基于“痰毒”理论探讨化痰解毒法对中晚期非小细胞肺癌患者带瘤生存的临床意义

目的 探讨化痰解毒法对气虚痰毒型和阴虚痰毒型中晚期非小细胞肺癌(NSCLC)患者近期疗效和远期带瘤生存的影响。 方法 选择2015年8月—2016年7月期间在台州市第一人民医院呼吸内科就诊的207例中晚期NSCLC患者，其中气虚痰毒型116例，阴虚痰毒型91例。80例患者仅采用西医化疗作为对照组，127例患者在此基础上给予益气化痰解毒汤(气虚痰毒型)和养阴散结方(阴虚痰毒型)作为治疗组。治疗4个疗程后，评估近期疗效、中医症状积分、Karnofsky评分，并进行Kaplan-Meier生存分析。 结果 对照组(45.00%)和治疗组(51.97%)患者总有效率比较差异无统计学意义(χ2=0.954,P=0.329)。治疗组气虚痰毒型患者和阴虚痰毒型患者中医症状总改善率分别为89.55%、83.33%，均高于对照组(均P<0.05)。治疗组患者中医证候积分和Karnofsky评分逐渐降低，低于治疗前和对照组(均P<0.05)。治疗组气虚痰毒型患者生存率(OS)为49.25%，高于对照组(均P<0.05)；而治疗组阴虚痰毒型患者OS为61.67%，与对照组相比差异无统计学意义(P=0.080)。 结论 基于“痰毒”理论辨证论治“气虚痰毒型”和“阴虚痰毒型”中晚期NSCLC患者，可显著改善临床证候，提高患者生活质量，尤其是益气化痰解毒汤可延长气虚痰毒型患者带瘤生存期。 

Clinical significance of phlegm detoxification on survival with tumor in advanced NSCLC patients based on the phlegm-poison theory

Objective To explore the effect of phlegm detoxification on the short-term curative and long-term survival with tumor in qi phlegm-poison type or yin phlegm-poison type patients with advanced non-small cell lung cancer (NSCLC). Methods From August 2015 to July 2016, 207 advanced NSCLC patients, including 116 patients with qi phlegm-poison type and 91 patients with yin phlegm-poison type, were collected and divided into control group with western medicine treatment (n=80) and treatment group (n=127) with Yiqi Huatan Jiedu Decoction (for qi phlegm-poison type) or Yangyin Sanjie Decoction (for yin phlegm-poison type). After 4 courses of treatment, the short-time efficacy, TCM syndrome scores, Karnofsky scores were evaluated. The Kaplan-Meier curve were performed. Results There was no significant difference in the total effective rate between the control group (45.00%) and the treatment group (51.97%, χ2=0.954, P=0.329). The response rates of patients in treatment group with qi phlegm-poison party or yin phlegm-poison party were 89.55% and 83.33%, respectively, higher than that of control group (P<0.05). The TCM syndrome score and Karnofsky score were gradually decreased, and lower than before treatment and control group (all P<0.05). The survival rate (OS) of patients in treatment group with qi phlegm-poison type were 49.25%, higher than that in control group (all P<0.05), while the OS of patients in treatment group with yin phlegm-poison type were 61.67%, there was no difference with control group (P=0.080). Conclusion Based on the phlegm-poison theory, phlegm detoxification would improve TCM syndrome and promote the life quality of NSCLC patients with qi phlegm-poison type and yin phlegm-poison type. Meanwhile, Yiqi phlegm jiedu decoction can prolong the survival with tumor of patients of qi phlegm-poison type.