum in the two groups all decreased significantly compared with those before treatment(P<0.05).After treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in peripheral blood of the two groups were significantly higher than those before treatment(P<0.05),and the improvement in the observation group was more significant(P<0.05).There was no significant difference in serumβ-CTX level

关 键 词：百合固金汤 卡瑞利珠单抗 PP方案 晚期肺癌 气阴两虚证 细胞免疫功能 

分 类 号：R734.2[医药卫生—肿瘤]