【作者】 易嘉雯；

【导师】 林丽珠；

【作者基本信息】 广州中医药大学 ， 中医学， 2010， 硕士

【摘要】 目的分析抗肿瘤化疗药所致周围神经毒性的中医病因病机,评估外用和血通痹方加减对抗肿瘤化疗药所致周围神经毒性的治疗效果及其安全性,为中医药在化疗药物所致周围神经毒性规范化治疗上的应用提供相关理论和实践参考。方法采用前瞻性自身前后对照方法,收集合格病例40例,予外用和血通痹方加减治疗抗肿瘤化疗药所致周围神经毒性。参考NCI周围神经毒性分级标准,观察用药前后神经毒性分级变化及起效时间,评估治疗效果。结果①40例患者中以夹杂气虚、血虚多见(共占75%),分级多以Ⅰ度毒性为主(47.5%)。其中应用泰素类化疗者多以夹杂血虚为主,表现为四肢末梢麻木尤甚,感觉袖套样减退；应用希罗达化疗者多以夹杂血热为主,表现为指趾色素沉着,可伴有脱屑；应用奥沙利铂化疗者多以夹杂寒凝为主,四肢畏冷,麻木疼痛等症遇寒加重。40例患者中舌暗者居多(82.5%),脉涩(52.5%)、虚(22.5%)、细(21/40，52.5%)居多。②经中医药辨证治疗,治愈21例,显效3例,有效15例,无效1例,总有效率97.5%。③泰素类组、希罗达组、奥沙利铂组、奥沙利铂+希罗达组之间疗效无明显差异(P=0.137)。气虚型、血虚型、血热型、寒凝型之间疗效有差异(P=0.032)；其中气虚型、血虚型分别与血热型比较,疗效有显著性差异。④不同分级神经毒性治疗的平均起效时间之间有差异(F=4.646,P=0.016)；Ⅲ级神经毒性与Ⅰ、Ⅱ级治疗的平均起效时间之间有显著性差异,时间明显延长。不同化疗用药组的治疗平均起效时间之间无差异。血热型与其余三型相比起效时间有差异,起效时间延长。⑤不同疗程疗效比较有显著差别,疗程越长,疗效越好,治愈率越高(P=0.000)。⑥随访2个月,未发现毒性复发情况。结论①化疗所致周围神经毒性多以Ⅰ级毒性为主；在证型夹杂方面,以气虚型和血虚型多见；患者常伴见舌暗、脉涩、虚细等表现,从侧面佐证了神经毒性患者气血不足、脉络瘀滞的病机。②本方案辨证加减治疗抗肿瘤化疗药所致周围神经毒性有确切的疗效：能显著改善患者神经毒性症状,并能稳定疗效；气虚型和血虚型这两种证型的疗效尤为明显。此外,本研究方案安全性好,随访巩固疗效亦可。从而初步显示了本方案在降低化疗所致周围神经毒性副反应方面的优势。更多还原

【Abstract】 Purpose:To analyses etiology and pathogenesis in TCM of peripheral nerve toxicity caused by anti-tumor chemotherapy drugs, then evaluate the treatment and security of external using Hexue Tongbi Fang to treat peripheral nerve toxicity caused by anti-tumor chemotherapy drugs, in order to provide relevant theoretical and practical reference in the Chinese medicine Standardized therapy of peripheral nerve toxicity caused by anti-tumor chemotherapy drugs.Methods:Using prospective and self-controlled research methods, collect a total of 40 cases, give the external using of Hexue Tongbi Fang to treat peripheral nerve toxicity caused by anti-tumor chemotherapy drugs. Then formulate a standard of peripheral nerve toxicity according to NCI, contrast the changes of peripheral nerve toxicity before and after treatment period and the onset time, for the sake of evaluating the efficafy of Chinese medicine.Results:①In 40 cases, the most common types of TCM syndrome is qi deficiency and blood deficiency Type(75%), then the most common grades of peripheral nerve toxicity is Grade 1(47.5%). Among them which used the chemotherapy drugs such as Taxol are most including blood deficiency syndrome, showing numb of distal limbs, diminished sense of sleeve-like. The patients which used the chemotherapy drugs such as Xeloda are most including blood heat syndrome, showing limb peripheral pigmentation and desquamation. The patients which used the chemotherapy drugs such as L-OHP are most including cold congealing syndrome, showing cold of the limbs and numb pain which may increase by cold.②In 40 cases of Chinese medicine group,21 cases were cured,3 cases were clear improved,15 cases were improved(the improvement rate was 97.5%,2 cases were ineffective. Total effective rate was 97.5%.③In regard of drug group among Taxol, Xeloda, L-OHP, L-OHP+Xeloda, showing no significant difference (P=0.137). In regard of the types of TCM syndrome, we found that it shows significant difference in efficacy between blood deficiency Type and blood heat Type, or between blood deficiency Type and blood heat Type.④In regard of the onset time of GradeⅠ-Ⅲshowing significant difference (F=4.646, P=0.016),GradeⅢ’s onset time are much longer than GradeⅡand Grade I’s. In regard of the onset time of drug groups showing no significant difference. In regard of the onset time of types of TCM syndrome showing significant difference, the Xuere Type needed more time to recovery.⑤In regard of treatment cycles shows significant difference, the longer course of treatment, the better result of treatment (P=0.000)⑥We followed up the patients for 2 months, didn’t recrudescence. Conclusion:①The most common grades of peripheral nerve toxicity is "GradeⅠ", and the most common types of TCM syndrome are qi deficiency Type and blood deficiency Type. Most of patients have those symptoms of blood stasis, such as painful dark tongue、deep thready pulse, it may coincide the hypothesis that most patients has the physical condition of Qi-Blood deficiency and obstruction of meridian and collateral.②The TCM therapy in this study has definite therapeutic effect to peripheral nerve toxicity caused by anti-tumor chemotherapy drugs:It can improve patients’subjective symptoms significantly, reduce peripheral nerve toxicity. Compare with other types of TCM syndrome, qi deficiency Type and blood deficiency Type have more significant efficafy. Furthermore, The TCM therapy had no side effect. Altogether, it preliminary shows the advantages of Chinese medicine in reducing peripheral nerve toxicity caused by anti-tumor chemotherapy drugs.更多还原