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1.四川省医学科学院 四川省人民医院,成都 610025
2.成都市老年康疗院,成都 610004
袁敏,主治医师,从事胸外科临床工作,E-mail:878462570@qq.com
* 杨云珍,主治医师,从事胸外科、整形临床工作,E-mail:1141295633@qq.com
收稿日期:2021-01-27,
网络出版日期:2021-02-22,
纸质出版日期:2021-11-05
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袁敏,杨云珍,钟雷等.归脾汤加减内服联合中药热熨对乳腺癌术后气血两虚证患者康复的影响[J].中国实验方剂学杂志,2021,27(21):150-155.
YUAN Min,YAGN Yun-zhen,ZHONG Lei,et al.Observe Impact Modified Guipitang Administration Combined with Hot Pressing of Traditional Chinese Medicine on Rehabilitation in Patients with Deficiency of Qi and Blood Syndrome Breast Cancer Postoperative[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(21):150-155.
袁敏,杨云珍,钟雷等.归脾汤加减内服联合中药热熨对乳腺癌术后气血两虚证患者康复的影响[J].中国实验方剂学杂志,2021,27(21):150-155. DOI: 10.13422/j.cnki.syfjx.20210633.
YUAN Min,YAGN Yun-zhen,ZHONG Lei,et al.Observe Impact Modified Guipitang Administration Combined with Hot Pressing of Traditional Chinese Medicine on Rehabilitation in Patients with Deficiency of Qi and Blood Syndrome Breast Cancer Postoperative[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(21):150-155. DOI: 10.13422/j.cnki.syfjx.20210633.
目的
2
观察归脾汤内服联合中药热熨对乳腺癌术后气血两虚证患者的康复效果及对免疫功能和肿瘤标志物的影响。
方法
2
将154例患者采用随机按数字表法分为观察组和对照组各77例。两组患者术后给予综合治疗。对照组口服八珍颗粒,8 g/次,2次/d。观察组给予归脾汤辨证内服,1剂/d,两组疗程均为8周;并结合中药热熨患侧胸前、肩部及上肢,20 min/次,2次/d,每周治疗5 d,前4周。记录淋巴水肿、皮下积液、皮瓣生长不良、睡眠障碍、肩关节功能障碍等发生情况;进行治疗前后欧洲癌症研究治疗组织生命质量测定量表-30(EORTC QLQ-30),癌因性疲劳和气血两虚证评分;检测治疗前后T淋巴细胞亚群(CD3
+
,CD4
+
,CD8
+
水平及CD4
+
/CD8
+
),调节性T细胞(Treg),抑制性T细胞(Ts),细胞毒T细胞(Tc),人生长分化因子3(GDF3),血清糖类抗原153(CA153),癌胚抗原(CEA)和人表皮生长因子受体-2(HER-2)水平。
结果
2
治疗后观察组淋巴水肿、皮下积液、皮瓣生长不良、睡眠障碍、肩关节功能障碍的发生率为8(10.39%),9(11.69%),11(14.29%),25(32.47%)和8(10.39%),分别低于对照组的18(23.38%),20(25.97%),23(29.87%),46(59.74%)和19(24.68%)(
P
<
0.05,
P
<
0.01);观察组总体生命质量和功能评分均高于对照组(
P
<
0.01),症状评分低于对照组(
P
<
0.01);观察组癌因性疲劳和气血两虚证积分均低于对照组(
P
<
0.01);观察组Tc,CD3
+
,CD4
+
,CD4
+
/CD8
+
均高于对照组(
P
<
0.01),Treg,Ts和CD8
+
均低于对照组(
P
<
0.01);观察组GDF3,CA153,CEA和HER-2均低于对照组(
P
<
0.01)。
结论
2
在西医常规综合治疗的基础上,归脾汤内服联合中药热熨用于乳腺癌术后患者,可降低术后并发症,减轻疲劳程度、术后症状和中医证候,增强机体免疫功能,提高患者的生活质量,促进了术后康复,并可抑制肿瘤标志物的表达,改善了患者的预后。
Objective
2
To observe the rehabilitation effect of modified Guipitang administration combined with traditional Chinese medicine (TCM) hot pressing in patients with deficiency of Qi and blood syndrome breast cancer postoperative, and investigate its effect on immune function and tumor markers.
Method
2
One hundred and fifty-four patients were divided into observation group (77 cases) and control group (77 cases) by random number table. Two groups were given comprehensive treatment measures after operation. Patients in control group additionally took Bazhen granules orally, 8 g/time, 2 times/day, for eight weeks. Patients in observation group additionally took Guipitang orally for syndrome differentiation, 1 dose/day for eight weeks. The chest, shoulders and upper limbs of the affected side were hot-pressed with TCM, 20 min/time, 2 times/ day, 5 days a week, the first 4 weeks. The occurrence of lymphedema, subcutaneous fluid, poor skin flap growth, sleep disturbance, shoulder joint dysfunction, etc. Were recorded in both groups. Before and after treatment, the scores of European organization for research and treatment of cancer quality of life questionnaire core-30(EORTC QLQ-30), and scores of cancer-induced fatigue and Qi and blood deficiency were graded. T lymphocyte subsets (CD3
+
, CD4
+
, CD8
+
levels and CD4
+
/CD8
+
), regulatory T cells (Treg), inhibitory T cells (Ts), cytotoxic T cells (Tc), human growth differentiation factor 3 (GDF3), serum carbohydrate antigen 153 (CA153), carcinoembryonic antigen (CEA) and human epidermal growth factor -2 (HER-2) levels were detected before and after treatment.
Result
2
After treatment, the observation group incidence of lymphedema, subcutaneous effusion, poor skin flap growth, sleep disturbance and shoulder joint dysfunction was 8(10.39%), 9(11.69%), 11(14.29%), 25(32.47%) and 8 (10.39%) respectively in the observation group, all lower than 18(23.38%), 20(25.97%), 23(29.87%), 46(59.74%) and 19(24.68%) in the control group(
P
<
0.05,
P
<
0.01). The scores of overall quality of life and function scores in the observation group were higher than those in the control group (
P
<
0.01), hile symptom score was lower than that in the control group (
P
<
0.01). The scores of cancer-induced fatigue deficiency of Qi and blood syndrome in the observation group were lower than those in the control group (
P
<
0.01). The Tc, CD3
+
, CD4
+
, CD4
+
/CD8
+
levels in the observation group were higher than those of the control group (
P
<
0.01), while the Treg, Ts, CD8
+
levels were lower than those in the control group (
P
<
0.01). The GDF3, CA153, CEA, HER-2 levels in the observation group were lower than those in the control group (
P
<
0.01).
Conclusion
2
On the basis of conventional comprehensive interventions of western medicine, Guipitang combined with TCM hot pressing for breast cancer patients after surgery can reduce postoperative complications, reduce fatigue, postoperative symptoms and TCM syndromes. Besides, it can enhance the immune function of the body, improve the quality of life, promote postoperative recovery, and inhibit the expression of tumor markers, thus improving the prognosis of patients.
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