【作者】 唐龙飞；

【导师】 李晓峰；

【作者基本信息】 福建中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的观察香砂六君子汤加味治疗晚期非小细胞肺癌化疗所致食欲减退的临床疗效及对患者血清白细胞介素-1(IL-1)水平变化的影响。资料与方法将60例符合纳入标准的晚期非小细胞肺癌患者随机分成两组,治疗组30例采用香砂六君子汤加味联合化疗,对照组30例采用醋酸甲地孕酮联合化疗,3周为一个化疗周期,2周期为一个疗程。观察食欲、血清IL-1水平、肿瘤客观疗效、体重、卡氏评分及不良反应的变化情况。结果1.每周期第21天两组的食欲评分均高于同一周期的第2天,差异有统计学意义(P<0.05)；每周期第21天治疗组食欲评分均略高于对照组,但差异无显著性(P>0.05)。2.治疗第21、42天两组IL-1水平比治疗第2天水平均明显降低,差异有统计学意义(P<0.05);治疗第42天两组IL-1水平比治疗第21天水平有所降低,差异有统计学意义(P<0.05)；治疗第2、21、42天两组IL-1水平比较,差异均无统计学意义(P>0.05)。两组的IL-1水平与食欲评分进行等级相关分析显示,相关系数r均<0、P均<0.05,提示IL-1水平与食欲评分之间呈负相关关系。3.在肿瘤客观疗效上,有效率：治疗组为43.3%、对照组为40.0%,稳定率：治疗组为83.3%、对照组为76.7%,两组比较,均无显著性差异(P>0.05)。4.治疗后两组体重均有所增加,与治疗前比较,无显著性差异(P>0.05)；对照组体重略高于治疗组,两组比较,无显著性差异(P>0.05)。5.治疗后两组卡氏评分均有提高,与治疗前比较,有显著性差异(P<0.05)；治疗组卡氏评分比对照组稍有提高,但无显著性差异(P>0.05)。6.治疗组未出现水肿、高血压情况,两组均未见血栓性静脉炎发生；治疗组出现便秘情况低于对照组,两组比较,有显著性差异(P<0.05)。7.治疗组出现白细胞降低、恶心呕吐及腹泻等化疗毒副反应的例数较对照组少,有显著性差异(P均<0.05)；两组在其余各项化疗毒性反应方面比较,无显著性差异(P均>0.05)。结论1.香砂六君子汤加味能明显改善晚期非小细胞肺癌患者化疗所致食欲减退、提高患者生活质量及降低IL-1的水平,疗效与醋酸甲地孕酮相当。2.香砂六君子汤加味无醋酸甲地孕酮在水肿、高血压、便秘方面的副作用。3.香砂六君子汤加味在减轻白细胞降低、恶心呕吐及腹泻等化疗毒副反应方面优于醋酸甲地孕酮。更多还原

【Abstract】 ObjectiveTo observe the clinical curative effect of the anorexia induced by chemotherapy in patients with advanced non-small cell lung cancer through Additive Xiangshaliujunzi Decoction and the influence on the change of serum level of interleukin-1(IL-1). Materials and MethodsThe 60 non-small cell lung cancer patients according with standards were randomly divided into two groups,30 cases of the therapy group were treated with combined Additive Xiangshaliujunzi Decoction and chemotherapy,30 cases of the control group were treated with combined megestrol acetate and chemotherapy. A cycle of chemotherapy would be 3 weeks,while a course of treatment would include 2 cycles of chemotherapy.The observation indicators would contained patients’appetite,serum level of IL-1,tumor objective curative effect,body weight, karnofsky and side effects.The curative effects would be evaluated after one course of treatment.Resultsl.On the 21st day of a chemotherapy cycle, the scores of appetite ratings in both groups are higher than those of the 2nd day of the same chemotherapy cycle,and the difference is significant (P<0.05). On the 21st day of a chemotherapy cycle, the scores of appetite ratings in therapy group are slightly higher than those of the control group,but the difference is insignificant (P>0.05).2.On the 21st and 42nd day of the treatment course, the serum level of IL-1 in two groups is lower than that of the 2nd day of the treatment course,and the difference is significant (P<0.05).On the 42nd day, the serum level of IL-1 in two groups is lower than that of the 21st day of the treatment course, and the difference is significant (P<0.05).On the 2nd, 21st and 42nd day,there is no significant difference(P>0.05) on the change of the serum level of IL-1 between two groups.The correlation coefficient between the serum level of IL-1 and appetite ratings is negative, and the difference is significant (P<0.05),which indicates that there exists a negative correlation between each other.3.In objective curative effects of the tumor,therapy group attained the efficiency of 43.3% and the stability rate of 83.3%,while in control group the efficiency is 40.0% and the stability rate is 76.7%.The difference is insignificant (P>0.05) in aspects of the efficiency and the stability rate between two groups.4.After the treatment, the patients in both groups gain weight than before the treatment, but the difference is insignificant(P>0.05).There is also no significant difference(P>0.05) in aspect of body weight between two groups after the treatment.5.After the treatment, the scores of Kamofsky in both groups are higher than before the treatment, and the difference is significant (P<0.05).The scores of Kamofsky in therapy group are higher than the control group, but the difference is insignificant (P>0.05).6.During the treatment,the therapy group has no case of edema, high blood pressure or thrombophlebitis.Patients with constipation in therapy group are fewer than the control group,and the difference is significant (P<0.05).7.Patients with leukocyte reduction,nausea,vomiting or diarrhoea in therapy group are fewer than the control group,and the difference is significant (P<0.05).There is no significant difference (P>0.05) in other aspects of toxic and side effects between two groups. Conclusions1.Additive Xiangshaliujunzi Decoction can obviously improve the anorexia induced by chemotherapy in patients with advanced non-small cell lung cancer, enhance the quality of life and reduce the serum level of IL-1.The curative effect is equivalent to that of megestrol acetate.2.Additive Xiangshaliujunzi Decoction has no side effects on edema, high blood pressure or thrombophlebitis,while megestrol acetate has.3.Additive Xiangshaliujunzi Decoction is better than megestrol acetate on relieving the toxic and side effects induced by chemotherapy,such as leukocyte reduction,nausea,vomiting or diarrhea.更多还原