中药配合心理干预方案提高肿瘤患者生活质量的初步研究

【作者】 贾玫；

【导师】 陈信义；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2007， 硕士

【摘要】 目的:综合治疗是目前治疗恶性肿瘤的主要方法,其中中医药在综合治疗中的地位日显凸出。虽然中医心理干预治疗恶性肿瘤有一定疗效,然而缺乏规范化治疗方案及疗效标准,尚未在临床中得到广泛应用。本课题旨在客观评价中药配合中医心理干预方案在改善肿瘤患者心理状态、调节免疫功能及提高生活质量等方面的临床疗效,并试图为完善恶性肿瘤综合治疗,并形成初步的规范化心理治疗方案提供临床依据。方法:通过前瞻性随机对照临床研究,以心理状态评分(Hamilton抑郁自评量表计分)、免疫功能(NK、T细胞亚群)检测指标和生活质量计分(EORTC QLQ-C30(version 3)生活质量调查问卷)为重点研究指标,在北京中医药大学东直门医院和中国医学科学院肿瘤医院观察了符合纳入病例标准的53例恶性肿瘤患者,按不平衡指数最小的分配原则,随机分配到治疗组及对照组,两组比例为1:1。对照组:采用常规治疗,包括化疗、对症治疗和支持治疗等。治疗组:在对照组治疗基础上,增加中药配合中医心理干预疗法。全部病例均连续治疗14天为一个治疗周期。每组分别观察治疗1个周期。统计分析采用SPSS11.0统计分析软件进行计算。组间资料两两比较采用t检验。治疗前后比较用配对t检验。结果:中医心理干预方案对于改善肿瘤患者的心理状态、生活质量具有明显作用,在情感关系、免疫指标等方面的改善较对照组均有统计学意义。①中医心理干预治疗组第8天测评,与疗前比较,Hamilton评分有所上升,但无统计学意义(P>0.05);第15天测评,Hamilton评分明显下降,与疗前相比有统计学意义(P<0.01)。而常规治疗对照组中,疗后两次测评与治疗前比较,Hamilton评分略有上升,无统计学意义。②中医心理干预治疗组第8天测评,8例QOL明显改善,与对照组(仅1例改善)比较,具有统计学意义(P<0.01);第15天测评,治疗组QOL评分明显上升,生活质量明显提高者达到22例,与常规治疗对照组(QOL改善者仅有2例)相比,有效率分别为75.9%和8.3%,具有统计学意义(P<0.001)。③中医心理干预治疗组第15天测评免疫功能,治疗组与对照组相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有统计学意义(P<0.05),治疗组NK细胞疗后虽比对照组上升,但无统计学意义(P>0.05);治疗组治疗前、疗后相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有统计学意义(P<0.05)。结论:以调畅情志为主的中医心理干预治疗可以作为肿瘤综合治疗的一部分,对提高肿瘤患者生活质量方面大有裨益,反映出中药配合心理治疗方案在一定程度上调节机体免疫功能的一种趋势。本课题的研究结果显示中医心理治疗可以使肿瘤患者心理状态改善,生活质量提高,免疫指标好转,三者之间存在直接相关性。提示在肿瘤患者综合治疗中,中药配合心理干预疗法不但有助于控制肿瘤的发展,还具有一定的社会和经济效应,该方案值得进一步探索与完善。更多还原

【Abstract】 Purpose In the prospective, random control study the author aimed to objectively evaluate the therapeutic effect of traditional Chinese medicine combined with mental intervention therapy (TCM mental intervention therapy) on improving mental status, regulating immune function and elevating quality of life(QOL) of tumor patients. Furthermore, it is hoped that the study to be helpful for preliminarily forming the therapy of standardized psychotherapy of TCM, which may provide clinical data for consummating combined therapy of tumor.Methods 53 cases of tumor patients were observed in Dongzhimen Hospital and Cancer hospital of Chinese Academy of Medical Sciences.Taking mental status score, immune function index and evaluation of QOL as focal points, it was intensively explored the mechanism of TCM with mental intervention therapy interrupting tumor development, i.e. to control tumor by means of regulating the immune state of the patients, and more to improve QOL of the patients to draw assistance from changing the mental status.Results TCM mental intervention therapy indicates obvious effect in the different aspects of mental status, immune function and quality of life. Compared with the control group the study showed notable statistical difference on the index of mentation and immune function. PartⅠHamilton Score. In the group of TCM mental intervention therapy, day 8th survey indicated that Hamilton Score was slightly increased compared with day 1st(P value>0.05). While day 15th survey showed that Hamilton Score was notably decreased compared with day 1st(P value<0.01). On the contrary, in the group which utilized routine therapy the both surveies on day 8th and 15th Hamilton Score was slightly increased compared with day 1st(P value>0.05).PartⅡQOL Index. In the group of TCM mental intervention therapy, day 8th survey indicated that quality of life of 8 cases was obviously improveed compared with control group (P value<0.05). Day 15th survey showed that QOL Index was notably decreased compared with day 1st, 22 cases among which QOLwere notably improved while in control group,only 2 cases, the effective ratio was 75.9% to 8.3% (P value<0.001). PartⅢImmune function. Part of cases in the group of TCM mental intervention therapy showed immune functional recovery.Conclusion TCM mental intervention therapy which stresses on regulating and smoothing mentation of tumor patients is much helpful for improving QOL and, in certain extent, the therapy could regulate immune fuction. Results of the study demonstrate that the therapy of TCM mental intervention improving mental status, recovering immune function and elevating quality of life of tumor patients, the three aspects are directly correlated, therefore TCM mental intervention therapy, as a part of combined therapy of tumor, makes for control tumor development and need further study.更多还原