【作者】 李明；

【导师】 陈泽涛；

【作者基本信息】 山东中医药大学 ， 中西医结合临床， 2012， 博士

【摘要】 目的：根据益气化瘀法则，选用参芪扶正注射液、血栓通粉针与化疗联合应用治疗老年肺癌（60-75岁），观察益气化瘀中药的临床疗效，并探讨其作用机制。方法：将80名老年非小细胞肺癌（NSCLC）Ⅳ期的患者随机分为治疗组（化疗+中药组）、对照组（单纯化疗组），两组均采用多西他赛加顺铂化疗，治疗组加用参芪扶正注射液、血栓通粉针。对68例可评价病例，通过治疗后近期疗效评价、症状、卡氏评分、体重、凝血系列、D-二聚体（D-D）、T细胞亚群、NK细胞活性等相关指标变化及化疗不良反应、疾病进展时间（TTP）、中位生存期（MST）比较，总结和评价益气化瘀中药的疗效。结果：治疗组总有效率为39.5%，对照组总有效率为26.7%，治疗组总有效率高于对照组，但两组比较无统计学差异（P＞0.05）。治疗组不良反应发生率较对照组低，症状改善情况优于对照组，卡氏评分高于对照组，对免疫指标、凝血状态的改善情况优于对照组，两组比较有统计学差异（P﹤0.05）。治疗组中位疾病进展时间为155天，对照组为127天，治疗组中位疾病进展时间长于对照组，但两组之间无统计学差异（P＞0.05）。中位生存期治疗组为320天，对照组为239天，治疗组中位生存期长于对照组，两组比较有统计学差异（P﹤0.05）。结论：1.气虚血瘀是老年肺癌的主要病机，根据益气化瘀法则选用的参芪扶正注射液、血栓通粉针与化疗联合应用，可减轻化疗不良反应，改善临床症状，提高患者生活质量，延长患者生存期；2.老年晚期NSCLC多存在血液高凝状态，本研究应用活血化瘀药血栓通治疗老年晚期NSCLC，未发现有促进其复发和转移的作用。更多还原

【Abstract】 Objective：Based on the principle of supplementing Qi and removing blood stasis,aged patients with lung cancer were treated with taxotere and cisplatin in combination withShen-qi-fu-zheng injection(SQFZ) and Xue-shuan-tong powder for injection(XST).Furthermore, clinically therapeutic effects were observed and potential mechanism wasdiscussed.Methods:80cases with advanced non-small cell lung cancer (NSCLC) were dividedinto treatment group (40cases) and control group (40cases) at random. Taxotere andcisplatin were given to the control group, while the treatment group was treated withchemotherapy in combination with SQFZ and XST.68cases completed the entire study.The short-term clinical efficacy, symptoms, performance status (PS) score, body weight,markers of blood coagulation, D-dimer(D-D), T cell subgroups, adverse events, time toprogression (TTP) and median survival time (MST) in two groups were compared andanalyzed.Results：Short-term efficacy：The overall effective rate in treatment group (39.5%)was slightly higher than in the control group (26.7%), but there was no significantdifference between two groups (P＞0.05).The incidences of adverse reaction in treatmentgroup were significantly lower than those in the control group (P＜0.05). The performancestatus score, symptomatic improvement and amendments of immune indicators andcoagulation markers in the treatment group were significantly better than in the controlgroup(P＜0.05). The median time to progression in treatment group was155days, whilethat in control group was127days. Although the median time to progress tended to be higher in the treatment group than in control group, the difference between the two groupsdid not reach statistical significance. The median survival time (MST) of treatment groupwas320days, and it was significantly higher than that of control group (P＜0.05).Conclusion：(1) Blood stasis due to Qi deficiency is a main pathogenesis in agedpatients with advanced NSCLC, and chemotherapy in combination with the principle ofsupplementing Qi and removing blood stasis might be helpful to attenuate adverse drugevents, improve clinical symptoms and quality of life, and prolong the survial time.(2)Hypercoagulabale state exists generally in aged patients with advanced NSCLC, andapplication of medicines for promoting blood circulation and removing blood stasis doesnot speed up recurrence and metastasis of lung cancer in our study.更多还原