基于“虚气留滞”理论探讨益气调腑汤治疗晚期结直肠癌脾虚气滞型患者的回顾性研究  

A retrospective study on the treatment of patients with advanced colorectal cancer of spleen deficiency and qi stagnation pattern using Yiqi Tiaofu Decoction based on the theory of"deficient qi stagnation"

作　　者：叶子玉 宋程 唐蔚[3] 刘欢[1,2] 刘传龙 华雨薇 YE Ziyu;SONG Cheng;TANG Wei;LIU Huan;LIU Chuanlong;HUA Yuwei(Hunan University of Chinese Medicine,Changsha,Hunan 410208,China;Hunan Cancer Hospital,Changsha,Hunan 410013,China;Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine(The Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine),Changsha,Hunan 410006,China)

机构地区：[1]湖南中医药大学,湖南长沙410208 [2]湖南省肿瘤医院,湖南长沙410013 [3]湖南省中西医结合医院(湖南省中医药研究院附属医院),湖南长沙410006

出　　处：《湖南中医药大学学报》2025年第2期363-369,共7页Journal of Hunan University of Chinese Medicine

基　　金：湖南省自然科学基金项目(2022JJ30362);湖南省中医药管理局重点项目(A2023049,A2024019)。

摘　　要：目的基于“虚气留滞”理论探究益气调腑汤对晚期结直肠癌(CRC)脾虚气滞型患者的临床疗效。方法回顾2020年8月18日至2022年9月1日就诊于湖南省中西医结合医院门诊及住院部的107例晚期CRC脾虚气滞型患者病例资料,将这些患者分为治疗组(n=55)与对照组(n=52),治疗组采用益气调腑汤联合一般西医治疗,对照组采用一般西医治疗。分析比较治疗6周后两组患者的中医证候积分(腹胀肠鸣、神疲乏力、食少纳呆、大便稀溏)、肿瘤标志物[血清癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、糖类抗原50(CA50)]、T细胞亚群[T淋巴细胞(CD3^(+))、辅助性T细胞(CD4^(+))、细胞毒性T细胞(CD8^(+))、CD4^(+)/CD8^(+)]、毒副反应(恶心呕吐、肝肾功能损伤、手足皮肤、腹泻、骨髓抑制)变化,并比较两组患者总生存期(OS)变化。结果治疗6周后,两组患者中医证候积分和CEA、CA19-9、CA50水平均低于治疗前(P<0.05),且治疗组中医证候积分和CEA、CA19-9、CA50水平均低于对照组(P<0.05)。治疗6周后,两组患者CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均高于治疗前(P<0.05),且治疗组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组(P<0.05),CD8^(+)水平稍高于对照组但差异无统计学意义(P>0.05)。治疗组肝肾功能损伤、手足皮肤、骨髓抑制毒副反应发生率均低于对照组但差异无统计学意义(P>0.05),恶心呕吐、腹泻毒副反应发生率低于对照组(P<0.05)。治疗组患者中位OS为21.2个月,对照组患者中位OS为15.6个月,差异无统计学意义(P>0.05),但治疗组患者OS较对照组有升高趋势。结论益气调腑汤可改善晚期CRC脾虚气滞型患者的临床症状及其生活质量,增强机体抗癌能力,有效缓解恶心呕吐及腹泻毒副反应,具有一定的临床疗效。Objective To explore the clinical efficacy of Yiqi Tiaofu Decoction in patients with advanced colorectal cancer(CRC)of spleen deficiency and qi stagnation pattern based on the theory of"deficient qi stagnation".Methods A retrospective study was conducted on the case data of 107 patients with advanced CRC of spleen deficiency and qi stagnation pattern who were treated at the outpatient and inpatient departments of Hunan Provincial Hospital of Traditional Chinese and Western Medicine from August 18,2020 to September 1,2022.These patients were divided into treatment group(n=55)and control group(n=52).The treatment group was treated with Yiqi Tiaofu Decoction combined with conventional Western medicine,while the control group was only treated with conventional Western medicine.After six weeks of treatment,comparisons were made between the two groups in terms of Chinese medicine pattern scores(abdominal distension,bowel sounds,fatigue,weakness,poor appetite,and loose stool),tumor markers[serum carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9),carbohydrate antigen 50(CA50)],T-cell subsets[T lymphocytes(CD3^(+)),helper T cells(CD4^(+)),cytotoxic T cells(CD8^(+)),and CD4^(+)/CD8^(+)ratio],and adverse reactions(nausea,vomiting,liver and kidney function impairment,hand-foot skin reactions,diarrhea,and myelosuppression).Additionally,the overall survival(OS)of patients in both groups was compared.Results After six weeks of treatment,the Chinese medicine pattern scores and levels of CEA,CA19-9,and CA50 were lower in both groups compared to pre-treatment levels(P<0.05),with the treatment group exhibiting lower Chinese medicine pattern scores and levels of CEA,CA19-9,and CA50 than the control group(P<0.05).After six weeks of treatment,the levels of CD3^(+),CD4^(+),CD8^(+),and CD4^(+)/CD8^(+)ratio were higher in both groups compared to pre-treatment levels(P<0.05),with the treatment group showing higher levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)ratio than the control group(P<0.05).The CD8^(+)level was slightly h

关 键 词：结直肠癌 益气调腑汤 虚气留滞 总生存期 肿瘤标志物 免疫功能 回顾性研究 

分 类 号：R273[医药卫生—中西医结合]