1.上海中医药大学附属龙华医院肿瘤科(上海 200032)
2.江苏省苏北人民医院肿瘤科(江苏 扬州 225001)
钦敬茹,女,硕士,主要从事中医药治疗恶性肿瘤的临床与研究工作
王中奇,主任医师,博士研究生导师;E-mail:aledx@sina.com
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钦敬茹, 杨鹭, 王雯珺, 等. 温阳散结中药内服、外敷联合常规疗法治疗肿瘤骨转移疼痛的临床研究[J]. 上海中医药杂志, 2021,55(10):40-45.
Jingru QIN, Lu YANG, Wenjun WANG, et al. Clinical research on the treatment of tumor osseous metastasis pain by combining internal and external application of Wenyang Sanjie Decoction with conventional therapy[J]. Shanghai Journal of Traditional Chinese Medicine, 2021,55(10):40-45.
钦敬茹, 杨鹭, 王雯珺, 等. 温阳散结中药内服、外敷联合常规疗法治疗肿瘤骨转移疼痛的临床研究[J]. 上海中医药杂志, 2021,55(10):40-45. DOI: 10.16305/j.1007-1334.2021.1911164.
Jingru QIN, Lu YANG, Wenjun WANG, et al. Clinical research on the treatment of tumor osseous metastasis pain by combining internal and external application of Wenyang Sanjie Decoction with conventional therapy[J]. Shanghai Journal of Traditional Chinese Medicine, 2021,55(10):40-45. DOI: 10.16305/j.1007-1334.2021.1911164.
目的,2,观察温阳散结中药内服、外敷联合常规疗法治疗肿瘤骨转移疼痛的临床疗效。,方法,2,将93例肿瘤骨转移疼痛患者随机分为对照组(47例)和治疗组(46例),对照组采用常规止痛治疗,治疗组在对照组治疗措施的基础上加用温阳散结中药内服、外敷,两组均连续治疗6个周期。观察两组爆发痛次数,比较疼痛数字评分(NRS)、盐酸羟考酮24 h用量、相关实验室指标、欧洲癌症研究与治疗组织的骨转移特异子量表(EORTC QLQ-BM22)评分的变化情况,同时进行安全性评价。,结果,2,①试验过程中,治疗组脱落1例,对照组脱落1例、剔除1例,最终完成试验者90例,治疗组、对照组各45例。②治疗2周期、治疗4周期、治疗6周期与治疗前组内比较,两组NRS评分均降低(,P,<,0.001);治疗2周期、治疗4周期、治疗6周期组间比较,治疗组NRS评分低于对照组(,P,<,0.05)。③在整个治疗过程中,治疗组爆发痛次数少于对照组,差异有统计学意义(,P,<,0.05)。④治疗4周期、治疗6周期与治疗第3天组内比较,治疗组盐酸羟考酮24 h用量减少(,P,<,0.001),对照组盐酸羟考酮24 h用量增加(,P,<,0.001);治疗4周期、治疗6周期组间比较,治疗组盐酸羟考酮24 h用量少于对照组(,P,<,0.05)。⑤治疗4周期与治疗前组内比较,治疗组血钙水平降低(,P,<,0.01);治疗6周期与治疗前组内比较,治疗组肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平降低(,P,<,0.01),对照组碱性磷酸酶(ALP)水平升高(,P,<,0.01)。治疗4周期、治疗6周期组间比较,治疗组IL-6水平低于对照组(,P,<,0.05)。⑥治疗2周期与治疗前组内比较,治疗组EORTC QLQ-BM22量表中的疼痛部位、疼痛程度、功能障碍模块评分降低(,P,<,0.01);治疗4周期、治疗6周期与治疗前组内比较,两组疼痛部位、疼痛程度、功能障碍模块评分降低(,P,<,0.01)。治疗6周期组间比较,治疗组功能障碍模块评分低于对照组(,P,<,0.05)。⑦治疗组不良反应发生例数少于对照组,差异有统计学意义(,P,<,0.05)。,结论,2,与常规止痛相比,加用温阳散结中药内服、外敷治疗肿瘤骨转移疼痛疗效满意,可以减少爆发痛次数和镇痛药物剂量,改善患者生存质量,其机制可能与降低血清TNF-α、IL-6、钙水平有关。
Objective,2,To observe the clinical efficacy of internal and external application of Wenyang Sanjie Decoction combined with conventional therapy in the treatment of tumor osseous metastasis pain.,Methods,2,Ninety-three patients with tumor osseous metastasis pain were randomly divided into a control group (,n,=47) and a treatment group (,n,=46). The control group was administered with conventional analgesic therapy, while the treatment group was administed with internal and external application of Wenyang Sanjie Decoction besides the treatment measures of the control group. Both groups were treated continuously for 6 cycles. The frequency of pain outbreaks in the two groups was observed, the changes of pain numeric rating scale (NRS) score, 24-h dosage of oxycodone hydrochloride, laboratory indexes, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Bone Metastases22 (EORTC QLQ-BM22) score were compared, and safety evaluation was also performed.,Results,2,①During the trial, there was one drop-out case in the treatment group, and in the control group one case