清热养阴消肿汤对鼻咽癌放疗所致唾液腺损伤患者唾液分泌及细胞免疫功能的影响

目的观察清热养阴消肿汤对鼻咽癌放疗所致唾液腺损伤患者唾液分泌及细胞免疫功能的影响。方法将2017年5月—2018年5月湖南中医药大学第一附属医院收治的76例鼻咽癌放疗所致唾液腺损伤患者随机分为2组,对照组38例于放疗当日给予生理盐水含漱治疗,观察组38例在对照组基础上于放疗当日另给予清热养阴消肿汤治疗,连续治疗8周,比较2组治疗后临床总有效率及卡氏评分(KPS评分)、放射性唾液腺损伤(LENT/SOMA评分)、唾液分泌功能(唾液流速、淀粉酶分泌速度)及细胞免疫功能(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、NK细胞)的改善情况,并统计2组治疗期间不良反应发生情况。结果观察组总有效率为76.3%(29/38),显著高于对照组总有效率55.3%(21/38)(P<0.05);观察组治疗后KPS评分较治疗前明显升高(P<0.05),对照组治疗后KPS评分较治疗前明显降低(P<0.05),2组治疗后LENT/SOMA评分均明显降低(P均<0.05),且观察组治疗后KPS评分和LENT/SOMA评分改善均明显优于对照组(P均<0.05);2组治疗后唾液流速和淀粉酶分泌速度均明显下降(P均<0.05),但观察组治疗后唾液流速和淀粉酶分泌速度均明显高于对照组(P均<0.05);观察组治疗后CD3^+、CD4^+、CD4^+/CD8^+、NK细胞均明显升高(P均<0.05),且均高于对照组(P均<0.05),CD8+水平降低(P<0.05),且低于对照组(P<0.05);对照组治疗前后CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、NK细胞比较差异无统计学意义(P均>0.05);2组治疗期间均未出现严重不良反应,部分患者出现血常规异常经对症治疗后均恢复正常。结论清热养阴消肿汤能够有效改善鼻咽癌患者放疗后唾液腺功能损伤,促进唾液分泌,提高机体免疫力,且不良反应较少。

Effect of Qingre Yangyin Xiaozhong decoction on salivary secretion and cellular immune function in patients with salivary gland injury induced by radiotherapy for nasopharyngeal carcinoma

Objective It is to observe the effects of Qingre Yangyin Xiaozhong decoction on salivary secretion and cellular immune function in patients with salivary gland injury induced by nasopharyngeal carcinoma radiotherapy.Methods Sixty-six patients with salivary gland injury induced by radiotherapy for nasopharyngeal carcinoma treated in the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from May 2017 to May 2018 were randomly divided into two groups:38 patients in the control group were treated with physiological saline by mouthwash on the day of radiotherapy,and 38 patients in the observation group were treated with Qingre Yangyin Xiaozhong decoction on the day of radiotherapy based on the control group.Both groups were treated for 8 weeks.The total clinical efficacy and the improvements of Kelvin score(KPS score),radiation salivary gland injury(LENT/SOMA score),salivary function(salary flow rate,amylase secretion rate)and cells immune function(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+,NK cells)after treatment were compared in the two groups,and the incidence of adverse reactions during the treatment of the two groups was counted.Results The total effective rate of the observation group was 76.3%,which was significantly higher than that 55.3%of the control group(P<0.05).The KPS score of the observation group was significantly higher and the KPS score of the control group after treatment was significantly than that before the treatment(P<0.05);the LENT/SOMA scores of the two groups were significantly reduced after treatment(P<0.05),and the improvements of KPS score and LENT/SOMA score of the observation group were significantly better than those of the control group after treatment(P<0.05);the saliva flow rate and amylase secretion rate were significantly reduced after treatment in both groups(P<0.05),but the saliva flow rate and amylase secretion rate were significantly higher in the observation group after treatment than those in the control group(P<0.05);the levels of CD3^+,CD4^+,CD4^+/CD8^+,and NK cells all were increased significantly after treatment(all P<0.05),and were higher than those in the control group(all P<0.05).CD8+level was decreased(P<0.05),and was lower than those in the control group(P<0.05);there was no significant difference in CD3^+,CD4^+,CD8^+,CD4^+/CD8^+,and NK cells before and after treatment in the control group(all P>0.05);no serious adverse reactions occurred during the treatment in the two groups,blood routine was abnormal in some patients,but the abnormalities returned to normal after symptomatic treatment.Conclusion Qingre Yangyin Xiaozhong decoction can effectively improve salivary gland function damage,promote saliva secretion,improve the body's immunity,and have fewer adverse reactions in patients with salivary gland injury induced by radiotherapy for nasopharyngeal carcinoma.