前列消癥汤联合内分泌疗法治疗D期前列腺癌的临床观察

【作者】 薄海；

【导师】 张亚强；

【作者基本信息】 北京中医药大学 ， 中医外科学， 2008， 硕士

【摘要】 目的:研究前列消癥汤对前列腺癌的治疗作用。方法:近些年来我科采取中西医结合的方法治疗前列腺癌,即在常规西药治疗同时口服前列消癥汤加减方,每剂浓煎300mL,早晚各口服150ml。前列消癥汤是刘猷枋教授应用现代医学结合中医药传统理论,根据多年临床经验总结而成,该方由生薏米,炙黄芪,黄精,白花蛇舌草,土贝母,莪术,猪苓组成,方中以生薏米健脾渗湿为君药,炙黄芪、黄精补气健脾养阴,白花蛇舌草解毒软坚为臣药,伍以莪术、土贝母、猪苓解毒散结、祛瘀止痛,如此配伍,共达补益气血、清热解毒利湿之功,体现了中医扶正祛邪的原则。实验研究已经证实生薏米中的不饱和脂肪酸有抗肿瘤作用,同时也是有效的抗肿瘤促进剂;黄芪和黄精均有免疫调节作用,能提高细胞免疫、体液免疫、补体水平,对免疫抑制有一定对抗作用;此外黄芪还有抗肿瘤作用,其有效成分黄芪多糖对淋巴细胞激活有增效作用,能增强人体外周血单个核细胞产生肿瘤坏死因子,增强LNK细胞细胞毒作用等;白花蛇舌草中的白花蛇舌草素,土贝母中的土贝母糖甙,猪苓中的猪苓酮,莪术中的萜类成分榄香烯和莪术醇均具有抗肿瘤作用。本课题选取首次发现前列腺癌患者20例,将其均衡的分为治疗组和对照组两组,治疗组采用内分泌治疗联合前列消癥汤加减方治疗,对照组单纯用内分泌治疗。治疗6个月后,通过观察两组生存质量量化评分表(欧洲肿瘤研究与治疗组织(EORTC)制定的前列腺癌患者生存质量量表),中医症状记分,血清PSA变化,并通过观察两组治疗前后的血、尿,便及肝肾功能,心电图结果来记录可能的不良反应。应用统计软件SPSS11.0,计量资料治疗前后的变化采用自身配对的t检验(正态分布时);不服从正态分布时,采用轶和检验P<0.05为差异有显著性意义,所有的统计检验均为双侧概率检验。结果:从本次研究的结果可以看出,治疗6月后患者排尿不畅,或尿频尿急,尿痛血尿,体力状况,骨痛,血清PSA均不同程度得到改善,但治疗组优于对照组。同时与对照组相比,治疗组很少出现烘热汗出,头晕,疲劳乏力、食欲不振、便秘、失眠及情绪变化。结论:前列消癥汤联合内分泌治疗可显著改善前列腺癌患者的临床症状,降低血清PSA,提高患者的生存质量。更多还原

【Abstract】 Objective: to research the therapeutic action of Qianlie Xiaozheng Tang (QXT, Decoction of Softening Hard-mass in Prostate ) on PCAMethods: During these years we treated PCA patients with the method of combining TCM and bio-medicine. That is to say, we gave patients QXT while they were recieving routine bio-medical therapy. QXT was cooked into 300ml of each dose, 150ml po M ev N. Applying the result of modern science reseach and the theory of traditional Chinese medicine, Professor Liu Youfang made up QXT with his clinical experiences over years. QXT is composed by Yimi (raw), Fhuangqi (parched), Huangjing, Sheshecao (write-flowered), Tubeimu, Ezhu, Zhuling. Yimi with the function of strengthening the spleen and eliminating damp is the monarch drug of the decoction; Huangqi and Huangjing with the function of invigorating qi, strengthening the spleen and enriching yin combinining with Sheshecao functioning of detoxication and softening hard masses is the ministerial drugs; with the help of Tubeimu, Ezhu, Zhuling, this formulae has the action of benefiting qi & blood, clearing heat, detoxicating, and eliminating damp, which shows the TCM principle ---- supporting healthy energy to eliminate evils. It has been proved in the expirical study that unsaturated fatty acid contained in Yimi has the function of anti-tumor and anti-tumor-promoter. Huangqi and Huangjing can regulate immunization; besides, Huangqi also has the function of anti-tumor.Oldenlandin in Sheshecao,bolbostemmae,rhizoma Glycoside in Tubeimu, Polyporus ketone in Zhuling,and Terpene of elemene & curcumenol in Ezhu all have the function of anti-tumor.20 consecutive patients were included in our study who were first-time diagnosed as PCA on State-D and put into two groups in equilibration: the therapeutic group and the control group. Patients in the therapeutic group accepted the hormonal therapy combined with QXT, while in the control group patients received the hormonal therapy singly. After 6-month treatments, through observation on EORTC QLQ of two groups, scoring of TCM symptoms, changing of serum PsA, blood, excrement and urine routine before and after the treatments, hepar & renal function, and ECG we evaluated the therapeutic effect and recorded the possible untoward effects, and analyzed the data with the statistic software SPSS11.0. Results: After 6-month treatments, the clinical symptoms and signs (unsmooth urination, frequent & urgent maturation, physical strength, etc.), and the status of serum PsA are all improved on different levels, the therapeutic group being improved better than the control group. At the same time, comparing with ones in the control group, patients in the therapeutic group are less getting tidal fever, sweating, dizziness, acratia, poor appetite, constipation, insomnia, and mood change.Conclusions: QXT significantly improved the clinical symptoms and sighs of the Stage-D PCA patients who are receiving the hormonal therapy, decreased the serum PsA, and raised the level of QoL (Quality of Life).更多还原