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目的:探讨中医综合疗法辅助经肝动脉化疗灌注栓塞(TACE)术治疗中晚期原发性肝癌的近期疗效及对患者生活质量、免疫功能及转移等方面的影响。方法:83例患者根据不同的治疗方式分为对照组40例和观察组43例。对照组采用TACE术(使用药物包括吡柔比星、氟尿嘧啶、丝裂霉素及超液化碘化油),4周重复1次,共治疗2次,术后给予护肝、护胃等对症支持治疗。观察组在对照组治疗基础上加用①榄香烯注射液,0.4~0.6 g/次,静脉滴注,连续使用3周,停药1周后再注射3周;②参麦注射液,60 mL/次,静脉滴注,每次TACE术后连续使用2周;③解毒消癌方:1剂/d,常规水煎分2~3次服用。两组疗程均为8周。采用CT或核磁共振成像(MRI)观察治疗前后实体瘤大小;采用欧洲癌症研究和治疗组织生命质量核心量表(EORTCQLQ-C30)进行治疗前后评分;采用流式细胞仪法检测治疗前后外周血T淋巴细胞亚群(CD3+,CD4+,CD4+/CD8+)和自然杀伤细胞(NK)水平;检测治疗前后血管内皮生长因子(VEGF)、细胞间黏附分子-1(ICAM-1)和血甲胎蛋白(AFP)水平。结果:对照组实体瘤疗效有效率为77.5%,观察组为93%,观察组优于对照组(P<0.05);治疗后对照组T淋巴细胞亚群(CD3+,CD4+,CD4+/CD8+)和NK细胞水平均呈下降趋势;观察组T淋巴细胞亚群和NK细胞水平较治疗前上升(P<0.05或P<0.01),治疗后观察组CD3+,CD4+,CD4+/CD8+和NK水平均高于对照组(P<0.01);治疗后观察组认知功能外的其他功能维度评分均较治疗前上升(P<0.01),并高于对照组(P<0.05或P<0.01);治疗后观察组在疲倦、疼痛、恶心与呕吐、失眠、食欲丧失等维度评分方面低于对照组(P<0.01);观察组治疗后AFP,ICAM-1和VEGV水平均低于对照组(P<0.01)。结论:采用榄香烯注射液、参脉注射液静脉滴注及解毒消癌方口服配合TACE治疗中晚期原发性肝癌起到了增效作用,并能提高患者生活质量和免疫功能,减轻患者病情,对肿瘤的转移可能具有一定的抑制作用。
Objective: To investigate the short-term curative effect of traditional Chinese medicine combined with transcatheter arterial chemoembolization (TACE) on advanced primary liver cancer and its influence on quality of life, immune function and metastasis of patients. Methods: According to different treatment methods, 83 patients were divided into control group (40 cases) and observation group (43 cases). The control group was treated with TACE (using drugs including pirarubicin, fluorouracil, mitomycin and ultra-liquefied iodized oil), repeated once every 4 weeks for 2 times and given symptomatic supportive care treatment. The observation group was treated with elemene (0.4 ~ 0.6 g / time) by intravenous infusion for 3 weeks, and then for 3 weeks after stopping for 1 week; ②Shenmai injection 60 mL / time, intravenous infusion, continuous use of TACE for 2 weeks each; ③ detoxification Xiao Fang: 1 / d, conventional decoction points 2 or 3 times. The two groups were treated for 8 weeks. The size of the solid tumor before and after treatment was observed by CT or MRI. The score of EORTCQLQ-C30 before and after treatment was scored by using the European Agency for Research on Cancer and the quality of life of the treated tissue. The levels of T (CD3 +, CD4 +, CD4 + / CD8 +) and natural killer (NK) were measured before and after treatment. The levels of vascular endothelial growth factor (VEGF), intercellular adhesion molecule- 1 (ICAM- 1) and alpha-fetoprotein AFP) level. Results: The effective rate of solid tumor in control group was 77.5% and that in observation group was 93%, the observation group was better than the control group (P <0.05). After treatment, T lymphocyte subsets (CD3 +, CD4 +, CD4 + / CD8 + (P <0.05 or P <0.01). After treatment, the levels of CD3 +, CD4 +, CD4 + / CD8 + and NK in the observation group were all higher than those in the observation group (P <0.01). After treatment, the scores of other functional dimensions in the observation group were higher than those before treatment (P <0.01), and higher than those in the control group (P <0.05 or P <0.01). After treatment, The scores of AFP, ICAM-1 and VEGV in the observation group were lower than those in the control group (P <0.01). The scores of fatigue, pain, nausea and vomiting, insomnia and loss of appetite were lower than those of the control group . Conclusion: The use of elemene injection, intravenous infusion of Shenmai injection and detoxification Xiaojialifang with TACE in the treatment of advanced primary liver cancer has synergistic effect, and can improve patients quality of life and immune function, reduce the patient's condition , May have some inhibitory effect on tumor metastasis.