本文關(guān)鍵詞： 加味六味地黃湯 惡性腫瘤 化療 血小板減少癥 臨床療效　出處：《成都中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的：臨床中腫瘤化療所致的血小板減少癥(CIT)是癌癥患者常見的問題。目前尚未有相關(guān)的指南指導(dǎo)這部分患者的治療。血小板減少除了出血風(fēng)險(xiǎn),也會限制腫瘤患者治療的化療劑量和化療頻率。故本研究在導(dǎo)師李世杰教授治療CIT的臨床經(jīng)驗(yàn)基礎(chǔ)上,以腫瘤化療后血小板計(jì)數(shù)100x 109／L為研究對象,觀察“加味六味地黃湯”治療CIT的臨床療效及安全性,為臨床應(yīng)用提供一定的依據(jù)。研究方法：將來源于成都中醫(yī)藥大學(xué)附屬醫(yī)院腫瘤科住院的90例符合本試驗(yàn)納入標(biāo)準(zhǔn)的患者,按就診先后順序,隨機(jī)分入治療組和對照組,每組各45例,兩組基線無顯著差異,具有可比性。治療組采用加味六味地黃湯免煎顆粒,對照組采用利可君片,療程均為21天,觀察患者用藥后第4天、第7天、第10天、第14天、第21天的血小板計(jì)數(shù)變化,對比兩組患者治療前后KPS評分、中醫(yī)證候積分改變情況,評估治療后心、肝、腎功能和不良反應(yīng),以評價(jià)“加味六味地黃湯”的療效及安全性。研究結(jié)果：(1)治療后在提高血小板計(jì)數(shù)水平、縮短血小板減少的持續(xù)時(shí)間、加快血小板的恢復(fù)、預(yù)防CIT的復(fù)發(fā)、減少血小板的輸注、增加KPS評分和改善中醫(yī)證候等方面治療組均優(yōu)于對照組,差別具有統(tǒng)計(jì)學(xué)意義(P均0.05)。(2)治療組出現(xiàn)6例不良反應(yīng),均為Ⅰ級,可自行緩解,對試驗(yàn)結(jié)果無直接影響；兩組患者均未見明顯心、肝、腎功能方面的毒副作用。研究結(jié)論：加味六味地黃湯可提高CIT患者的血小板計(jì)數(shù)水平,縮短血小板減少的持續(xù)時(shí)間、加快血小板的恢復(fù),減少出血及出血風(fēng)險(xiǎn)、預(yù)防CIT的復(fù)發(fā)。同時(shí)可改善患者的中醫(yī)證候和增加KPS評分,以減輕患者的痛苦,提高患者的生活質(zhì)量。且價(jià)格適宜,能減少化療患者的經(jīng)濟(jì)負(fù)擔(dān),具有安全性,可廣泛應(yīng)用于臨床。但本研究觀察時(shí)間較短,需延長觀察時(shí)間和排除干擾因素,以期對加味六味地黃湯的遠(yuǎn)期療效及安全性做出更精準(zhǔn)的評價(jià)。
[Abstract]:Objective: To study the clinical chemotherapy induced thrombocytopenia (CIT) is a common problem in cancer patients. There have been no guidelines to guide the treatment of these patients. In addition to thrombocytopenia and bleeding risk, will also limit the treatment of patients with cancer chemotherapy and chemotherapy dose frequency. So this study the clinic experience of Professor Li Shijie the treatment of CIT, the platelet count after chemotherapy 100x 109 / L as the research object, observe the clinical effect and safety of modified six Dihuang Decoction "in the treatment of CIT, and provide a basis for clinical application. Methods: the future research in oncology Affiliated Hospital of Chengdu University of Traditional Chinese Medicine hospital 90 patients met the inclusion criteria of this patients, according to the visiting sequence, were randomly divided into treatment group and control group, 45 cases in each group, there was no significant difference between the two groups at baseline and comparable treatment group with modified. Six Ingredient Rehmannia Decoction granules, the control group using Leucogen Tablets, lasted for 21 days, fourth days, observe patients after seventh days, tenth days, fourteenth days, twenty-first days, the changes of the platelet count, KPS score before and after treatment were compared between two groups, TCM syndrome score changes after treatment, assessment of heart, liver the renal function, and adverse reactions, to evaluate the efficacy and safety of modified Rehmanniae Decoction of six ingredients ". Results: (1) after treatment in improving the level of platelet count, shorten the duration of thrombocytopenia, accelerate the platelet recovery, prevent the recurrence of CIT, reduce platelet transfusion, increase KPS score and improve TCM syndrome and other aspects of the treatment group were better than the control group, the difference was statistically significant (P < 0.05). (2) 6 cases had adverse reactions in treatment group, were grade I, relieve itself, has no direct impact on the test results; two groups of patients were no obvious heart, liver, kidney The function of the side effects. Conclusion: modified Rehmanniae Decoction of six ingredients can improve the level of platelet count in patients with CIT, reduce the duration of thrombocytopenia, accelerate platelet recovery, reduce bleeding and bleeding risk, prevention of recurrence of CIT. At the same time can improve the TCM syndrome and the KPS score increased, in order to reduce patient the pain, improve the quality of life of patients. And the price is appropriate, can reduce the economic burden of the patients with chemotherapy, safety, can be widely used in clinic. But the shorter observation time, longer observation time and eliminate interference factors, make the evaluation more accurate long-term efficacy and safety of modified Rehmanniae Decoction of six ingredients in order.

【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R273

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