加味归芍六君子汤联合阿帕替尼治疗气虚血瘀型ⅢB-Ⅳ期胃癌的临床疗效观察

【作者】 刘欢；

【导师】 张红；

【作者基本信息】 湖南中医药大学 ， 中医内科学（专业学位）， 2022， 硕士

【摘要】 目的:通过观察加味归芍六君子汤联合阿帕替尼及阿帕替尼单药在气虚血瘀型IIIB-IV期胃癌患者中的临床效果及安全情况,阐明加味归芍六君子汤联合阿帕替尼对于晚期胃癌患者所表现出的优势,为中西医结合治疗晚期胃癌提供优化的诊疗方案。方法:选取自2021年1月至2022年1月期间于湖南中药大学第一附属医院肿瘤科门诊就诊的符合诊断标准和病例标准的ⅢB-Ⅳ期晚期胃癌患者,共计60例,按照随机数字表法分为治疗组(加味归芍六君子汤联合阿帕替尼)及对照组(阿帕替尼单药)(两组在性别、年龄、病理分期等方面无显著差异)。且两组均以两个疗程为限,每个疗程为期28天,观察两组的实体瘤疗效、卡氏评分、肿瘤标志物指标、中医临床症候及不良反应发生率变化情况,采用SPSS21.0统计软件进行统计分析,对比治疗前后及组间差异,评价加味归芍六君子汤联合阿帕替尼的疗效及安全性。结果:(1)近期实体瘤客观疗效:治疗组的疾病控制率以及客观缓解率均优于对照组,但经统计分析,两组之间的差异并不显著(P>0.05)。(2)KPS评分:相较于接受治疗前而言,两组KPS评分在治疗后皆有呈现上升趋势,且差异明显(P<0.05)。将两组治疗后的KPS评分进行对比,治疗组虽略高于对照组,但并不具有显著差异(P>0.05)。(3)中医证候方面:无论从中医证候积分方面来看,还是从中医证候疗效而言,治疗组都较对照组展现出显著性优势,差别明显(P<0.05)。(4)血清肿瘤标志物:两组治疗后的血清CEA、CA199、CA724指标均较治疗前大幅度下跌,具有显著差异(P<0.05)。将两组治疗后的各项肿瘤标志物进行组别比较,不存在显著差别(P>0.05)。(5)不良反应:在接受治疗后,治疗组出现血红蛋白下降、高血压及腹泻的情况明显比对照组少,存在高度统计学差异(P<0.05)。其余不良反应发生率治疗组虽低于对照组,但二者之间并不存在显著性差别(P>0.05)。结论:加味归芍六君子汤联合阿帕替尼组具有一定的抑制胃癌及改善生活质量的作用,且较之于单药阿帕替尼更能够缓解气虚血瘀型晚期患者的不适症状,减轻阿帕替尼治疗中出现的不良反应。更多还原

【Abstract】 Objective: To observe the clinical effect and safety of Jiawei Guishao Liujunzi Decoction combined with apatinib and apatinib alone in patients with stage IIIB-IV gastric cancer of qi deficiency and blood stasis type,to clarify the superiority of Jiawei Guishao Liujunzi Decoction combined with apatinib for patients with advanced gastric cancer,and to provide an optimized diagnosis and treatment scheme for advanced gastric cancer treated with integrated traditional Chinese and western medicine.Methods: From January 2021 to January 2022,60 patients with advanced gastric cancer in stage Ⅲ B-Ⅳ who met the diagnostic criteria and case criteria in the oncology department of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine were selected and divided into treatment group(Jiawei Guishao Liujunzi Decoction combined with apatinib)and control group(apatinib alone)according to the random number table method(there was no significant difference in gender,age,pathological stage,etc.).And both groups are limited to two courses of treatment,each course of treatment lasts for 28 days.Observe the changes of curative effect of solid tumor,Karnofsky score,tumor marker index,clinical symptoms of traditional Chinese medicine and incidence of adverse reactions in both groups,and make statistical analysis by SPSS21.0 statistical software,compare the differences before and after treatment and between groups,and evaluate the curative effect and safety of Jiawei Guishao Liujunzi Decoction combined with apatinib.Results:(1)Objective curative effect of solid tumor in the near future: The disease control rate and objective remission rate of the treatment group are better than those of the control group,but the statistical analysis shows that there is no significant difference between the two groups.(P>0.05).(2)KPS score: Compared with before treatment,KPS scores of both groups showed an upward trend after treatment,and the difference was obvious(P<0.05).After treatment,KPS scores were compared among groups.Although the treatment group was slightly higher,there was no significant difference(P>0.05).(3)Curative effect of TCM syndromes: No matter from the point of view of TCM syndrome score or curative effect of TCM syndrome,the treatment group showed significant advantages compared with the control group(P<0.05).(4)Serum tumor markers: Compared with before treatment,the indexes of serum CEA,CA199 and CA724 in the two groups decreased significantly after treatment(P<0.05).After treatment,there was no significant difference in tumor markers between groups(P>0.05).(5)Adverse reactions: After treatment,the cases of hemoglobin reduction,hypertension and diarrhea in the treatment group were significantly less than those in the control group,and there was a high statistical difference.(P<0.05).The incidence of other adverse reactions in the treatment group was lower than that in the control group,but there was no significant difference between the two groups(P>0.05).Conclusion: Jiawei Guishao Liujunzi Decoction combined with apatinib can inhibit gastric cancer and improve the quality of life to a certain extent.Compared with apatinib alone,Jiawei Guishao Liujunzi Decoction can alleviate the discomfort symptoms of advanced patients with qi deficiency and blood stasis,and reduce the adverse reactions in the treatment of apatinib.更多还原