摘要
【目的】探讨中医外治法温通抗癌方外敷治疗脾肾阳虚证晚期胃癌恶性腹水的临床疗效。【方法】将108例脾肾阳虚证晚期胃癌恶性腹水患者随机分为治疗组和对照组,每组各54例。对照组给予最佳姑息治疗,包括利尿剂呋塞米片(40 mg,每日1次)和螺内酯片(40 mg,每日2次)及静脉营养支持治疗等;治疗组给予温通抗癌方以神阙穴为中心外敷腹部治疗,每日1次,每次6 h,连续治疗4周。观察2组患者治疗前后腹围、Karnofsky功能状态(KPS)评分、欧洲癌症治疗研究组织的癌症患者生命质量测定量表(EORTC QLQ-C30)评分及腹腔积液和血清中肿瘤标志物[恶性肿瘤特异性生长因子(TSGF)、转化生长因子β1(TGF-β1)、癌胚抗原(CEA)]的变化情况,评价2组患者的中医证候疗效和安全性。【结果】(1)研究过程中,治疗组脱落2例,对照组脱落4例,最终完成全部疗程102例,其中治疗组52例,对照组50例。(2)治疗4周后,治疗组的总有效率为63.5%(33/52),对照组为42.0%(21/50),组间比较,治疗组的中医证候疗效明显优于对照组(P<0.05)。(3)治疗后,治疗组的KPS评分、EORTC QLQ-C30评分改善程度和腹围减少程度均明显优于对照组(P<0.05)。(4)治疗后,治疗组腹腔积液和血清中TSGF浓度均无明显变化(P>0.05),对照组则均较治疗前升高(P<0.05);治疗后,治疗组血清中TGF-β1浓度较治疗前下降(P<0.05),腹腔积液中TGF-β1浓度无明显变化(P>0.05),而对照组则均较治疗前明显升高(P<0.05);治疗后,治疗组腹腔积液和血清中的CEA浓度均明显降低(P<0.05),而对照组则均较治疗前无明显变化(P>0.05)。组间比较,治疗组腹腔积液和血清中TSGF、TGF-β1和CEA浓度均明显低于对照组(P<0.05)。(5)治疗过程中,2组患者的血常规、肝功能、肾功能、心电图等安全性指标均无明显异常变化。【结论】温通抗癌方局部外敷治疗脾肾阳虚证晚期胃癌恶性腹水患者疗效确切,能有效改善中医临床症状,减轻腹水和提高生活质量,并能稳定腹腔积液和血清中的TSGF、TGF-β1浓度及降低CEA浓度,减缓胃癌的进展。
Objective To investigate the clinical efficacy of external application of Wentong Kang’ai Prescription in treating advanced gastric cancer complicated with malignant ascites of spleen-kidney yang deficiency type.Methods A total of 108 patients of advanced gastric cancer complicated with malignant ascites of spleen-kidney yang deficiency type were randomly divided into treatment group and control group,with 54 cases in each group.The control group was given the best palliative treatment,including oral use of diuretic furosemide tablets(40 mg,once a day)and spironolactone tablets(40 mg,twice a day)together with intravenous nutritional support.The treatment group was given external application of Wentong Kang’ai Prescription on the abdominal region around Shenque(CV8)point for 6 hours each time,once a day,and the treatment lasted for 4 continuous weeks.The observation indexes included the pre-and post-treatment abdominal circumference,Karnofsky Performance Status(KPS)scores,the scores of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire 30(EORTC QLQ-C30),and tumor markers of tumor-specific growth factor(TSGF),transforming growth factorβ1(TGF-β1),and carcinoembryonic antigen(CEA)in the ascites and serum of the two groups.After treatment,the traditional Chinese medicine(TCM)syndrome efficacy and the clinical safety in the two groups were evaluated.Results(1)During the trial,the treatment group had 2 cases falling off and the control group had 4 cases falling off,and finally a total of 102 cases completed the whole course of treatment,including52 cases in the treatment group and 50 cases in the control group.(2)After 4 weeks of treatment,the total effective rate of the treatment group was 63.5%(33/52)and that of the control group was 42.0%(21/50).The intergroup comparison showed that the TCM syndrome efficacy in the treatment group was significantly superior to that in the control group(P<0.05).(3)After treatment,the improvement of KPS scores and EORTC QLQ-C30 scores and the reduction of abdominal circumference in the treatment group were significantly superior to those in the control group(P<0.05).(4)After treatment,TSGF level in the ascites and serum of the treatment group was stable(P>0.05),TGF-β1 level in the serum was decreased(P<0.05)while TGF-β1 level in the ascites showed no obvious change(P>0.05),and CEA level in the ascites and serum was significantly decreased compared with those before treatment(P<0.05);in the control group,TSGF level and TGF-β1 level in the ascites and serum were increased(P<0.05)while CEA level in the ascites and serum showed no obvious change(P>0.05)in comparison with those before treatment.The intergroup comparison showed that the levels of TSGF,TGF-β1 and CEA in the ascites and serum of the treatment group were significantly lower than those in the control group(P<0.05).(5)During the treatment,there were no significant abnormal changes in the examination results for blood routine test,liver function,kidney function,electrocardiogram or other safety indicators in the two groups.Conclusion External application of Wentong Kang’ai Prescription exerts certain effect in treating advanced gastric cancer patients with malignant ascites of spleen-kidney yang deficiency syndrome.The herbal prescription can effectively improve the TCM clinical symptoms,relieve ascites,improve the quality of life,stabilize the levels of TSGF and TGF-β1 in the ascites and serum,and reduce the CEA level,so as to slow down the progression of gastric cancer.
作者
黄永恒
邹凤娇
谭惠璇
赵昌林
HUANG Yong-Heng;ZOU Feng-Jiao;TAN Hui-Xuan;ZHAO Chang-Lin(Graduate School,Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Guangdong Clifford Hospital,Guangzhou 511495 Guangdong,China;Dept.of Rehabilitation Treatment,School of Health,Guangdong Pharmaceutical University,Guangzhou 510006 Guangdong,China)
出处
《广州中医药大学学报》
CAS
2022年第6期1254-1261,共8页
Journal of Guangzhou University of Traditional Chinese Medicine
基金
广东省中医药局科研课题(编号:20181222)
关键词
温通抗癌方
中医外治法
晚期胃癌
恶性腹水
脾肾阳虚证
生活质量
肿瘤标志物
Wentong Kang’ai Prescription
external treatment of traditional Chinese medicine
advanced gastriccancer
malignant ascites
spleen-kidney yang deficiency syndrome
quality of life
tumor markers
