益气健脾方辅助FOLFOX4化疗方案治疗胃癌术后脾胃虚弱证临床研究

目的探讨益气健脾方辅助FOLFOX4化疗方案治疗胃癌术后脾胃虚弱证患者的应用价值,观察其对肿瘤标志物、血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)及营养指标的影响。方法采用随机数字表法将92例胃癌术后脾胃虚弱证患者分为对照组和观察组各46例。对照组采用FOLFOX4化疗方案,21 d为1个化疗周期,观察组在对照组基础上予益气健脾方,于化疗周期首日开始连续口服2周。2组均治疗4个化疗周期。观察2组治疗前后乏力、胃纳差、便溏评分情况,比较2组治疗前后癌胚抗原(CEA)、糖类抗原(CA)199、MMP-9、VEGF、胃泌素、血红蛋白(HGB)、总蛋白、前白蛋白(PA)水平,观察2组治疗后1、2年总生存率、转移率及复发率。结果与本组治疗前比较,2组治疗后CEA、CA199、MMP-9、VEGF水平明显降低,胃泌素、HGB、总蛋白、PA水平明显升高(P<0.05);2组治疗后比较,观察组CEA、CA199、MMP-9、VEGF水平明显低于对照组,胃泌素、HGB、总蛋白、PA水平明显高于对照组(P<0.05)。与本组治疗前比较,2组治疗后乏力、胃纳差、便溏评分明显降低(P<0.05);2组治疗后比较,观察组上述中医症状评分明显低于对照组(P<0.05)。治疗后2年观察组总生存率优于对照组,转移率及复发率低于对照组(P<0.05);观察组骨髓抑制、胃肠道不适、外周神经毒性、肝功能损伤、肾功能损伤等Ⅲ~Ⅳ级化疗不良反应总发生率低于对照组(P<0.05)。结论在FOLFOX4化疗方案基础上辅以益气健脾方对于胃癌术后脾胃虚弱证患者有重要意义,可抑制新生血管再生,改善营养状态,预防化疗不良反应。

Clinical Study on Yiqi Jianpi Prescription Combined with FOLFOX4 Regimen in Treatment of Postoperative Patients with Gastric Cancer of Spleen-stomach Deficiency Type

Objective To investigate the application value of Yiqi Jianpi Prescription combined with FOLFOX4 regimen in postoperative patients with gastric cancer(spleen-stomach deficiency type);To observe its effects on vascular endothelial growth factor(VEGF), matrix metalloproteinase-9(MMP-9), and nutritional status indicators. Methods Random number table method was used to divide 92 cases of postoperative gastric cancer patients with spleen-stomach deficiency type into control group and observation group, with 46 cases in each group. The control group received FOLFOX4 regimen chemotherapy for 21 days as a chemotherapy cycle. The observation group was given Yiqi Jianpi Prescription on the basis of the control group and started oral administration for 2 weeks on the first day of the chemotherapy cycle. Both groups were treated for 4 cycles of chemotherapy. Fatigue, gastric appetite, and stool scores of the two groups before and after treatment were observed, and the carcinoembryonic antigen(CEA), sugar antigen(CA) 199, MMP-9, VEGF, gastrin, hemoglobin(HGB), total protein, and prealbumin(PA) levels were compared. The overall survival rate, metastasis rate, and relapse rate of the two groups 1 and 2 years after treatment were observed. Results Compared with before treatment, the levels of CEA, CA199, MMP-9, and VEGF were significantly reduced, and the levels of gastrin, HGB, total protein, and PA significantly increased after treatment in the two groups(P<0.05);After treatment, the levels of CEA, CA199, MMP-9, and VEGF in the observation group were significantly lower than those in the control group, and the levels of gastrin, HGB, total protein, and PA were significantly higher than those in the control group(P<0.05). Compared with before treatment, fatigue, gastric appetite, and stool scores were significantly reduced in the two groups after treatment(P<0.05);After treatment, the TCM symptom scores in the observation group were significantly lower than those in the control group(P<0.05). After 2 years of treatment, the overall survival rate of the observation group was better than that of the control group, and the rate of metastasis and recurrence was lower than that of the control group(P<0.05). The overall incidence of chemotherapy adverse reactions of grade Ⅲ~Ⅳ including myelosuppression, gastrointestinal discomfort, peripheral neurotoxicity, liver dysfunction and kidney dysfunction was lower than that of the control group(P<0.05). Conclusion It is of great significance for postoperative patients with gastric cancer(spleen-stomach deficiency type) to combine Yiqi Jianpi Prescription with FOLFOX4 regimen due to the capability to inhibit neovascularization, improve nutritional status, and prevent the adverse reactions of chemotherapy.