黄芪桂枝五物汤治疗奥沙利铂周围神经毒性的临床观察

目的观察黄芪桂枝五物汤治疗奥沙利铂周围神经毒性的临床效果。方法将90例符合纳入标准的患者随机分为中药治疗组、西药对照组和单纯化疗组,每组各30例。单纯化疗组予含奥沙利铂的化疗方案,中药治疗组同时加用黄芪桂枝五物汤,西药对照组加用弥可保（甲钴胺片）。各组均以21天为1个疗程,共治疗2个疗程,观察临床中医证候疗效及治疗后神经毒性分级、肌电图变化情况。结果①中药治疗组、西药对照组和单纯化疗组临床中医证候总有效率分别为92.86%、48.28%、0.00%;组间临床中医证候疗效比较,差异有统计学意义（P〈0.05）。②治疗后3组Levi’s评级差异有统计学意义（P〈0.01）,其中单纯化疗组升高（P〈0.01）,中药治疗组、西药对照组降低（P〈0.01）。③各组治疗前后比较,运动神经传导速度均无明显改变（P〉0.05）,且组间治疗后差异亦无统计学意义（P〉0.05）;治疗前后组内比较,单纯化疗组腓浅神经的传导速度明显降低（P〈0.05）,中药治疗组、西药对照组的正中、腓浅神经的SNCV差异无统计学意义（P〉0.05）;组间治疗后比较,中药治疗组和西药对照组的左正中神经、左右腓浅神经的SNCV,与单纯化疗组比较,差异有统计学意义（P〈0.01）,中药治疗组与西药对照组差异无统计学意义（P〉0.05）。结论黄芪桂枝五物汤对奥沙利铂导致的周围神经毒性有较好的治疗作用,其对临床症状的改善作用更为显著。

Clinical research on the effects of "Huangqi Guizhi Wuwu Decoction" on peripheral neurotoxicity induced by oxaliplatin

Objective To observe the curative effect of the peripheral neurotoxicity induced by oxaliplatin together with ＂Huangqi Guizhi Wuwu Decoction＂.Methods Ninety subjects were randomly divided into Chinese medicine treatment（TCM） group,control group（western medicine） and the blank group（no any other medicine）.Each group had 30 cases.All the 90 patients had been treated by Oxaliplatin chemotherapy.The cases in the TCM group were treated with ＂Huangqi Guizhi Wuwu Decoction＂,the cases in the control group with methycobal and the cases in the blank group with no medicine.The treatment lasted two courses,with 21 days in a course.The changes of the neurotoxicity grading,clinical symptoms and electromyography were observed after treatment.Results ①The total effective rate for clinical symptoms was 92.86% in TCM group,48.28% in the control group and 0.00% in the blank group,with striking differences between the three groups（P0.01）.②After treatment,the Levi＇s scores of all the 3 groups were significantly different（P0.01）;the Levi＇s score of blank group was increased（P0.05）,and the Levi＇s scores of TCM group and control group were decreased（P0.05）.③The electromyography showed that MNCV of all the 3 groups had no obvious difference before and after the treatment,and there was no obvious difference between the three groups.Comparing the changes before and after treatment in each group： the SNCV of the superficial peroneal nerve in the blank group was significantly lowered（P0.01）,and its change of the SNCV of median nerve had no statistical significance.The changes of SNCV of the median nerve and superficial peroneal nerve in TCM group and control group had no statistical difference.Compared with blank group,the SNCV of median nerve of the left,both superficial peroneal nerve in TCM group and in the control group had statistical difference（P0.01）,but with no obvious difference between TCM group and control group.Conclusion ＂Huangqi Guizhi Wuwu Decoction＂ is effective in reducing the peripheral neurotoxicity induced by Oxaliplatin and in relieving clinical symptoms.