固本化积汤联合化疗治疗晚期非小细胞肺癌的临床观察

1、固本化积汤联合化疗治疗晚期非小细胞肺癌的临床观察 11-05-17 15:14:00 编辑：studa20 作者：王宏乐 龙志芳 朱士奎 王贵辰 高社光 郑金海 赵铁英 康日新 陈金鹏【摘要】 目的 观察固本化积汤联合化疗治疗晚期非小细胞肺癌的近期疗效。方法 将194例晚期非小细胞肺癌患者随机分为2组。治疗组102例采用固本化积汤(每日1剂，1个月为1个疗程，共治疗3个疗程)配合化疗(NP或VP方案，3周为1个疗程，共治疗3个疗程)治疗。对照组92例单纯予化疗，方法同治疗组。观察2组瘤体大小变化、生活质量、体质量、主要症状改善情况及不良反应情况。结果 治疗组瘤体变化有效率28.4%，对照组13

2、.0%，2组比较差异有统计学意义(P0.01)；治疗组治疗后卡氏评分与本组治疗前及对照组治疗后比较差异均有统计学意义(P0.01)；对照组治疗后体质量与本组治疗前及治疗组治疗后比较差异均有统计学意义(P0.01)；治疗组预后情况、症状改善情况均优于对照组(P0.05，P0.01)。治疗组不良反应情况少于对照组(P0.05，P0.01)。结论 固本化积汤联合化疗治疗晚期非小细胞肺癌近期疗效优于单纯化疗，可作为晚期非小细胞肺癌的有效治疗方案。 【关键词】 癌 非小细胞肺 抗肿瘤联合化疗方案 中药疗法 【Abstract】 Objective To observe the short term th

3、erapeutic efficacy of integrated Gubenhuaji Decoction and chemotherapy (IGDC) in treating non-small cell lung cancer(NSCLC) in and phase. Methods 194 patients with non-small cell cancer(NSCLC) in and phase were randomly divided into the IGDC group (n=102) and the Western medicine (WM) group (n=92).

4、Patients in the IGDC group were treated by integrated Gubenhuaji decoction and chemotherapy. Patients in WM group were treated by chemotherapy. The excluded or dropping off cases were 10 in IGDC and 15 in WM. Clinical trials were conducted in 3 hospitals and 3 months of treatment was taken as one th

5、erapeutic course. The main observation indexes were tumor size, quality of life, Karnofsky scores, body weight, adverse reaction, etc. Results The total effective rate of tumor remission in the IGDC group and WM group were 28.4 and 13.0, respectively. There was statistical significance between two g

6、roups (P0.01). Karnofksy score significantly raised in the IGDC group after treatment in comparison with that before treatment (P0.01). The karnofsky score in IGDC group was higher than that in WM after treatment (P0.01). The patients body weights in the 2 groups were all reduced. The reduction in t

7、he IGDC group was lower than that in WM group (P0.01). The effect in the IGDC group was better than that in WM group in aspects of improving such tumor related symptoms as cough, short breath, anorexia, fatigue, etc (P0.01, P0.05). Adverse reaction in the IGDC group was lesser than that in the WM gr

8、oup (P0.05, P3个月；不能或不愿手术者；卡氏评分360分；年龄1875岁；各项检查指标符合化疗要求；停止放化疗1个月；愿意接受本方案治疗。1.3 排除标准无明确的肿瘤病灶（包括可测量和不可测量的）；不符合纳入标准；妊娠期或哺乳期妇女；合并严重的心脑血管疾病，或精神障碍等疾病；服药依从性差，不能坚持完成治疗的患者。1.4 一般资料 全部194例为河北省曲周县内科、河北省邯郸市复兴区中医院内科和河北省鸡泽县中西医结合医院内科患者，随机分为2组。治疗组102例，男74例，女28例；病程（4.775.86）个月；卡氏评分（71.837.6）分；分期：a期9 例，b期42例， 期51例；解剖

9、类型：中央型34例，周围型68例；病理类型：鳞癌38例，腺癌59例，其他5例。对照组92例，男75例，女17例；病程（4.466.02）个月；卡氏评分（71.748.28）分；分期：a期10例，b期38例， 期44例；解剖类型：中央型35例，周围型56例，其它1例；病理类型：鳞癌26例，腺癌58例，其他8例。2组病例一般资料比较差异无统计学意义（P0.05），具有可比性。1.5 治疗方法予化疗，用NP或VP方案，酒石酸长春瑞滨25 mg/m2，或长春地辛（VDS）3 mg/m2，第1、8日静脉注射；顺铂（DDP）20 mg/m2，第15日静脉滴注。3周为1个疗程，化疗周期为3个疗程。在对照组基

10、础上配合固本化积汤加减。基本方：黄芪3060 g，问荆1525 g，浙贝母1030 g，白英15 g，龙葵15 g，半枝莲30 g，丹参10 g。肺脾气虚型，治宜健脾益肺，基本方加党参、白术、茯苓、半夏、陈皮；阴虚痰热型，治宜滋阴清肺、化痰散结，基本方加薏苡仁、生地黄、仙鹤草、黄芩、沙参；气阴两虚型，治宜益气养阴、固本化积，基本方加人参、麦门冬、五味子、百合；痰湿瘀阻型，治宜化痰祛瘀、渗湿消积，基本方加薏苡仁、瓜蒌、薤白、半夏、当归尾。每日1剂，1个月为1个疗程，共治疗3个疗程。1.6 观察项目与检测方法分为完全缓解（CR）、部分缓解（PR）、无变化（NC）、病变进展（PD），有效=CR+PR，稳定=CR+PR+NC。显效：卡氏评分治疗后比治疗前提高20分；有效：卡氏评分治疗后比治疗前提高1020分；稳定：卡氏评分治疗后比治疗前提高10分或无变化；无效：卡氏评分治疗后比治疗前下降。显效率=显效/总例数100%，有效率=(显效+有效)/总例数100%，稳定率=(显效+有效+稳定)/总例数