【作者】 许延林；

【导师】 林国华；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 硕士

【摘要】 目的：通过采用前瞻性随机临床对照研究的方法,观察火针四花穴对肺癌化疗患者的临床疗效。了解火针四花穴对肺癌化疗患者细胞因子IL-2、TNF-a、T淋巴细胞亚群、化疗毒副反应、生存质量及体力状况的影响,从而确立一种减轻化疗毒副反应、减轻化疗引起的生存质量及体力状况下降的有效方法及有效穴对,探讨火针四花穴减轻肺癌化疗毒副反应、减轻化疗引起的生存质量及体力状况下降的可能作用机制。方法：将符合标准的60例肺癌化疗病人,采用简单随机法分为两组,以单纯化疗为对照组,以化疗配合火针四花穴治疗为治疗组。化疗：化疗方案采用紫杉醇联合顺铂或吉西他滨联合顺铂的联合化疗方案,常规应用预防化疗毒副反应的西药,进行为期一周的一疗程治疗。火针四花穴：双侧膈俞、胆俞穴局部消毒后,涂上一层薄薄的跌打万花油,用烧红的火针迅速准确地刺入穴位0.1mm,并敏捷出针,连续刺3下,用棉球按压针孔片刻,并再涂上一层薄薄的跌打万花油,1次／天,共7天。以细胞因子IL-2、TNF-a、T淋巴细胞亚群、抗癌药物毒性反应分度、生存质量表、Karnofasky体力状况评分作为疗效评价指标。所有指标均于化疗前1天及疗程结束后第2天评定一次,观察期为1周。应用所得数据建立数据库,采用SPSS19.0统计软件进行统计分析。结果：治疗前两组抗癌药物毒性反应分度,经统计学检验,差异无统计学差异(P>0.05)。治疗后两组抗癌药物毒性反应分度均较治疗前增高(P<0.05,P<0.01),但治疗组相对较轻(P<0.05),差异均有统计学意义；治疗组血液系统损害、胃肠道不适较对照组轻(P<0.01,P<0.05),差异有统计学意义。治疗前两组生存质量评分、Karnofasky体力状况评分,经统计学检验,差异均无统计学差异(P>0.05)。治疗后,两组生存质量评分均较治疗前升高(P均<0.01),Karnofasky体力状况评分均较治疗前下降(P均<0.01),但治疗组生存质量评分较对照组低(P<0.05),Karnofasky体力状况评分较对照组高(P<0.05),差异有统计学意义。治疗前两组IL-2、TNF-a、T淋巴细胞亚群水平,经统计学检验,差异均无统计学差异(P>0.05)。治疗后,治疗组IL-2水平较治疗前升高(P<0.01),TNF-a水平下降(P<0.01),CD3+、CD4+、CD8+、CD[／CD。+水平无明显变化(P>0.05)；对照组IL-2水平较治疗前升高(P<0.01),TNF-a水平无明显变化(P>0.05),CD3+、CD4+、CD4+/CD8+水平下降(P<0.01),CD8+水平升高(P<0.01)。两组治疗后比较,治疗组IL-2、CD3+、CD4+、CD4+／CD8+水平较对照组高(P均<0.01),TNF-a、CD8+水平较对照组低(P均<0.01),差异有显著统计学意义。结论：肺癌化疗患者配合火针四花穴可减轻化疗引起的生存质量、Karnofasky体力状况的下降；减轻抗癌药物毒性反应；减少化疗引起的血液系统损害、胃肠道不适；可在一定程度上提高IL-2水平,降低TNF-a水平,减轻化疗对T淋巴细胞亚群的损害。火针四花穴能减轻化疗毒副反应、减轻化疗引起的生存质量下降,可能与其能在一定程度上提高肺癌化疗患者的免疫功能有关。更多还原

