本文選題：張氏抗癌散　切入點：原發(fā)性彌漫性肝癌　出處：《湖北中醫(yī)藥大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:通過觀察半肝交替調(diào)強適形放療聯(lián)合中藥張氏抗癌散治療原發(fā)性彌漫性肝癌的近期療效及毒副作用,探索原發(fā)性彌漫性肝癌的有效治療方案,以期延長原發(fā)性彌漫性肝癌患者的生存期,提高生活質(zhì)量,減輕放療所致毒副反應,為中西醫(yī)結合治療原發(fā)性彌漫性肝癌探索新方式。方法:所選78例病例均來自武漢市第五醫(yī)院腫瘤二科2010年10月至2013年12月期間住院患者,所有病例均符合原發(fā)性彌漫性肝癌的診斷。78例患者隨機分為A、B兩組。A組為中藥聯(lián)合放療組,B組為單純放療組。治療方法:將兩組患者肝臟放療靶區(qū)分為左右半肝,行半肝交替調(diào)強適形放療,劑量為1.7Gy-2Gy/次,5次/周,上午先照射病灶多的一側半肝,下午照射病灶少的另外一側半肝,兩次照射至少間隔6小時以上,總劑量達到30Gy左右。A組在放療的基礎上施加中藥,于放療前一周開始服用,直至放療結束后1-3月,B組不服中藥,單純放療,兩組患者放療方法、劑量相同。治療前后對患者臨床癥狀積分、近期療效、生存率、細胞免疫功能、毒副作用等指標進行監(jiān)測,定期隨訪患者并記錄生存期,將所有數(shù)據(jù)進行統(tǒng)計學分析。結果:A、B兩組按計劃完成治療的患者例數(shù)分別是38例、37例。兩組患者治療后臨床癥狀積分評估,兩組痊愈率分別為0%(0/38)、0%(0/37),顯效率分別為13.16%(5/38)、5.41%(2/37),有效率分別為60.53%(23/38)、37.84%(14/37),無效率分別為26.32%(10/38)、56.76%(21/37),總有效率分別為73.69%(28/38)、43.24%(16/37),經(jīng)統(tǒng)計學分析,P=0.007,差別有意義。A、B兩組完全緩解(CR)率分別為0%(0/38)、0%(0/37),部分緩解(PR)率分別為7.89%(3/38)、5.41%(2/37),無變化(NC)率分別為71.05%(27/38)、72.97%(27/37),進展(PD)率分別為21.05%(8/38)、21.62%(8/37),兩組總有效率分別為78.95%(30/38)、78.38%(29/37),兩組差別比較,P=0.815,無統(tǒng)計學意義。A、B兩組治療后三月生存率分別為92.11%(35/38)、89.19%(33/37),六月生存率分別為47.37%(18/38)、40.54%(15/37),一年生存率分別為18.42%(7/38)、2.7%(1/37),兩組三月生存率、六月生存率差別比較,P分別為0.664、0.551,均無統(tǒng)計學意義;而一年生存率比較,P=0.027,差別有統(tǒng)計學意義。A、B兩組治療前CD3+、CD4+、CD8+、CD4+/CD8+水平相當,差別比較無統(tǒng)計學意義,P值分別為0.967、0.244、0.890、0.882;A、B兩組治療后CD3+、CD4+、CD4+/CD8+均較治療前升高,A組P值分別為0.000、0.000、0.000,B組P值分別為0.000、0.034、0.000;CD8+較治療前下降,A組P值為0.000,B組P值為0.000;A、B兩組治療后CD3+、CD4+、CD8+、CD4+/CD8+比較亦有統(tǒng)計學差異,P值分別為0.028、0.046、0.038、0.006。治療者中產(chǎn)生的主要毒副作用是消化道反應、放射性肝損傷及骨髓抑制,兩組I-II級消化道反應的發(fā)生率分別為34.21%(13/38)、40.54%(15/37),I-II級放射性肝損傷的發(fā)生率分別為21.05%(8/38)、43.24%(16/37),I-II度骨髓抑制的發(fā)生率分別為44.74%(17/38)、67.57%(25/37),放射性肝損傷及骨髓抑制差別比較均有統(tǒng)計學意義,P值分別是0.039、0.046;消化道反應差別比較,無統(tǒng)計學意義,P值為0.571。結論:半肝交替調(diào)強適形放療聯(lián)合中藥張氏抗癌散治療原發(fā)性彌漫性肝癌能改善肝癌患者的臨床癥狀,提高患者生活質(zhì)量和免疫力,延長生存期,減少毒副作用的發(fā)生,為中西醫(yī)結合治療原發(fā)性彌漫性肝癌提供了新的方向。
[Abstract]:Objective: To observe the curative effect of semi liver alternate intensity-modulated radiotherapy combined with traditional Chinese Medicine Zhang kangaisan treatment of primary diffuse liver cancer and side effects, to explore the effective treatment of primary diffuse hepatocellular carcinoma, in order to extend the primary diffuse liver cancer survival of patients, improve the quality of life. Reduce the adverse reactions caused by radiotherapy, combined treatment of primary diffuse hepatocellular carcinoma and explore new ways for traditional Chinese medicine and Western medicine. Methods: 78 cases were collected from the fifth hospital of Wuhan from October 2010 to December 2013 during the two tumor patients, all cases were consistent with primary diffuse liver cancer diagnosis.78 patients were randomly divided into A two, B group.A group for the traditional Chinese medicine combined with radiotherapy group, B group for the radiotherapy group. Treatment methods: two patients of liver radiotherapy is divided into left and right half liver, for semi liver alternate intensity-modulated radiotherapy, the dose was 1.7Gy-2Gy/, 5 times / week, morning One half liver lesions were the first irradiation, irradiation lesions less the other side of the afternoon half liver, two exposure interval of at least 6 hours or more, the total dose reach about 30Gy in the.A group on the basis of radiotherapy applied in traditional Chinese medicine, taking a week before radiotherapy, 1-3 months until the end of radiotherapy, group B with traditional Chinese medicine, simple radiotherapy, dose group two patients before and after treatment. The same method, the clinical symptom score, curative effect, survival rate, cell immune function and side effects were monitored, patients were followed up regularly and record the survival period, all the data were statistically analyzed. Results: A, B two group the number of cases according to the treatment plans were 38 cases, 37 cases. Evaluate the clinical symptom score of two groups of patients after treatment, recovery rate of two groups were 0% (0/38), 0% (0/37), effective rate was 13.16% (5/38), 5.41% (2/37), effective rate was 60.53% (23/38), 37.84% (14/37 no). 鏁堢巼鍒嗗埆涓，

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