摘要
目的观察加味葛根芩连汤治疗宫颈癌同步放化疗致急性放射性肠损伤(ARE)的临床疗效及对炎症因子、氧化应激、肠道黏膜屏障和肠道菌群的影响。方法将108例ARE患者随机分为对照组与观察组各54例。对照组口服蒙脱石散和复方谷氨酰胺肠溶胶囊,病情不能控制者加用地塞米松+蒙脱石散进行灌肠;观察组在对照组的基础上加用加味葛根芩连汤内服,疗程均为14 d。比较治疗后临床疗效;进行中医证候评分;检测治疗前后炎症因子如白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP),氧化应激指标如超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)和8-羟基脱氧鸟苷(8-OHdG);检测治疗前后血清二胺氧化酶(DAO)、D-乳酸和内毒素水平;进行治疗前后肠道菌群检测。结果观察组总有效率为94.44%,高于对照组的73.58%(P<0.05)。两组患者治疗后各中医证候评分均较前降低(P<0.05),且观察组改善幅度更大(P<0.05)。在炎症指标方面,两组IL-6、TNF-α和CRP水平治疗后均下降(P<0.05),观察组降幅更显著(P<0.05);而IL-2水平则呈现上升趋势(P<0.05),且观察组升高更明显(P<0.05)。氧化应激指标显示,两组MDA和8-OHdG水平治疗后降低(P<0.05),观察组更低(P<0.05);SOD和GSH-Px水平均升高(P<0.05),观察组增幅更大(P<0.05)。在肠道屏障功能方面,两组DAO、D-乳酸和内毒素水平均下降(P<0.05),观察组下降更显著(P<0.05)。肠道菌群分析表明,治疗后两组大肠埃希菌数量减少(P<0.05),观察组降幅更大(P<0.05);而乳酸杆菌和双歧杆菌数量增加(P<0.05),观察组增长更显著(P<0.05)。结论加味葛根芩连汤治疗宫颈癌同步放化疗致ARE患者,能减轻临床症状和放射性损伤分级,临床疗效显著,其作用机制可能与抗炎、氧化应激损伤,调节肠道菌群失调,保护肠道功能有关。
Objective:To observe the clinical efficacy of Modified Gegen Qinlian Decoction in the treatment of acute radiation enteritis(ARE)induced by concurrent chemoradiotherapy for cervical cancer,and its effects on inflammatory factors,oxidative stress,intestinal mucosal barrier and intestinal flora.Methods:A total of 108 patients with ARE were randomly divided into a control group and an observation group,with 54 cases in each group.The control group was given oral montmorillonite powder and compound glutamine enteric-coated capsules;if the condition was not controlled,dexamethasone+montmorillonite powder enema was added.The observation group was additionally given oral Modified Gegen Qinlian Decoction on the basis of the control group,with a course of 14 days for both groups.The clinical efficacy after treatment was compared;TCM syndrome scores were evaluated;inflammatory factors[interleukin−2(IL−2),interleukin−6(IL−6),tumor necrosis factor-α(TNF−α),C−reactive protein(CRP)],oxidative stress indicators[superoxidedismutase(SOD),malondialdehyde(MDA),glutathione peroxidase(GSH-Px),8−hydroxydeoxyguanosine(8-OHdG)],serum levels of diamine oxidase(DAO),D-lactic acid and endotoxin,and intestinal flora were detected before and after treatment.Results:The total effective rate of clinical efficacy in the observation group was 94.44%,which was significantly better than 73.58%in the control group(P<0.05).After treatment,the scores of each TCM syndrome in both groups were lower than those before treatment(P<0.05),and the improvement range in the observation group was greater(P<0.05).Regarding inflammatory indicators,the levels of IL−6,TNF−αand CRP in both groups decreased after treatment(P<0.05),and the decrease in the observation group was more significant(P<0.05);while the level of IL−2 showed an upward trend(P<0.05),and the increase in the observation group was more obvious(P<0.05).Oxidative stress indicators showed that the levels of MDA and 8-OHdG in both groups decreased after treatment(P<0.05),and those in the observation group were lower(P<0.05);the levels of SOD and GSH-Px increased(P<0.05),and the increase in the observation group was greater(P<0.05).In terms of intestinal barrier function,the levels of DAO,Dlactic acid and endotoxin in both groups decreased after treatment(P<0.05),and the decrease in the observation group was more significant(P<0.05).Intestinal flora analysis showed that after treatment,the number of Escherichia coli in both groups decreased(P<0.05),and the decrease in the observation group was greater(P<0.05);while the number of Lactobacillus and Bifidobacterium increased(P<O.05),and the increase in the observation group was more significant(P<0.05).Conclusion:Modified Gegen Qinlian Decoction in the treatment of ARE patients induced by concurrent chemoradiotherapy for cervical cancer can reduce clinical symptoms and radiation injury grade,with significant clinical efficacy.Its mechanism may be related to anti-inflammation,alleviating oxidative stress injury,regulating intestinal flora imbalance and protecting intestinal function.
作者
于雯娟
李文斌
康朔麟
付烊
Yu Wenjuan;Li Wenbin;Kang Shuolin;Fu Yang(Qianjiang Hospital of Renmin Hospital of Wuhan University,Qianjiang Central Hospital,Hubei,Qianjiang 433100,China)
出处
《中国中医急症》
2025年第12期1874-1878,共5页
Journal of Emergency in Traditional Chinese Medicine
基金
湖北省科技计划项目(2019CFB635)
襄阳市科学技术局医疗卫生领域科技计划项目(2022YL39A)。
关键词
子宫颈癌
急性放射性肠损伤
加味葛根芩连汤
炎症因子
氧化应激
肠道黏膜屏障
肠道菌群
Cervical cancer
Acute radiation enteritis
Modified Gegen Qinlian Decoction
Inflammatory factors
Oxidative stress
Intestinal mucosal barrier
Intestinal flora
