化疗后骨髓抑制中医综合防治方案临床研究
|
摘要
本文综述了近十年来中医药治疗化疗后骨髓抑制的研究现状及进展,并系统的探讨了中西医对恶性肿瘤化疗后骨髓抑制的病因病机、治法方药。
临床研究通过采用前瞻性随机对照研究方法，将入选病例分为A组、B组两组。A组用中医综合防治方案（复方丹参注射液＋六味地黄丸）＋化疗；B组用津血力（G-CSF）＋化疗。两组共观察化疗后骨髓抑制30例，以骨髓抑制发生率、临床症状和体征、血象、化疗通过率、价格与临床疗效比等为观察指标。临床研究结果表明： ①A组能有效降低骨髓抑制发生率，经统计学处理，差异有显著性(P<0.05)；②A组白细胞最低值明显高于B组，经统计学处理，差异有显著性(P<0.05)； ③A组能明显升高血红蛋白值，经统计学处理，差异有显著性(P<0.05)；④临床症状改善率，A组86.67% ，B组46.67% ，经统计学处理，差异有显著性(P<0.05)；⑤A组化疗通过率明显优于B组，经统计学处理，差异有显著性(P<0.05)；⑥A组缓解骨髓抑制有效率76.67% ，B组86.67% ，经统计学处理，差异无显著性(P>0.05)；⑦A组在每单位疗效所需费用明显低于B组，经统计学处理，差异有显著性(P<0.05)。
结论：中医综合防治方案具有预防化疗后骨髓抑制的发生，减轻骨髓抑制程度，缓解临床症状，保证化疗顺利完成等综合效应，同时，还能降低医疗费用,符合我国基本的医疗保险政策。因而，中医综合防治方案具有广泛的临床应用前景。
The author here presented her theoretical and primary clinical studies on the chemotherapy- followed bone marrow depression.
In the part of theoretical study, the paper presented and analyzed the opinions of TCM and West Medicine about the etiology, pathogenesis, therapeutic principles and prescriptions of chemotherapy-followed bone marrow depression. It also summarized the general situation of the research on the chemotherapy-followed bone marrow depression especially in the near 10 years.
In the part of clinical study, 30 patients with the cancer needed chemotherapy were divided into group A and B randomly. Group A was treated with Nourishing Kidney and Smoothing Blood Chinese Herbs one week before, during and one week after chemotherapy. Group B was treated with granular clonbeg stimulating factor (G-CSF),3-7 days, once leucocytes dropped bellow 3000×109/L after chemotherapy. With these treatments, the times of the patients developed to bone marrow depression in group A was 6 times, while in group B was all the times. Two groups were also studied in contrast in the aspects of clinical symptoms, hemoglobin value, the proportion of clinical effect and medical cost. The results also showed that in the aspect of increasing leucocytes, the effective rate of group A is 76.67%, while of group B is 83.33%, there is no significant difference between the two groups(p﹥0.05). In the aspect of relieving clinical manifestations, such as soreness and weakness in the lumbar region and knees, feverish sensation in the chest, palms and soles, dizziness, night sweat, constipation, black menstruation with clot, the dark purple tongue, group A is superior to group B(all p﹤0.05). It was also found that Integrated Treatment Plan of TCM could alleviate the chemotherapy-followed bone marrow depression, contribute to the smooth finishing of chemotherapy through prevention the decreasing of leucocytes and erythrocyte (p﹤0.05). In the aspect of preventing the decreasing of leucocytes, no significant difference was found between Integrated Treatment Plan of TCM and G-CSF(p﹥0.05) but in the aspect of medical cost, however, the cost of Chinese medicine is much lower than G-CSF.
Clinical observation demonstrated that Integrated Treatment Plan of TCM is effective in preventing and alleviating chemotherapy-followed bone marrow depression, contributing to the smooth finishing of chemotherapy and relieving clinical manifestations. It can also decrease medical cost. We believe that Integrated Treatment Plan of TCM has a good prospect of clinical complication.
