养正散结汤联合放化疗治疗胃癌根治术后腹腔淋巴结转移癌临床研究

目的:探讨养正散结汤联合放化疗对胃癌根治术后腹腔淋巴结转移癌的疗效及血管内皮生长因子(VEGF)、缺氧诱导因子-1α(HIF-1α)的影响。方法:选择114例胃癌根治术后腹腔淋巴结转移癌患者,依照随机数字表法分为两组,各57例。对照组采用放化疗,观察组在对照组的基础上采用养正散结汤治疗,两组均治疗2个月。观察两组治疗前后中医临床症状评分、血清HIF-1α、VEGF水平、T淋巴细胞亚群(CD4⁺、CD8⁺)及NK细胞水平,比较两组临床疗效及治疗期间不良反应发生情况,随访1年,对比两组患者的总生存期(OS)与无进展生存期(PFS)。结果:两组治疗前血清HIF-1α、VEGF水平、NK、CD8⁺、CD4⁺水平、中医临床症状评分比较均无统计学差异(P>0.05); 两组治疗后的中医临床症状评分均低于治疗前(P<0.05),且观察组低于对照组(P<0.05); 治疗后,两组血清HIF-1α水平均升高(P<0.05),且观察组更高(P<0.05); 治疗后,两组的血清VEGF水平均比治疗前降低(P<0.05),且观察组高于对照组(P<0.05); 治疗后,对照组NK、CD4⁺、CD8⁺水平均降低(P<0.05),观察组CD8⁺水平降低(P<0.05),观察组NK、CD4⁺水平均升高(P<0.05),且观察组NK、CD4⁺、CD8⁺水平均高于对照组(P<0.05); 治疗4周后,观察组临床控制率比对照组高(P<0.05); 两组治疗期间白细胞减少、心脏毒性、神经毒性、血小板减少、脱发等Ⅲ和Ⅳ级不良反应发生率比较差异均无统计学意义(P>0.05); 观察组和对照组中位PFS分别为7.12个月和5.64个月,两组PFS曲线比较,差异有统计学意义(P<0.05); 观察组和对照组中位OS分别为8.79个月和6.24个月,两组OS曲线比较,差异有统计学意义(P<0.05)。结论:养正散结汤联合放化疗治疗胃癌根治术后腹腔淋巴结转移癌患者,疗效显著,可改善机体免疫功能及血清HIF-1α、VEGF水平,延长生存时间。

The curative effect of Yangzheng Sanjie decoction combined with radiotherapy and chemotherapy on abdominal lymph node metastasis after radical operation of gastric cancer

Objective:To explore the effect of Yangzheng Sanjie decoction combined with radiotherapy and chemotherapy on abdominal lymph node metastasis after radical gastric cancer surgery and the effect of vascular endothelial growth factor(VEGF)and hypoxia-inducible factor-1α(HIF-1α).Methods:A total of 114 patients with abdominal lymph node metastasis after radical gastric cancer surgery were selected and divided into 2 groups according to random number method,with 57 cases in each group.The control group was treated with radiotherapy and chemotherapy,and the observation group was treated with Yangzheng Sanjie decoction on the basis of the control group.Both groups were treated for 2 months.The Chinese medicine clinical symptom scores,serum HIF-1α,VEGF levels,T lymphocyte subsets(CD4⁺,CD8⁺)and NK cell levels before and after treatment in the two groups were observed.The clinical efficacy and the occurrence of adverse reactions during the treatment period of the two groups were compared.Follow-up for 1 year,the overall survival(OS)and progression-free survival(PFS)of the two groups were compared.Results:There was no significant difference in serum HIF-1α,VEGF levels,NK,CD8⁺,CD4⁺levels,and Chinese medicine clinical symptom scores between the two groups before treatment(P>0.05).The Chinese medicine clinical symptom scores of the two groups after treatment were lower than those before treatment(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,and the serum HIF-1α levels in the two groups increased(P<0.05),and the observation group was higher(P<0.05),after treatment,and the serum VEGF levels in the two groups decreased(P<0.05),and the observation group was more high(P<0.05).After treatment,the control group NK,CD4⁺,CD8⁺ levels decreased(P<0.05),and the observation group CD8⁺levels decreased(P<0.05),and the observation group NK,CD4⁺ levels increased(P<0.05),and the observation group NK,CD4⁺ and CD8⁺ levels are higher than the control group(P<0.05).After 4 weeks of treatment,the clinical control rate of the control group was lower than that of the observation group(P<0.05).During treatment,there was no significant difference in the incidence of grade Ⅲ and Ⅳ adverse reactions such as leukopenia,cardiotoxicity,neurotoxicity,thrombocytopenia,and alopecia between the two groups(P>0.05).The median PFS of the observation group and the control group were 7.12 months and 5.64 months,respectively.Comparison of PFS curves between the two groups,the difference was statistically significant(P<0.05).The median OS of the observation group and the control group were 8.79 months and 6.24 months,respectively.There was a statistically significant difference between the two groups of OS curves(P<0.05).Conclusion:The combination of Yangzheng Sanjie decoction combined with radiotherapy and chemotherapy in the treatment of patients with abdominal lymph node metastasis after radical gastric cancer has a significant effect.It can improve the body's immune function and serum HIF-1α and VEGF levels,prolong survival time,and is safe and reliable.