清金化痰汤加味联合痰热清注射液治疗肺癌性淋巴管炎患者的临床观察  

Clinical Observation of Modified Qingjin Huatan Decoction Jiawei Combined with Tanreqing Injection in the Treatment of Patients with Pulmonary Lymphangitic Carcinomatosis

作　　者：贺新玉 张红[2] HE Xinyu;ZHANG Hong(Hunan University of Chinese Medicine,Hunan Changsha 410208,China;The First Affiliated Hospital of Hunan University of Chinese Medicine,Hunan Changsha 410207,China)

机构地区：[1]湖南中医药大学,湖南长沙410208 [2]湖南中医药大学第一附属医院,湖南长沙410007

出　　处：《中医药临床杂志》2024年第11期2163-2169,共7页Clinical Journal of Traditional Chinese Medicine

基　　金：湖南省自然科学基金(2020JJ4485);湖南省中医药管理局指导课题(C2023001)。

摘　　要：目的:观察清金化痰汤加味联合痰热清注射液治疗肺癌性淋巴管炎患者的临床疗效。方法:将符合标准的30例确诊肺癌性淋巴管炎且中医辨证为痰热壅肺的患者随机分为观察组和对照组。对照组为西医对症支持治疗,观察组在西医对症支持治疗的基础上给予清金化痰汤加味联合痰热清注射液治疗,2组疗程均为14天。比较2组患者治疗前后的临床表现、中医证候总积分、C反应蛋白(CRP)、降钙素原(PCT)、血管内皮生长因子(VEGF)水平、免疫球蛋白(IgA、IgG、IgM)、T淋巴细胞亚群(CD_(3)^(+)、CD_(4)^(+))、血氧分压(PO_(2))、血二氧化碳分压(PaCO_(2))以及癌胚抗原(CEA)、糖类抗原CA125(CA125)、细胞角蛋白19片段(CYFRA21-1)等肿瘤标志物指标水平,观察治疗过程中2组不良反应发生情况。结果:治疗后,观察组患者气促、呼吸困难等临床症状、肺弥散功能和咳嗽、气喘、发热、口渴、面红、便结等中医症状积分均显著改善,且显著优于对照组(P<0.05);观察组患者治疗后VEGF、CEA、CA125、CYFRA21-1、CRP、PCT、IgA、IgG、IgM、CD_(3)^(+)、CD_(4)^(+)水平均降低,观察组较对照组降低更为显著(P<0.05);2组患者治疗后PO2均升高,且观察组较对照组升高更为显著(P<0.05),观察组患者治疗后PaCO_(2)较治疗前降低,且低于对照组(P<0.05),对照组患者治疗后PaCO_(2)较治疗前差异无统计学意义(P>0.05);2组患者治疗过程中均出现一定程度骨髓抑制、皮肤反应、消化道反应、肝肾功能异常等不良反应,经处理可缓解,2组比较结果差异无统计学意义(P>0.05)。结论:在清金化痰汤加味联合痰热清注射液治疗肺癌性淋巴管炎患者临床疗效显著,可改善患者呼吸功能、减轻炎症反应、增强抗肿瘤免疫功能,可以有效提高患者生活质量,并在一定程度上改善远期预后。Objective:To observe the clinical efficacy of Qingjin Huatan Decoction plus Tanreqing Injection in the treatment of patients with lung cancer lymphangitis.Methods:Thirty patients diagnosed with lung cancer lymphangitis and diagnosed with phlegm-heat obstructing the lung according to TCM differentiation who met the criteria were randomly divided into an observation group and a control group.The control group received symptomatic supportive treatment of Western medicine,while the observation group was given Qingjin Huatan Decoction plus Tanreqing Injection on the basis of symptomatic supportive treatment of Western medicine.The treatment course of both groups was 14 days.The clinical manifestations,total score of TCM syndrome,C-reactive protein(CRP),procalcitonin(PCT),vascular endothelial growth factor(VEGF)levels,immunoglobulins(IgA,IgG,IgM),T lymphocyte subsets(CD3+,CD4+),blood oxygen partial pressure(PO_(2)),blood carbon dioxide partial pressure(PaCO_(2)),carcinoembryonic antigen(CEA),carbohydrate antigen CA125(CA125),cytokeratin 19 fragment(CYFRA21-1)and other tumor markers were compared between the two groups before and after treatment,and the occurrence of adverse reactions in the two groups during treatment was observed.Results:After treatment,the clinical symptoms such as shortness of breath and dyspnea,lung diffusion function and TCM symptom scores such as cough,wheezing,fever,thirst,flushing and constipation in the observation group were significantly improved,and were significantly better than those in the control group(P<0.05).After treatment,the levels of VEGF,CEA,CA125,CYFRA21-1,CRP,PCT,IgA,IgG,IgM,CD3+ and CD4+in the observation group were all reduced,and the reduction in the observation group was more significant than that in the control group(P<0.05).After treatment,PO2 of the two groups of patients increased,and the increase in the observation group was more significant than that in the control group(P<0.05).After treatment,PaCO_(2)of the observation group was reduced compared with that before tre

关 键 词：肺癌性淋巴管炎 痰热清注射液 清金化痰汤 痰热壅肺 

分 类 号：R256.19[医药卫生—中医内科学]