临床研究通过采用前瞻性随机对照研究方法，将入选病例分为A组、B组两组。A组用中医综合防治方案（复方丹参注射液＋六味地黄丸）＋化疗；B组用津血力（G-CSF）＋化疗。两组共观察化疗后骨髓抑制30例，以骨髓抑制发生率、临床症状和体征、血象、化疗通过率、价格与临床疗效比等为观察指标。临床研究结果表明： ①A组能有效降低骨髓抑制发生率，经统计学处理，差异有显著性(P<0.05)；②A组白细胞最低值明显高于B组，经统计学处理，差异有显著性(P<0.05)； ③A组能明显升高血红蛋白值，经统计学处理，差异有显著性(P<0.05)；④临床症状改善率，A组86.67% ，B组46.67% ，经统计学处理，差异有显著性(P<0.05)；⑤A组化疗通过率明显优于B组，经统计学处理，差异有显著性(P<0.05)；⑥A组缓解骨髓抑制有效率76.67% ，B组86.67% ，经统计学处理，差异无显著性(P>0.05)；⑦A组在每单位疗效所需费用明显低于B组，经统计学处理，差异有显著性(P<0.05)。
结论：中医综合防治方案具有预防化疗后骨髓抑制的发生，减轻骨髓抑制程度，缓解临床症状，保证化疗顺利完成等综合效应，同时，还能降低医疗费用,符合我国基本的医疗保险政策。因而，中医综合防治方案具有广泛的临床应用前景。
The author here presented her theoretical and primary clinical studies on the chemotherapy- followed bone marrow depression.
In the part of theoretical study, the paper presented and analyzed the opinions of TCM and West Medicine about the etiology, pathogenesis, therapeutic principles and prescriptions of chemotherapy-followed bone marrow depression. It also summarized the general situation of the research on the chemotherapy-followed bone marrow depression especially in the near 10 years.
In the part of clinical study, 30 patients with the cancer needed chemotherapy were divided into group A and B randomly. Group A was treated with Nourishing Kidney and Smoothing Blood Chinese Herbs one week before, during and one week after chemotherapy. Group B was treated with granular clonbeg stimulating factor (G-CSF),3-7 days, once leucocytes dropped bellow 3000×109/L after chemotherapy. With these treatments, the times of the patients developed to bone marrow depression in group A was 6 times, while in group B was all the times. Two groups were also studied in contrast in the aspects of clinical symptoms, hemoglobin value, the proportion of clinical effect and medical cost. The results also showed that in the aspect of increasing leucocytes, the effective rate of group A is 76.67%, while of group B is 83.33%, there is no significant difference between the two groups(p﹥0.05). In the aspect of relieving clinical manifestations, such as soreness and weakness in the lumbar region and knees, feverish sensation in the chest, palms and soles, dizziness, night sweat, constipation, black menstruation with clot, the dark purple tongue, group A is superior to group B(all p﹤0.05). It was also found that Integrated Treatment Plan of TCM could alleviate the chemotherapy-followed bone marrow depression, contribute to the smooth finishing of chemotherapy through prevention the decreasing of leucocytes and erythrocyte (p﹤0.05). In the aspect of preventing the decreasing of leucocytes, no significant difference was found between Integrated Treatment Plan of TCM and G-CSF(p﹥0.05) but in the aspect of medical cost, however, the cost of Chinese medicine is much lower than G-CSF.
Clinical observation demonstrated that Integrated Treatment Plan of TCM is effective in preventing and alleviating chemotherapy-followed bone marrow depression, contributing to the smooth finishing of chemotherapy and relieving clinical manifestations. It can also decrease medical cost. We believe that Integrated Treatment Plan of TCM has a good prospect of clinical complication.