【Abstract】 Objecti veA prospective randomized controlled study on the clinic effects of Fire needle on SiHua in chemotherapy patients with lung cancer. To understand the effects on IL-2, TNF-a,T lymphocyte subsets level and the toxic and side reaction, quality of life,physical condition of Fire needle on SiHua in chemotherapy patients with lung cancer, trying to find effective treatments and a group of effective acupoints with fewer adverse effects of chemotherapy and the fall of the quality of life and physical condition in chemotherapy patients with lung cancer;to explore the possible mechanisms of reducing adverse effects and the fall of the quality of life and physical condition in chemotherapy patients with lung cancer.Methods60eligible lung cancer patients with chemotherapy were simple randomly divided into two groups, the control group with simple chemotherapy and the treatment group with chemotherapy plus fire needle on SiHua. The chemotherapy included the combination chemotherapy with paclitaxel and Cisplat in or Gemcitabine plus Cisplatin, with the conventional medicine for preventing adverse effeets of chemotherapy. A week made a course.As for the fire needle on SiHua, after the local disinfection of the bilateral Geshu and Dashu points, a thin layer of Dedawanhua oil was apllied on SiHua. Then the red-hot fire needle quickly and accurately picked acupoints0.1mm by3times, and was pulled out agility. Then, using a cotton ball to press the acupoints for a moment, and a thin layer of Dedawanhua oil was apllied on the points. The course contains one treatment a day for7days. Before and after the treatment, the IL-2level, TNF-a level, T lymphocyte subsets level, anti-cancer drug toxicity assessment classification level, quality of life and Karnofasky score were separately evaluated as efficacy indicator with one week observation period. All the data were collected into a database and were analyzed by SPSS19.0statistical software.ResultsBefore the treatment, there were no significant differences in the ant i-cancer drug toxicity assessment classification level between the two gr oups (P>0.05). After the treatment, the anti-cancer drug toxicity assessment classification level increased(p<0.05, p<0.01) in two groups,but it was re latively mild in treatment group(p<0.05).The damage to the blood system a nd the gastrointestinal discomforts of chemotherapy in treatment group re duced(P<0.01, P<0.05).Before the treatment, there were no significant differences in the qua lity of life and Karnofasky score between the two groups(P>0.05). After th e treatment, the quality of life score of two groups were increased(p<0.01),the Karnofasky score were decreased(p<0.01), the quality of life score of treatment group reduced(p<0.05) compared with the control group and th e Karnofasky score of treatment group increased (p<0.05) compared with the control group.Before the treatment, there were no significant differences in the IL-2level, TNF-a level. IL-2level, lymphocyte subsets level between the two g roups (P>0.05). After the treatment, the IL-2level of treatment group incre ased (p<0.01),the TNF-a level of treatment group reduced(P<0.01), and there were no significant change(p>0.05) in the CD3-、CD4-、CD8-、CD4+、/CD8-Level of t reatment group;the IL-2level of control group increased(p<0.01), the CD3+、 CD4+、CD4+/CD8+Level of control group reduced (p<0.01) and the CD8-Level of c ontrol group increased(P<0.01), there was no significant change(p>0.05)in the TNF-a level of control group. After the treatment, the IL-2level and CD3+、CD4+、CD4+/CD8+Level of treatment group increased (P<0.01) compared with the control group and the TNF-a level and CD8+Level of treatment groupred uced(P<0.01) compared with the control group.ConclusionCombined chemotherapy of fire needle on SiHua can reduce anti-cancer drug toxicity assessment classification level;and it can reduce the damage of blood system and gastrointestinal discomfort caused by chemotherapy;and it can reduce the fall of the quality of life and physical condition by the chemotherapy;and it can increase the IL-2level, decrease the TNF-a level of the chemotherapy patients with lung cancer in a certain extent, and reduce the damage on T lymphocyte subsets by the chemotherapy. Fire needle on SiHua can reduce the adverse effects and the fall of the quality of life in patients with chemotherapy, may be related to a certain extent improve immune function in chemotherapy patients with lung cancer.更多还原