气血瘀滞型非小细胞肺癌患者“瘀毒”病机临床特征及补肺化瘀汤辅助治疗干预机制  

Clinical Characteristics of Stasis-Toxin Pathogenesis in Patients with NonsmallCell Lung Cancer of Blood Stasis and Qi Stagnation Syndrome and theInterventional Mechanism of Adjuvant Therapy with Bufei Huayu Decoction

作　　者：王芳 杨兴嫕[1] 孙琮[1] 王士汉[1] WANG Fang;YANG Xing-Yi;SUN Cong;WANG Shi-Han(Liu’an Hospital of Traditional Chinese Medicine,Liu’an 237000 Anhui,China)

机构地区：[1]六安市中医院,安徽六安237000

出　　处：《广州中医药大学学报》2024年第1期68-77,共10页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：安徽省教育厅中医药防治肺系重大疾病重点实验室开放项目(编号:JYTKF2020-6)。

摘　　要：【目的】探讨气血瘀滞型非小细胞肺癌(non-small cell lung cancer,NSCLC)患者“瘀毒”病机的临床特征以及补肺化瘀汤辅助治疗的干预机制。【方法】选取六安市中医院呼吸内科2021年1月至2022年9月收治的78例气血瘀滞型NSCLC患者作为NSCLC组,另选取71例同期健康体检志愿者为健康对照组,观察NSCLC组“瘀毒”病机的临床特征,比较2组凝血功能指标的差异。根据治疗方式的不同将NSCLC组患者分为补肺化瘀组40例和常规治疗组38例,常规治疗组采用常规化疗方案治疗,补肺化瘀组在常规治疗组的基础上加用补肺化瘀汤治疗,以3周为1个疗程,共治疗2个疗程。观察2组患者治疗前后中医证候积分、生活质量Karnofsky功能状态(KPS)评分、凝血功能、免疫功能、血清一氧化氮(NO)、血管内皮生长因子(VEGF)水平的变化情况,比较2组患者的临床疗效和治疗期间不良反应发生情况。【结果】(1)临床特征方面,NSCLC组患者临床分期为Ⅲ、Ⅳ期,病理类型为鳞癌、腺癌,KPS评分低于70分患者比例较高,中医证候积分较高,提示NSCLC患者病情较为严重;与健康对照组相比,NSCLC组患者的凝血酶原时间(PT)、凝血酶时间(TT)明显缩短,纤维蛋白原(FIB)、D-二聚体(D-D)水平明显升高,差异均有统计学意义(P<0.01)。(2)疗效方面,治疗6周后,补肺化瘀组的总有效率和总稳定率分别为32.50%(13/40)、85.00%(34/40),明显优于常规治疗组的13.16%(5/38)、60.53%(23/38),差异均有统计学意义(P<0.05)。(3)证候积分方面,治疗3周后,补肺化瘀组的各项中医证候积分(包括神疲乏力、胸闷气短、胸部刺痛、脉络瘀血等)和常规治疗组的神疲乏力、胸闷气短积分均较治疗前改善(P<0.05);治疗6周后,2组NSCLC患者的各项中医证候积分均较治疗前和治疗3周后改善(P<0.05);组间比较,除治疗3周后的胸闷气短外,补肺化瘀组在治疗3周和6周后对各项中医证候积分的改�Objective To investigate the clinical characteristics of stasis-toxin pathogenesis in patients with nonsmall cell lung cancer(NSCLC)of blood stasis and qi stagnation type,and to explore the interventional mechanism of adjuvant therapy with Bufei Huayu Decoction.Methods Seventy-eight patients with NSCLC of blood stasis and qi stagnation type admitted to the Department of Respiratory Medicine of Liu’an Hospital of Traditional Chinese Medicine from January 2021 to September 2022 were selected as the NSCLC group,and 71 volunteers who underwent physical examination during the same period served as the healthy control group.The clinical characteristics of stasis-toxin pathogenesis in the NSCLC group were observed,and the differences in the indicators of coagulation function were compared between NSCLC group and the healthy control group.According to the therapy,the NSCLC patients were divided into Bufei Huayu Decoction group(40 cases)and conventional treatment group(38 cases).The conventional treatment group was treated with conventional chemotherapy,while Bufei Huayu Decoction group was treated with Bufei Huayu Decoction together with conventional chemotherapy.Three weeks constituted one course of treatment,and the treatment lasted for 2 courses.The changes of traditional Chinese medicine(TCM)syndrome scores,Karnofsky Performance Status(KPS)score,coagulation function,immune function,serum nitric oxide(NO),vascular endothelial growth factor(VEGF)level in Bufei Huayu Decoction group and conventional treatment group were observed before and after treatment.Moreover,the clinical efficacy of the two groups and the occurrence of adverse reactions were compared during the treatment period.Results(1)NSCLC patients were classified into the clinical stagesⅢandⅣand the pathological types of squamous carcinoma and adenocarcinoma,had the high proportion of KPS scores lower than 70,and were scored with high TCM syndrome scores,suggesting that the illness condition of patients with NSCLC was serious.Compared with the healthy c

关 键 词：非小细胞肺癌 气血瘀滞 “瘀毒”病机 补肺化瘀汤 凝血功能 免疫功能 生活质量 不良反应 

分 类 号：R273.342[医药卫生—中西医结合]