本文選題：原發(fā)性肝癌 + 養(yǎng)陰補(bǔ)肝湯��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察并對比養(yǎng)陰補(bǔ)肝湯聯(lián)合TACE與單純TACE治療肝腎陰虛型原發(fā)性肝癌的臨床療效,評價臨床受益及毒副反應(yīng),從而為養(yǎng)陰補(bǔ)肝湯在肝癌綜合治療中的應(yīng)用提供指導(dǎo)意義,為臨床肝癌的辨證論治提供新的思路。方法:選擇2014年12月至2015年12月在石家莊市第五醫(yī)院住院的80例肝腎陰虛型原發(fā)性肝癌患者。80例原發(fā)性肝癌患者均符合衛(wèi)生部制定的原發(fā)性肝癌診療規(guī)范(2011年版)的診斷標(biāo)準(zhǔn),隨機(jī)分為兩組:對照組40例、綜合治療組40例。對照組給予常規(guī)介入治療,介入術(shù)后常規(guī)西醫(yī)基礎(chǔ)治療。綜合治療組在對照組治療方案基礎(chǔ)上于TACE術(shù)后第3天開始服養(yǎng)陰補(bǔ)肝湯,每日1劑,分兩次口服。兩組患者均連續(xù)治療4周為1個療程,1個療程后作療效判定。觀察兩組患者治療前后行為狀態(tài)Karnofsky評分變化、實(shí)體瘤大小及TACE后毒副反應(yīng)(惡心嘔吐、脅痛、發(fā)熱、肝損傷等)發(fā)生情況,比較兩組臨床獲益情況。TACE前3天、TACE后1周分別查肝功能觀察肝損傷情況,治療結(jié)束后復(fù)查肝功能了解肝損傷情況;治療前行CT或MRI評價腫瘤大小,治療結(jié)束后行CT或MRI評價腫瘤大小。實(shí)驗結(jié)果以x±s表示,用SPSS 13.0統(tǒng)計軟件作單因素方差分析(One-Way ANOVA),取P0.05為有顯著性意義。結(jié)果:綜合治療組與對照組80例患者,均完成4周治療,可評價療效及毒副反應(yīng)。(1)實(shí)體瘤療效:按照WHO實(shí)體瘤療效評價標(biāo)準(zhǔn),綜合治療組40例:完全緩解(CR):9例,部分緩解(PR):11例,穩(wěn)定(SD):11例,進(jìn)展(PD):9例,控制率:76%。對照組40例:完全緩解(CR):5例,部分緩解(PR):5例,穩(wěn)定(SD):16例,進(jìn)展(PD):14例,控制率:68%。兩組控制率比較差異無統(tǒng)計學(xué)意義(P0.05)。(2)生活治療改善情況:兩組均治療4周后評價生活質(zhì)量改善情況,根據(jù)國家中醫(yī)藥管理局頒布的《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》,治療組40例:改善25例,穩(wěn)定7例,惡化8例,有效率80.0%;對照組40例:改善10例,穩(wěn)定11例,惡化19例,有效率52.5%。兩組有效率比較差異無統(tǒng)計學(xué)意義(P0.05)。(3)毒副反應(yīng):采用WHO制定的抗腫瘤藥物毒副反應(yīng)分度標(biāo)準(zhǔn),分為0-Ⅳ度。主要包括肝損害、骨髓抑制(WBC、HBC、PLT)、惡心嘔吐、發(fā)熱。其中肝損害及惡心嘔吐IV度不良反應(yīng)在治療后未見發(fā)生,綜合治療組上述不良反應(yīng)發(fā)生率分別為45.0%、25.0%、45.0%、52.5%,對照組上述不良反應(yīng)發(fā)生率分別為50.0%、50.0%、75.0%、60.0%。兩組肝損害及發(fā)熱的發(fā)生率比較差異無統(tǒng)計學(xué)意義(P0.05);骨髓抑制及惡心嘔吐的發(fā)生率比較,綜合治療組發(fā)生率低于對照組,且差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:養(yǎng)陰補(bǔ)肝湯治療肝腎陰虛型原發(fā)性肝癌具有顯著的臨床療效,且在藥物毒副反應(yīng),尤其是減輕TACE后骨髓抑制及惡心嘔吐的發(fā)生上有較明顯療效,且由于其藥物組成簡單,藥味少,價格低廉,臨床療效肯定等原因,更值得進(jìn)一步研究及推廣。
[Abstract]:Objective: to observe and compare the clinical efficacy of Yangyin Bugan decoction combined with TACE and TACE in the treatment of liver and kidney yin deficiency primary liver cancer, and to evaluate the clinical benefits and side effects, so as to provide guidance for the application of Yangyin Bugan decoction in the comprehensive treatment of liver cancer. To provide a new way for clinical liver cancer treatment based on syndrome differentiation. Methods: from December 2014 to December 2015, 80 patients with primary liver cancer with liver and kidney yin deficiency were selected from the Fifth Hospital of Shijiazhuang. All of them were in accordance with the diagnostic criteria of the criteria for diagnosis and treatment of primary liver cancer (2011 edition) formulated by the Ministry of Health. They were randomly divided into two groups: control group (n = 40) and comprehensive treatment group (n = 40). The control group was treated with routine interventional therapy and basic western medicine after interventional operation. Combined treatment group on the basis of the control group on the third day after TACE began to take Yangyin Bugan decoction, 1 dose per day, divided into two oral. The patients in both groups were treated continuously for 4 weeks as a course of treatment, and the curative effect was evaluated after one course of treatment. The changes of Karnofsky score, size of solid tumor and side effects (nausea and vomiting, hypochondriac pain, fever, liver injury, etc.) were observed before and after treatment in the two groups. The clinical benefit of the two groups was compared. 1 week before TACE, 1 week after TACE, the liver function was examined to observe the liver injury, and the liver function was reviewed to understand the liver injury after the treatment, and the tumor size was evaluated by CT or MRI before treatment. Tumor size was evaluated by CT or MRI after treatment. The results were expressed as x 鹵s, and One-way ANOVAV was analyzed by SPSS 13.0 statistical software. Results: 80 patients in the combined treatment group and the control group were treated for 4 weeks, which could be used to evaluate the efficacy and toxicity of solid tumor. According to the evaluation standard of WHO solid tumor efficacy, 40 cases in the combined treatment group were as follows: 9 cases of complete remission, 11 cases of partial remission of WHO. There were 11 cases of SDU: 1, 9 cases of PDW, and 76% of control rate. In the control group, there were 5 cases of complete remission, 5 cases of partial remission, 16 cases of stabilization, 14 cases of progress and 14 cases of control. There was no significant difference in the control rate between the two groups (P 0.05). The improvement of life therapy was evaluated after 4 weeks of treatment in both groups, and the improvement of quality of life was evaluated after 4 weeks of treatment in both groups. According to the criteria for the diagnosis and treatment of TCM diseases and syndromes issued by the State Administration of traditional Chinese Medicine, the treatment group (40 cases) showed improvement in 25 cases, stable in 7 cases, deterioration in 8 cases, and effective rate in 80.0.The control group (40 cases) improved 10 cases, stabilized 11 cases, deteriorated 19 cases, and the effective rate was 52.5%. There was no significant difference in the effective rate between the two groups (P 0.05). The side effects were classified into 0-鈪，

本文編號：1796564