化痰熄风清脑方在放疗为主的非小细胞肺癌脑转移综合治疗中的作用

【作者】 王明琦；

【导师】 侯炜；

【作者基本信息】 北京中医药大学 ， 中医学， 2015， 硕士

【摘要】 背景：恶性肿瘤是威胁我国居民健康的主要慢性疾病之一,近年来随着工业、经济发展、环境恶化和人口老龄化,各种恶性肿瘤的发病率和死亡率在我国均呈现上升趋势。不论在城市还是农村,恶性肿瘤都已成为我国居民死亡原因之首。肺癌作为目前国内发病率最高、发病人数最多的恶性肿瘤,其预后不良的主要原因是局部复发或远处转移。肺癌患者发生脑转移已属疾病末期,预后差,自然中位生存期短,其治疗以最大限度地改善患者症状,提高生活质量和延长生存时间为主要目的,根据肿瘤的发生部位、病理类型、侵犯范围、发展趋势以及患者的身体状况,合理地、有计划地综合运用现有的治疗手段进行综合治疗。西医治疗方式对于肿瘤的治疗效果不可否认,但其高强度、大剂量、长周期的治疗常常使患者苦不堪言。而中医中药的运用在减毒增效、配合西医的辅助治疗和作为晚期癌症患者的主要治疗方面发挥着重要的作用。化痰熄风清脑方是笔者导师治疗肺癌脑转移的经验方,以二陈汤为基础化裁而得,临证加减,在临床应用中能够有效改善脑转移患者的部分症状,增强体力。目的：回顾性分析化痰熄风清脑方参与放疗为主的综合治疗对非小细胞肺癌脑转移患者的临床疗效,研究化痰熄风清脑方对患者部分症状、卡氏评分、放疗引起毒副反应以及脑转移无进展生存期和总生存期的影响。方法：按照已制定的诊断、纳入、排除标准,从2011年6月至2013年6月间于我院行全脑放疗(40Gy/20f/4w)的非小细胞肺癌脑转移患者中收集到33例仅进行以全脑照射为主的基础治疗的患者(设为对照组)和35例在进行放疗为主的基础治疗同时配合口服化痰熄风清脑方加减中药治疗的患者(设为治疗组),对两组患者病历信息中治疗前后的客观疗效、卡氏评分、临床症状、不良反应,以及无进展生存期、总生存期进行数据采集和分析。结果：化痰熄风清脑方合并全脑放疗为主的基础治疗与单纯基础治疗相比,两组治疗后转移瘤的客观疗效,治疗组有效率为34.3%,对照组有效率33.3%,治疗组略优于对照组,但(P>0.05)无统计学差异。对于卡氏评分改善情况的评价：治疗组有效率为45.7%,对照组有效率为21.2%,两组患者对比(P<0.05)治疗后体力状况的改善治疗组明显优于对照组。两组患者临床症状的改善情况：头晕头痛和乏力症状的改善治疗组优于对照组,且经统计学分析有明显差异性(P<0.05)；而半身不遂、抽搐、癫痫发作、感觉障碍、智力障碍等症状经统计学分析无明显差异性(P>0.05)。骨髓抑制方面,两组患者白细胞骨髓抑制和血小板骨髓抑制的发生率并无统计学差异(P>0.05),而血红蛋白骨髓抑制即贫血的发生率治疗组明显低于对照组,且具有统计学意义(P<0.05)。治疗组患者中位无进展生存期为3个月,样本的PFS平均分布为3.37±0.077月；对照组患者中位无进展生存期同样为3个月,样本的PFS平均分布为3.12±0.992月,两组比较(P=0.256>0.05)无统计学差异。治疗组中位生存期5个月,样本的OS平均分布为5.11±1.231月；对照组中位生存期5个月,样本的OS平均分布为4.70±1.212月,两组比较(P=0.176>0.05)无统计学差异。结论：使用化痰熄风清脑方配合全脑照射治疗非小细胞肺癌脑转移不仅可以有效改善头晕头痛、乏力等临床症状,增强患者的体力状况,还可以保护正常组织细胞,在一定程度上减少放疗所致骨髓抑制等毒副反应的发生,从而提高疗效,提升患者的生活质量。更多还原