引文
1 刘锋，麻柔.中西医临床血液病学.中国中医药出版社,1998年版
2 李佩文．中西医结合临床肿瘤学．第一版.中国中医药出版社，1996，244
3 田卫卫，王庆苗．恶性肿瘤化疗后骨髓抑制的病机及临床治疗探讨.河北中医, 2000,22（10）：791～792
4 扬晓峰、王锐、邱根全.孙喜才治疗肿瘤放化疗后白细胞减少症经验拾零.山西中医,2000,16(5): 7～8
5 田振典，李苏宣，阚全程等．归脾汤加减干扰化疗后白细胞下降序贯试验．河南医科大学学报, 1996,31（2）：80～81
6 刘嵚，姚力峰．辨证论治化疗后白细胞减少症32例疗效观察．中国中医药信息杂志,1998,5（7）：33～34
7 吴荻，张越，刘敬伟等．补气养血法治疗非霍奇金淋巴瘤化疗致白细胞减少46例．吉林中医药,2002,22（1）：17
8 蔡宇，赵益亚，金君梅等．化疗所致骨髓抑制的中医药辨证．吉林中医药,1998,（1）：1～2
9 田振典，李苏宣，阚全程等．归脾汤加减干扰化疗后白细胞下降序贯试验．河南医科大学学报,1996,31（2）：80～81
10 吴荻，张越，刘敬伟等．补气养血法治疗非霍奇金淋巴瘤化疗致白细胞减少46例．吉林中医药,2002,22（1）：17
11 刘振学．当归补血汤对减轻放化疗骨髓抑制的初步观察．实用中西医结合杂志,1993,(3)：166
12 张子丽，刘影，刘子厚．八珍汤加味治疗放疗及化疗所致的白细胞减少症．实用肿瘤学杂,1996,10(3)：43～44
13 李月华，朱海婴，叶启霞等．气血葆口服液对放化疗毒性作用的影响．中国中医药信息杂志,1996,3（7）：13
14 苗文红．补肾健脾法治疗肿瘤放化疗所致的骨髓抑制98例．陕西中医,2000,21(7)：289
15 王迎红，王怀璋，余永虎．中药对癌证化疗后骨髓保护作用的临床研究．河南中医药学刊,2000,15(6)：64～65
16 王玉华，曲士杰，郭郁等．扶正培本法防治肿瘤化疗后白细胞血小板减少．中国民间疗法,2001,9(11)：48
17 李永安，李国庆．化疗中气阴两虚证的辨证治疗．四川中医,2002,20（1）：14
18 孙隆生，朱新勇，于秋华等．癌血生合剂纠正肿瘤放化疗骨髓抑制100例分析．肿瘤防治研究, 1994,21(3):190～191
19 林能明，陈晓钟，郑晓等．生白宝口服液治疗恶性肿瘤放化疗引起的白细胞减少症的临床观察．肿瘤防治研究, 1995,22（6）：392
20 李明众，赵东利，王书文．复方皂矾丸对恶性肿瘤病人放化疗骨髓保护及升白作用．西北药学杂志, 1998,13(2)：80～81
21 宋海洪，陈泽涛，齐元意等．参莲温胆合剂治疗化疗所致的白细胞和血小板减少的临床观察和实验研究．上海中医杂志,1997,10（2）：13
22 赵国华，张新，戴卫东．半夏泻心汤在食管癌化疗中减毒作用的临床观察．中医研究,1996,9（2）：40～41
23 冯璞，赵扬，罗崇念．补肾合剂对免疫缺陷小鼠造血功能的影响．中草药,1998,29（11）：752～754
24 吴志奎，姜葆华，李永军．肾生髓理论的现代研究．中医杂志,1999,40（10）：626～628
25 田卫卫，王庆苗．恶性肿瘤化疗后骨髓抑制的病机及临床治疗探讨．河北中医, 2000,22（10）：791～792
26 王笑天. 癌证患者的瘀血证与血液高凝状态的研究．中国中西医结合学会活血化瘀研究学会编．血液证与活血化瘀研究．北京．学苑出版社；1990：260
27 李佩文，赵建成.恶性肿瘤并发症实用疗法.中国中医药出版社.1995年版
28 廖军祥，谢仁敷，郭惟．补肾活血方对骨髓造血作用的病理及电镜观察．实用中西医结合杂志,1991,4（12）：731～732
29 李楠，戴锡孟.补肾方药对骨髓造血影响的实验研究进展.天津中医学院学报,1994，（4）：44～46
30 张永祥.六味地黄汤现代药理学及化学的初步研究.基础医学与临床,2000，（5）15～19
31 方文贤,宋崇顺,周立孝.医用中医药理学.北京;人民卫生出版社,1998
32 汪长生.丹参注射液对大鼠急性心肌缺血及血液流变学的影响.皖南医学院学报,2002,(1)11～12
33 赵省，赵宏亮，宋长河．丹参防治肿瘤化疗所致骨髓抑制的研究．河南肿瘤学杂志,1994,7(2)：134～13
