中药温肾升白方结合艾灸治疗乳腺癌蒽环类药物化疗患者白细胞减少症34例临床观察  

Clinical Observation on Wenshen Shengbai Formula(温肾升白方)Combined with Moxibusiton in Improving Anthracycline Chemotherapy-induced Leukopenia in 34 Cases of Breast Cancer

作　　者：沙珊焱 李思雨 朱玮[2] 季亚婕[1,3] 张馨月[1] 乔宇[1,3] 张颖 吴焕淦 薛晓红[1] SHA Shanyan;LI Siyu;ZHU Wei;JI Yajie;ZHANG Xinyue;QIAO Yu;ZHANG Ying;WU Huangan;XUEXiaohong(Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai,200437;Zhongshan Hospital,Fudan University;Shanghai Research Institute of Acupuncture and Meridian)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海市虹口区200437 [2]复旦大学附属中山医院 [3]上海市针灸经络研究所

出　　处：《中医杂志》2023年第5期482-489,共8页Journal of Traditional Chinese Medicine

基　　金：上海市科学技术委员会科技计划项目(20Y21901100);上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划(16CR2026B)。

摘　　要：目的 探讨温肾升白方结合艾灸在改善乳腺癌蒽环类药物化疗所致白细胞减少症的作用。方法 纳入计划使用蒽环类药物化疗、中医辨证为气血两亏证兼肝肾阴虚证的乳腺癌患者105例,采用分层随机(区组)分组方法分为对照组、艾灸组及灸药组各35例。各组均给予蒽环类药物化疗,对照组不给予任何中医药治疗。艾灸组予艾灸治疗,化疗当天不艾灸,每个化疗周期第2天开始,连续灸13天,每个穴位每次灸15 min,每日2次;同时口服安慰剂中药,每次化疗结束后,避开胃肠道反应急性期(一般为化疗后5~7天)开始服用,每日1剂,连续服用2周。灸药组给予温肾升白方口服(服用方法同安慰剂中药),并结合艾灸治疗(方法同艾灸组)。各组均观察4个化疗周期,记录患者白细胞(WBC)计数、中性粒细胞(ANC)绝对值的最低值,以及注射重组人粒细胞集落刺激因子注射液(rhG-CSF)的使用剂量,并监测其肝肾功能、心电图、乳酸脱氢酶、肌酸肌酶、肌酸激酶同工酶等安全性指标。结果 与本组治疗前比较,各组患者4个化疗周期的WBC计数、ANC计数均降低(P<0.05)。与对照组比较,艾灸组在第3、4化疗周期的WBC计数、ANC计数均升高,灸药组4个周期的WBC计数、ANC计数亦升高(P<0.05)。与艾灸组比较,灸药组4个周期的WBC计数,第1、2、4周期的ANC计数均升高(P<0.05)。艾灸组、灸药组在各化疗周期的rhG-CSF使用剂量均低于对照组(P<0.05),但两组比较差异无统计学意义(P>0.05)。各组安全性指标比较差异无统计学意义(P>0.05)。结论 艾灸或温肾升白方联合艾灸均可改善化疗性白细胞减少症,减少rhG-CSF使用剂量,且安全性较好。Objective To investigate the effect of Wenshen Shengbai Formula(温肾升白方,WSF)combined with moxibustion in improving leukopenia induced by anthracycline chemotherapy for breast cancer patients.Methods A total of 105 breast cancer patients with qi and blood depletion syndrome and liver and kidney yin deficiency syndrome who were about to receive anthracycline chemotherapy were randomized into control group,moxibustion group and moxibustion+WSF group by stratified(block)randomization,with 35 patients in each group.During anthracycline chemotherapy for all groups,the control group was not given any traditional Chinese medicine treatment.The moxibustion group was given moxibustion treatment from the 2rd day of each chemotherapy cycle for 13 days;the moxibustion time at each acupoint was 15min,twice daily;simultaneously,placebo of WSF was orally taken after chemotherapy but avoiding the acute phase of gastrointestinal reactions(usually 5 to 7 days after chemotherapy),one dose daily for 2 consecutive weeks.The moxibustion+WSF group was given WSF with the same administration method of placeo,and moxibustion with the same method used in the moxibustion group.After four cycles of chemotherapy,the lowest white blood cell(WBC)count and absolute neutrophil count(ANC)were recorded,as well as the dosage of recombinant human granulocyte colony-stimulating factor injection(rhG-CSF),and the safety indicators including liver and kidney function,electrocardiogram,lactate dehydrogenase,creatine creatine enzyme,creatine kinase isoenzyme were observed.Results After chemotherapy,the WBC and ANC counts in each of the four cycles were significantly reduced(P<O.05).Compared to those in the control group,the WBC and ANC counts in the moxibustion group increased in the 3rd and 4th chemotherapy cycles,as well as those of all four chemotherapy cycles in the moxibustion+WSF group(P<0.05).Compared to those in the moxibustion group,the WBC counts of the four cycles and the ANC counts of the 1st,2nd,and 4th cycles in the moxibustion+WSF gro

关 键 词：乳腺癌 白细胞减少症 艾灸 气血两亏证 肝肾阴虚证 蒽环类化疗药 温肾升白方 

分 类 号：R273[医药卫生—中西医结合]