【Abstract】 Background:Cancer is one of the major chronic diseases that threat the health of Chinese residents, with the development of industry and economy, environmental degradation and the population aging in recent years, various cancer incidence and mortality rate are on the rise in our country. Malignant tumor has become the first reason of the residents’ death in both urban and rural areas of our country. Currently, lung cancer has the highest incidence and the largest number of malignant tumor cases, the poor prognosis is mainly due to local recurrence or distant metastasis. Lung cancer patients with brain metastases are in the terminal of disease, the prognosis is poor and the naturally median survival is short. The treatment mainly aims at improving the symptoms and the quality of life while prolonging survival time to maximize, using reasonable, planned comprehensive of existing treatments for comprehensive treatment according to location of the tumor, histological type, extent of involvement, developing trends and physical condition of the patients. The effect of western medical treatment is undeniable, but the characteristics of high strength, high-dose, long periods often make patients miserable. The Chinese medical treatment plays an important role in toxicity attenuation and efficacy potentiation, adjuvant with western medicine, and as the main treatment for patients with advanced cancer. Huatan Xifeng Qingnao Fang is the summary of experience in the treatment of lung cancer with brain metastasis of the author’s teacher, which is modified by Er Chen Tang. The using in clinical can improve some of the symptoms of the patients and enhance their physical conditions.Objective:A retrospective analysis of the clinical efficacy of non-small cell lung cancer patients with brain metastasis while Huatan Xifeng Qingnao Fang involved in the comprehensive treatment based on radiotherapy. Research the influence to the symptoms, Karnofsky score, radiotherapy toxicity and brain metastasis progression free survival (PFS) and overall survival (OS) of the prescription.Methods:According to the established standard of diagnosis, inclusion and exclusion, collect 33 cases who had only taken the basic treatment based on whole brain irradiation (as the control group) and 35 cases who had taken the traditional Chinese medicine prescription at the same time (as the treatment group) from all the non-small cell lung cancer patients with brain metastasis who took the treatment of WBRT (40Gy/20f/4w) in Guang’ anmen Hospital during June 2011 to June 2013. Collect and analyze the data of objective effect, Karnofsky score, clinical symptoms, adverse reactions, and progression free survival, overall survival getting from the two groups of patients before and after the treatment.Results:Treatment of Huatan Xifeng Qingnao Fang combined WBRT compared with simply WBRT, the objective effect showed no statistical difference while the effective rate of the treatment group was 34.3% and the control group was 33.3%. The evaluation of Karnofsky score improvement:the effective rate of the treatment group was 45.7% and the control group was 21.2% (P<0.05), which means the physical condition of treatment group was better than the control group. Improvement of clinical symptoms of the two groups of patients:dizziness, headache and fatigue had significant difference by statistically analysis (P<0.05) while hemiplegia, convulsions, seizures, sensory impairments, mental retardation had no significant difference (P> 0.05). On the bone marrow suppression side, the white blood cells and platelets bone marrow suppression incidence had no significant difference between the two groups (P> 0.05), but the treatment group had a lower statistically significant hemoglobin bone marrow suppression incidence (P<0.05). Median PFS of the patients in treatment group was 3 months, PFS average distribution of the sample was 3.37±0.077 months; median PFS of the patients in control group was also 3 months, PFS average distribution of the sample was 3.12±0.992 months, there was no statistical difference between the two groups (P=0.256>0.05). Median OS of the patients in treatment group was 5 months, OS average distribution of the sample was 5.11±1.231 months; median OS of the patients in control group was also 5 months, OS average distribution of the sample was 4.70±1.212 months, there was no statistical difference between the two groups (P=0.176>0.05).Conclusion:To treat the non-small cell lung cancer patients with brain metastasis using Huatan Xifeng Qingnao Fang combined with WBRT can not only effectively improve the clinical symptoms such as dizziness, headache, fatigue, and enhance the physical condition of the patients, but also protect normal tissue cells to reduce the occurrence of radiation-induced toxicity such as bone marrow suppression, so as to improve the quality of patients’life.更多还原