2 李佩文．中西医结合临床肿瘤学．第一版.中国中医药出版社，1996，244
3 田卫卫，王庆苗．恶性肿瘤化疗后骨髓抑制的病机及临床治疗探讨.河北中医, 2000,22（10）：791～792
4 扬晓峰、王锐、邱根全.孙喜才治疗肿瘤放化疗后白细胞减少症经验拾零.山西中医,2000,16(5): 7～8
5 田振典，李苏宣，阚全程等．归脾汤加减干扰化疗后白细胞下降序贯试验．河南医科大学学报, 1996,31（2）：80～81
6 刘嵚，姚力峰．辨证论治化疗后白细胞减少症32例疗效观察．中国中医药信息杂志,1998,5（7）：33～34
7 吴荻，张越，刘敬伟等．补气养血法治疗非霍奇金淋巴瘤化疗致白细胞减少46例．吉林中医药,2002,22（1）：17
8 蔡宇，赵益亚，金君梅等．化疗所致骨髓抑制的中医药辨证．吉林中医药,1998,（1）：1～2
9 田振典，李苏宣，阚全程等．归脾汤加减干扰化疗后白细胞下降序贯试验．河南医科大学学报,1996,31（2）：80～81
10 吴荻，张越，刘敬伟等．补气养血法治疗非霍奇金淋巴瘤化疗致白细胞减少46例．吉林中医药,2002,22（1）：17
11 刘振学．当归补血汤对减轻放化疗骨髓抑制的初步观察．实用中西医结合杂志,1993,(3)：166
12 张子丽，刘影，刘子厚．八珍汤加味治疗放疗及化疗所致的白细胞减少症．实用肿瘤学杂,1996,10(3)：43～44
13 李月华，朱海婴，叶启霞等．气血葆口服液对放化疗毒性作用的影响．中国中医药信息杂志,1996,3（7）：13
14 苗文红．补肾健脾法治疗肿瘤放化疗所致的骨髓抑制98例．陕西中医,2000,21(7)：289
15 王迎红，王怀璋，余永虎．中药对癌证化疗后骨髓保护作用的临床研究．河南中医药学刊,2000,15(6)：64～65
16 王玉华，曲士杰，郭郁等．扶正培本法防治肿瘤化疗后白细胞血小板减少．中国民间疗法,2001,9(11)：48
17 李永安，李国庆．化疗中气阴两虚证的辨证治疗．四川中医,2002,20（1）：14
18 孙隆生，朱新勇，于秋华等．癌血生合剂纠正肿瘤放化疗骨髓抑制100例分析．肿瘤防治研究, 1994,21(3):190～191
19 林能明，陈晓钟，郑晓等．生白宝口服液治疗恶性肿瘤放化疗引起的白细胞减少症的临床观察．肿瘤防治研究, 1995,22（6）：392
20 李明众，赵东利，王书文．复方皂矾丸对恶性肿瘤病人放化疗骨髓保护及升白作用．西北药学杂志, 1998,13(2)：80～81
21 宋海洪，陈泽涛，齐元意等．参莲温胆合剂治疗化疗所致的白细胞和血小板减少的临床观察和实验研究．上海中医杂志,1997,10（2）：13
22 赵国华，张新，戴卫东．半夏泻心汤在食管癌化疗中减毒作用的临床观察．中医研究,1996,9（2）：40～41
23 冯璞，赵扬，罗崇念．补肾合剂对免疫缺陷小鼠造血功能的影响．中草药,1998,29（11）：752～754
24 吴志奎，姜葆华，李永军．肾生髓理论的现代研究．中医杂志,1999,40（10）：626～628
25 田卫卫，王庆苗．恶性肿瘤化疗后骨髓抑制的病机及临床治疗探讨．河北中医, 2000,22（10）：791～792
26 王笑天. 癌证患者的瘀血证与血液高凝状态的研究．中国中西医结合学会活血化瘀研究学会编．血液证与活血化瘀研究．北京．学苑出版社；1990：260
27 李佩文，赵建成.恶性肿瘤并发症实用疗法.中国中医药出版社.1995年版
28 廖军祥，谢仁敷，郭惟．补肾活血方对骨髓造血作用的病理及电镜观察．实用中西医结合杂志,1991,4（12）：731～732
29 李楠，戴锡孟.补肾方药对骨髓造血影响的实验研究进展.天津中医学院学报,1994，（4）：44～46
30 张永祥.六味地黄汤现代药理学及化学的初步研究.基础医学与临床,2000，（5）15～19
31 方文贤,宋崇顺,周立孝.医用中医药理学.北京;人民卫生出版社,1998
32 汪长生.丹参注射液对大鼠急性心肌缺血及血液流变学的影响.皖南医学院学报,2002,(1)11～12
33 赵省，赵宏亮，宋长河．丹参防治肿瘤化疗所致骨髓抑制的研究．河南肿瘤学杂志,1994,7(2)：134～13