dropped out and one case was removed. Finally, 90 cases completed the trial, with 45 cases in each group. ②The NRS score decreased in both groups after 2 cycles of treatment, 4 cycles of treatment and 6 cycles of treatment respectively compared with that before treatment (,P,<,0.001); the NRS score of the treatment group was lower than that of the control group after 2 cycles of treatment, 4 cycles of treatment, and 6 cycles of treatment respectively (,P,<,0.05). ③During the whole treatment process, the frequency of painful outbreaks in the treatment group was lower than that in the control group, and the difference was statistically significant (,P,<,0.05). ④Compared with the condition after 3 days of treatment, the 24-h dosage of oxycodone hydrochloride decreased in the treatment group (,P,<,0.001) but increased in the control group (,P,<,0.001) after 4 cycles of treatment and 6 cycles of treatment; the 24-h dosage of oxycodone hydrochloride in the treatment group was lower than that in the control group after 4 cycles of treatment and 6 cycles of treatment (,P,<,0.05). ⑤Compared with the condition before treatment, the serum calcium level was lowered in the treatment group after 4 cycles of treatment (,P,<,0.01); after 6 cycles of treatment the tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels was lowered in the treatment group (,P,<,0.01), while the alkaline phosphatase (ALP) level increased in the control group (,P,<,0.01). The IL-6 level in the treatment group was lower than that in the control group after 4 cycles of treatment and 6 cycles of treatment respectively (,P,<,0.05). ⑥Compared with the pre-treatment condition, the scores of pain site, pain degree and dysfunction modules in the EORTC QLQ-BM22 were lowered in the treatment group after 2 cycles of treatment (,P,<,0.01). The intra-group comparison between the condition after 4 cycles of treatment and that after 6 cycles of treatment showed that the scores of pain site, pain degree and dysfunction modules decreased in both groups (,P,<,0.01). After 6 cycles of treatment, the score of dysfunction module in treatment group was lower than that in the control group (,P,<,0.05). ⑦The incidence of adverse reactions in the treatment group was lower than that in the control group, and the difference was statistically significant (,P,<,0.05).,Conclusions,2,Compared with the single use of conventional analgesia, the additional use of internal and external application of Wenyang Sanjie Decoction in the treatment of tumor osseous metastatic pain has achieved a satisfactory result, which could reduce the frequency of pain outbreaks and the dosage of analgesic drugs, and improve the survival quality of patients. The mechanism may be related to the reduction of serum TNF-α, IL-6 and calcium levels.
肿瘤骨转移癌痛中西医结合疗法温阳散结中药内服中药外敷细胞因子
tumor osseous metastasescancer painintegrated traditional Chinese and Western medicine therapyWenyang Sanjieinternal use of traditional Chinese herbal medicineexternal application of traditional Chinese herbal medicinecytokine
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