徐氏参芪苡术汤联合化疗治疗胃癌术后癌因性疲乏脾虚瘀毒型的临床观察及机制  

Clinical Observation and Mechanism Study of Xu's Shenqi Yizhu Decoction Combined with Chemotherapy in the Treatment of Cancer-related Fatigue of Stagnated-toxin Spleen Deficiency Type in Postoperative Gastric Cancer Patients

作　　者：沈志祥 陆为民[1] 石川 叶艋玮 雷梦园 刘芓妘 SHEN Zhixiang;LU Weimin;SHI Chuan;YE Mengwei;LEI Mengyuan;LIU Ziyun(Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院,南京210029

出　　处：《中国实验方剂学杂志》2025年第8期143-151,共9页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：江苏省卫生健康委员会科研课题(BJ18025);江苏省中医药管理局中医重点专科建设项目(苏中医医政[2023]5号)。

摘　　要：目的:评价徐氏参芪苡术汤治疗胃癌术后化疗癌因性疲乏(CRF)脾虚瘀毒型的临床疗效,并探讨其可能机制。方法:选取50例胃癌术后CRF脾虚瘀毒型患者,采用随机数字表法分为观察组、对照组,每组各25例。对照组予FLOT方案化疗(多西紫杉醇50 mg·m^(-2)第1天静脉滴注+奥沙利铂85 mg·m^(-2)第1天静脉滴注+亚叶酸钙200 mg·m^(-2)第1天静脉滴注+氟尿嘧啶2600 mg·m^(-2)第1天24 h持续静脉滴注,3周/次)及基础、对症支持治疗,观察组在对照组的基础上同时予徐氏参芪苡术汤治疗(水煎2次,200 mL口服,2次/d)。3周为1个疗程,共4疗程。观察两组治疗前后Piper疲乏量表(PFS)评分、Karnofsky Performance Status(KPS)量表评分、欧洲癌症治疗研究组织生命质量核心(EORTC-QLQ-C30)量表评分、中医证候评分,酶联免疫吸附测定法(ELISA)检测血清肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)、白细胞介素-6(IL-6)水平,记录两组患者治疗前后安全性检查结果及治疗期间不良事件发生情况。从基因表达综合数据库(GEO)下载胃腺癌患者及正常人外周血样本的转录组测序数据,并鉴定肿瘤组和正常组间的差异表达基因,根据京都基因与基因组百科全书(KEGG)和基因本体(GO)进行差异基因富集分析。从基因卡片(GeneCards)数据库获取基因的CRF相关性评分。结果:(1)与本组治疗前比较,观察组PFS总疲乏评分明显降低(P<0.05);与对照组治疗后比较,观察组PFS总疲乏评分明显降低(P<0.05);(2)与本组治疗前比较,观察组KPS评分明显降低(P<0.05);与对照组治疗后比较,观察组KPS评分明显降低(P<0.05);与本组治疗前比较,观察组EORTCQLQ-C30量表功能领域(躯体功能、角色功能、情绪功能、社会功能)及总体健康领域评分明显增高,症状领域评分(疲乏、气促、食欲不振、便秘、腹泻)明显降低(P<0.05);与对照组治疗后比较,观察组EORTC-QLQ-C30量表功能领域(躯体功能、�Objective:To evaluate the clinical efficacy of Xu's Shenqiyizhu(SQYZ)decoction combined with chemotherapy in the treatment of cancer-related fatigue(CRF)of stagnated-toxin spleen deficiency type after gastric cancer surgery and explore its possible mechanism.Methods:Fifty postoperative gastric cancer patients with CRF of stagnated-toxin spleen deficiency type were selected and randomly divided into an experimental group and a control group by using a random number table,with 25 cases in each group.The control group was treated with FLOT chemotherapy(50 mg·m^(-2)docetaxel(iv drip on day 1)+85 mg·m^(-2)oxaliplatin(iv drip on day 1)+200 mg·m^(-2)calcium folinate(iv drip on day 1)+2600 mg·m^(-2)fluorouracil(iv drip for 24 h on day 1),once every three weeks)and basic and symptomatic supportive treatment.The experimental group was treated with Xu's SQYZ decoction(decocted twice,200 mL taken orally twice a day)in addition to the treatment of the control group.One course of treatment lasted for three weeks,with a total of four courses conducted.Observation was performed on the piper fatigue scale(PFS)scores,karnofsky performance status(KPS)scores,European Organization for Research and Treatment of cancer quality of life questionnaire(EORTC QLQ-C30)scores,traditional Chinese medicine syndrome scores,and serum levels of tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),and interleukin-6(IL-6)detected via enzyme linked immunosorbent assay(ELISA)before and after treatment in the two groups.The safety test results before and after treatment for the two groups of patients,as well as the occurrence of adverse events during treatment,were recorded.Transcriptome sequencing data of peripheral blood samples from gastric adenocarcinoma patients and normal individuals were downloaded from the gene expression omnibus(GEO)database,and differentially expressed genes between the tumor and normal groups were identified.Differential gene enrichment analysis was made based on the Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gen

关 键 词：徐氏参芪苡术汤 脾虚瘀毒 癌因性疲乏 细胞因子 

分 类 号：R259[医药卫生—中西医结合] R587.1[医药卫生—中医内科学] R544.1[医药卫生—中医学]