中药加味一贯煎提高原发性肝癌晚期患者生存率的临床研究

目的:探讨中药加味一贯煎在提高晚期肝癌患者生存期及改善生活质量方面的疗效.方法:将复旦大学附属中山医院的原发性肝癌患者100例(男性84例,女性16例)随机分成中药组和对照组,2组均进行常规保肝及对症治疗,中药组加用加味一贯煎,比较2组患者的半年生存率、中位生存期、生活质量评分(Karnofsky)、体力状况美国东部肿瘤协作组(ECOG)评分、中医症候评分.结果:(1)中药组半年生存率为35.80％,中位生存期为114 d；对照组半年生存率为21.21％,中位生存期为71 d,中药组的生存时间显著长于对照组(P=0.041).(2)2组中医症状评分、生活质量评分(Karnofsky标准)、体力状况ECOG评分比较,差异均有统计学意义,中药组在改善症状、提高生活质量、改善体力方面优于对照组.晚期原发性肝癌患者病死危险性与ECOG评分和Child-Pugh分期密切相关.ECOG评分越高,病死的危险越大,即ECOG每增加一个单位,相应病死的危险性增加1.8倍；Child-Pugh评分越高,病死的危险越大,即Child-Pugh每增加一个单位,相应病死的危险性增加1.24倍.结论:加味一贯煎能显著提高晚期原发性肝癌患者半年生存率和中位生存期,改善晚期原发性肝癌患者生活质量和体力状况,降低中医症候评分.

Clinical Study on Jiawei Yiguanjian for Improvement of the Survival Rate in Advanced Hepatocellular Carcinoma Patients

Objective：To evaluate the effect of Jiawei Yiguanjian on improving survival time and life quality in advanced hepatocellular carcinoma（HCC） patients.Methods：A total of 100 patients（males 84,females 16） with advanced HCC of Zhongshan Hospital,Fudan university were randomized into two groups：The TCM therapy group and the control group.The control group received ordinary therapy while the treatment group received extra Jiawei Yiguanjian.The half-year survival rate,median survival time,quality of life score（Karnofsky）,score of Eastern Cooperative Oncology Group（ECOG） and score of traditionnal Chinese medical syndrome were compared between the two groups.Results：The half year survival rate with TCM therapy was 35.80%and the median survival time was 114 days,and 21.21%,71days of the control group respectively.The difference was significant between the two groups（P〈0.05）.There were much apparent differences in score of traditionnal Chinese medical syndrome,quality of life score（Karnofsky） and score of ECOG（P〈0.05）.The TCM therapy group was better than control group at improving symptom,life quality and physical strength.Meanwhile,the mortality risk of advanced HCC patients was related to ECOG score and Child-Pugh score.The mortality increased significantly with the rise of the ECOG score and Child-Pugh score,the mortality rate increased 1.8 times by adding one ECOG score and 1.24 times by adding one Child-Pugh score. Conclusions：Using Jiawei Yiguanjian can increase the half-year survival rate and median survival time,improve the life quality and physical status of advanced HCC patients and reduce the score of traditionnal Chinese medical syndrome.