桂枝茯苓丸和参麦散加减对宫颈癌患者术后放化疗的近期疗效观察

目的：观察桂枝茯苓丸和参麦散加减对宫颈癌术后放化疗患者的近期疗效、毒副反应及患者免疫功能的影响。方法：将75例宫颈癌术后放化疗患者按就诊先后顺序分为对照组36和观察组39例。对照组采用同步放化疗，化疗方案采用紫杉醇（TAX）+顺铂（DDP）。观察组在对照组治疗的基础上加用桂枝茯苓丸和参麦散加减，1剂/d，常规水煎服，两组疗程均为12周。两组放化疗期间均可给予相应对症支持治疗。采用核磁共振成像（MRI）观察肿瘤大小、记录毒性反应，进行治疗前后生存质量（KPS）评分，检测治疗前后外周血T淋巴细胞亚群（CD₃⁺，CD₄⁺，CD₈⁺，CD₄⁺/CD₈⁺）和血清免疫球蛋白（IgG，IgA，IgM），监测外周血中性粒细胞（N）和血红蛋白（Hb）水平。结果：观察组实体瘤疗效总有效率为97.43%，对照组为86.11%，两组比较差异无统计学意义；治疗后观察组KPS评分提高+稳定率为82.05%优于对照组的58.33%（P<0.05）；治疗后对照组CD₃⁺，CD₄⁺和CD₄⁺/CD₈⁺呈下降趋势，CD₈⁺呈上升趋势；观察组CD₃⁺，CD₄⁺和CD₄⁺/CD₈⁺高于对照组，CD₈⁺低于对照组（P<0.05）；治疗后对照组IgG，IgA变化不明显，IgM较治疗前下降，观察组IgG和IgM水平高于对照组（P<0.01）；两组在放化疗后外周血中性粒细胞和血红蛋白水平均下降，观察组在放化疗后第4，8及12周外周血中性粒细胞和血红蛋白水平均高于对照组（P<0.01）；经Ridit分析观察组膀胱刺激反应程度轻于对照组（P<0.05），骨髓抑制、皮肤反应及直肠刺激反应也呈轻于对照组趋势。结论：桂枝茯苓丸和参麦散加减提高了宫颈癌术后同步放化疗患者的免疫功能，能减轻毒副反应，改善患者生活质量。

Recent Curative Effect of Guizhi Fuling Pill and Shenmai San Add and Subtract Treatment to Chemoradiotherapy after Surgery with Cervical Cancer Patients

Objective: The purpose is to observe the influence of Guizhi Fuling pill and Shenmai san and subtract treatment to chemoradiotherapy after surgery on cervical cancer on recent curative effect,toxic and side effect and immunologic function. Method: Seventy-five cases of patients with cervical cancer chemoradiotherapy treatment were divided into control group (36 cases) and observation group (39 cases). For patients in control group,they took concurrent chemoradiotherapy.Adopt taxol(TAX) and cis-platinum(DDP) as chemotherapy regimens.Based on control group,patients in observation group took Guizhi Fuling pill and Shenmai san add and subtract treatment,1 does/day with conventional water.Both treatments were 12 weeks.During chemoradiotherapy time,two groups were given corresponding support therapy.Observe the tumor size and record toxic reaction by using magnetic resonance imaging (MRI).Processing kamofsky performance status(KPS) score and detecting peripheral blood T lymphocyte subsets(CD₃⁺,CD₄⁺,CD₈⁺,CD₄⁺/CD₈⁺),serum immunoglobulin(IgG,IgA,IgM) before and after treatment.Supervise the level of polymorphonuclear neutrophil(N) and hemoglobin(Hb). Result: The total effective rate of the observation group on solid tumor was 97.43%,the control group was 86.11%,showing no statistically significant among the two groups,after treatment,the grade of KPS (increasing+stable) of the observation group was 82.05%,superior to 58.33% of the control group(P<0.05),CD₃⁺,CD₄⁺ and CD₄⁺/CD₈⁺ declining curve,CD₈⁺ was on the increase,CD₃⁺,CD₄⁺ and CD₄⁺/CD₈⁺ of the observation group were higher than the control group,CD₈⁺ was lower than the control group(P<0.05), there were no obvious changes on IgG and IgA of the control group,IgM declined when compared with that before the treatment,the levels of IgG and IgM of the observation group were higher than the control group (P<0.01). after radiotherapy and chemotherapy,the levels of peripheral blood neutrophils and hemoglobin declined among the both of two groups,and at 4,8 and 12 weeks,the levels of peripheral blood neutrophils and hemoglobin declined of the observation group were higher than the control group (P<0.01), analyzed by Ridit,the reaction degree of irritation sign bladder of the observation group was lighter than the control group(P<0.05),besides,myelosuppression,cutaneous reaction and rectal distention stimulation reaction were also lighter than the control group. Conclusion: It can improve patients immune function when Guizhi Fuling pill which combined with Shenmai powder add and subtract treatments were used in concurrent chemoradiotherapy after the cervical cancer operation,and can reduce the side effect,improve the life quality of patients,which deserves promoting in the clinical.