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目的观察加味黄芪桂枝五物汤对奥沙利铂化疗所致周围神经毒性的防治效果。方法将接受改良FOLFOX方案化疗的68例结直肠癌及胃癌患者,随机分为对照组和治疗组,每组34例。对照组在接受化疗同时服用甲钴铵片,治疗组在接受化疗同时服用加味黄芪桂枝五物汤。两组均于化疗4个周期后,评价周围神经毒性发生情况及T淋巴细胞亚群(CD3~+、CD4~+、CD4~+/CD8~+)变化情况。结果 (1)治疗组发生周围神经毒性1级6例、2级3例、3级1例、4级0例,总发生率29.4%;对照组发生周围神经毒性1级11例、2级5例、3级2例、4级0例,总发生率52.9%。组间周围神经毒性总发生率比较,治疗组明显低于对照组(P<0.05)。(2)治疗前后组内比较,治疗组淋巴细胞亚群无明显变化,对照组CD3~+、CD4~+、CD4~+/CD8~+水平显著下降,差异有统计学意义(P<0.05);组间治疗后比较,CD3~+、CD4~+、CD4~+/CD8~+水平差异有统计学意义(P<0.05)。结论加味黄芪桂枝五物汤能有效减轻奥沙利铂引起的周围神经毒性反应,提高患者的细胞免疫功能。
Objective To observe the preventive and therapeutic effects of Modified Astragalus and Guizhi Wuwu Decoction on peripheral neurotoxicity induced by oxaliplatin chemotherapy. Methods Sixty-eight patients with colorectal cancer and gastric cancer receiving modified FOLFOX regimen were randomly divided into control group and treatment group, 34 cases in each group. The control group received mecobalamin tablets while receiving chemotherapy, while the treatment group received the modified Astragalus and Guizhi Wuwu Tang while receiving chemotherapy. After 4 cycles of chemotherapy, the two groups were evaluated the occurrence of peripheral neurotoxicity and the changes of T lymphocyte subsets (CD3 ~ +, CD4 ~ +, CD4 ~ + / CD8 ~ +). Results (1) Peripheral neurotoxicity in treatment group was 6 cases in grade 1, 3 in grade 2, 1 in grade 3 and 0 in grade 4, with a total incidence of 29.4%. In the control group, peripheral neurotoxicity was grade 1 in 11 and grade 2 in grade 5 Cases, 3 cases in 2 cases, 4 cases in 0 cases, the total incidence of 52.9%. The total incidence of peripheral neurotoxicity in the treatment group was significantly lower than that in the control group (P <0.05). (2) The levels of CD3 ~ +, CD4 ~ + and CD4 ~ + / CD8 ~ + in the control group were significantly lower than those in the control group before and after treatment (P <0.05) There were significant differences in the levels of CD3 ~ +, CD4 ~ +, CD4 ~ + / CD8 ~ + between the two groups after treatment (P <0.05). Conclusion Modified Astragalus and Guizhi Wuwu Decoction can effectively reduce the peripheral neurotoxicity induced by oxaliplatin and improve the cellular immune function of patients.