【摘要】：目的:觀察清熱解毒益氣養(yǎng)陰法防治鼻咽癌放療近期副反應(yīng)的臨床療效,對(duì)比治療組與觀察組的相關(guān)數(shù)據(jù),評(píng)估清熱解毒益氣養(yǎng)陰法在防治鼻咽癌放療近期副反應(yīng)方面的臨床價(jià)值。方法:采用隨機(jī)對(duì)照臨床研究的方法,納入50例初次放射治療的鼻咽癌患者,隨機(jī)分為治療組和對(duì)照組,每組分別為25例,治療組放療期間加用清熱解毒益氣養(yǎng)陰中藥治療。比較兩組在KPS評(píng)分、急性放射性口咽粘膜損傷分級(jí)及出現(xiàn)時(shí)間、急性放射性皮膚反應(yīng)分級(jí)及出現(xiàn)時(shí)間、急性放射性唾液腺損傷分級(jí)、放療后生存質(zhì)量方面的差異,并評(píng)價(jià)試驗(yàn)藥物相關(guān)不良反應(yīng)。結(jié)果:在急性放射性口咽粘膜損傷分級(jí)及出現(xiàn)時(shí)間方面,治療組出現(xiàn)1級(jí)與2級(jí)急性口咽粘膜反應(yīng)的時(shí)間與對(duì)照組相比較,差別不具有統(tǒng)計(jì)學(xué)意義(P0.05);治療組在3級(jí)急性口咽粘膜反應(yīng)發(fā)生率上明顯低于對(duì)照組,差別具有統(tǒng)計(jì)學(xué)意義(P0.05);提示在減少嚴(yán)重急性放射性口咽粘膜反應(yīng)方面,治療組具有明顯優(yōu)勢(shì)。在急性放射性皮膚反應(yīng)分級(jí)及出現(xiàn)時(shí)間方面,治療組出現(xiàn)1級(jí)急性放射性皮膚反應(yīng)的平均時(shí)間比對(duì)照組晚,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);在發(fā)生2級(jí)急性放射性皮膚反應(yīng)發(fā)生率方面,治療組比觀察組低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);治療組出現(xiàn)3級(jí)急性放射性皮膚反應(yīng)發(fā)生率與對(duì)照組相比較,差別無統(tǒng)計(jì)學(xué)意義(P0.05)。在急性放射性唾液腺損傷程度方面,入組患者唾液腺損傷均集中在1-3級(jí)。治療組與對(duì)照組在不同程度放射性唾液腺損傷程度發(fā)生率方面,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);在3級(jí)唾液腺損傷中治療組發(fā)生率為0%,對(duì)照組發(fā)生率為12%,說明治療組可以減少嚴(yán)重層級(jí)的唾液腺損傷發(fā)生率。在放療后生存質(zhì)量比較方面,放療后兩組間患者均有不同程度的咽痛、口干、痰多表現(xiàn)。其中兩組患者在咽痛、口干、疲勞、痰多程度方面,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),治療組上述癥狀的嚴(yán)重程度低于對(duì)照組;兩組患者在失眠程度方面,差異不具有統(tǒng)計(jì)學(xué)意義(P0.05)。在KPS評(píng)分方面,我們分別在放射治療前及治療后進(jìn)行組內(nèi)比較,結(jié)果差異無統(tǒng)計(jì)學(xué)意義(P0.05);說明兩組KPS基線平衡性良好,清熱解毒益氣養(yǎng)陰法在保持鼻咽癌放療后患者行為體力狀態(tài)方面未見顯著療效。在不良反應(yīng)方面,兩組血液系統(tǒng)、肝腎功能不良反應(yīng)比較,兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。說明治療組所使用中藥患者耐受性良好。結(jié)論:清熱解毒益氣養(yǎng)陰法可以減少嚴(yán)重程度的急性放射性口咽粘膜反應(yīng)、減少急性放射性皮膚反應(yīng)、減少嚴(yán)重層級(jí)的唾液腺損傷發(fā)生率,提高患者在放療后生存質(zhì)量,試驗(yàn)藥物耐受性良好。
[Abstract]:Objective: to observe the clinical effect of clearing heat and detoxifying qi and nourishing yin on the side effects of radiotherapy for nasopharyngeal carcinoma (NPC), and to compare the relative data between the treatment group and the observation group. To evaluate the clinical value of clearing heat and detoxifying qi and nourishing yin in the prevention and treatment of side effects of radiotherapy for nasopharyngeal carcinoma (NPC). Methods: 50 patients with nasopharyngeal carcinoma were randomly divided into treatment group (n = 25) and control group (n = 25). The difference between the two groups in KPS score, grade and time of acute radiation oropharyngeal mucosal injury, grade and time of acute radiation skin reaction, grade of acute radioactive salivary gland injury, quality of life after radiotherapy were compared between the two groups. Drug-related adverse reactions were evaluated. Results: in the grade and time of acute radiation oropharyngeal mucosal injury, the time of acute oropharyngeal mucosal reaction in the treatment group was higher than that in the control group. The difference was not statistically significant (P0.05); the incidence of acute oropharyngeal mucosal reaction in the treatment group was significantly lower than that in the control group (P0.05). The treatment group had obvious advantages. The average time of acute radiation skin reaction in the treatment group was later than that in the control group, the difference was statistically significant (P0.05), and the incidence of acute radiation skin reaction in the treatment group was higher than that in the control group (P0.05). The treatment group was lower than the observation group, the difference was statistically significant (P0.05); the treatment group had 3 grade acute radiation skin reaction rate compared with the control group, the difference was not statistically significant (P0.05). In acute radiation-induced salivary gland injury, the salivary gland injury was mainly in grade 1-3. The incidence of different degrees of radioactive salivary gland injury in the treatment group and the control group, The difference was statistically significant (P0.05); the incidence of salivary gland injury in the treatment group was 0, and that in the control group was 12, indicating that the treatment group can reduce the incidence of serious level of salivary gland injury. In the aspect of quality of life after radiotherapy, there were different degrees of pharynx, dry mouth and sputum between the two groups. Two groups of patients in pharynx, dry mouth, fatigue, sputum, the difference was statistically significant (P0.05), the treatment group in the severity of the symptoms compared with the control group; the two groups of patients in the degree of insomnia, the difference was not statistically significant (P0.05). In terms of KPS score, we compared the results before and after radiotherapy, the results were not statistically significant (P0.05), indicating that the KPS baseline balance between the two groups is good, The method of clearing away heat and detoxifying qi and nourishing yin has no significant effect on maintaining the behavioral physical state of patients with nasopharyngeal carcinoma after radiotherapy. In the side of adverse reactions, the two groups of blood system, liver and kidney function adverse reactions, there was no significant difference between the two groups (P0.05). The results showed that the patients in the treatment group had good tolerance. Conclusion: the method of clearing heat, detoxifying and supplementing qi and nourishing yin can reduce acute radiation oropharyngeal mucosal reaction, reduce acute radiation skin reaction, reduce the incidence of serious salivary gland injury, and improve the quality of life of patients after radiotherapy. The drug tolerance is good.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.63

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