摘要
目的:探讨莲花清肝汤加减辅助经导管肝动脉化疗栓塞(TACE)治疗中晚期肝热血瘀型原发性肝癌(PLC)的临床疗效。方法:采用前瞻性随机对照研究,纳入2020年1月至2022年6月收治的121例中晚期肝热血瘀型PLC患者,随机分为对照组60例,观察组61例。两组患者均给予常规保肝、抗病毒治疗及TACE治疗,观察组在此基础上加用莲花清肝汤加减方,疗程均为12周,自首次TACE术后随访2年。评价两组患者的疗效及不良反应、中医证候积分、肿瘤标志物[血清甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原-125(CA125)]、肝功能[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)]、凝血功能[凝血酶原时间(PT)、凝血酶原活动度(PTA)]及术后2年生存率。结果:与对照组比较,观察组患者疾病控制率降低(P<0.05),两组患者客观缓解率比较差异无统计学意义(P>0.05);与对照组比较,观察组患者中医证候积分降低[(10.4±1.6)分vs(13.1±1.3)分,P<0.05],观察组患者血清肿瘤标志物AFP、CEA、CA125下降[(518.3±88.0)μg/L vs(830.5±92.5)μg/L;(17.8±4.5)kU/L vs(23.4±4.2)kU/L;(27.2±9.3)kU/L vs(35.4±10.2)kU/L,均P<0.05],观察组患者肝功能指标ALT、AST、TBil下降[(40.7±5.2)U/L vs(52.2±6.5)U/L;(48.5±9.3)U/L vs(56.3±10.2)U/L;(18.2±2.5)μmol/L vs(22.6±3.1)μmol/L,均P<0.05]。观察组凝血功能优于对照组,PT更短[(12.4±1.8)s vs(17.3±1.8)s],PTA更高[(86.1±7.2)%vs(71.5±8.6)%,均P<0.05]。两组患者治疗相关不良反应发生率差异无统计学意义(P>0.05),观察组患者未出现与中药相关的严重不良事件。术后2年随访期间,观察组患者生存率为68.33%,显著高于对照组的44.83%(P<0.05)。结论:莲花清肝汤加减辅助TACE治疗中晚期肝热血瘀型PLC,可提高疾病控制率,降低肿瘤标志物水平,改善肝功能及凝血功能,提升患者生存率,且安全性良好。
Objective:To explore the clinical efficacy of modified Lianhua Qinggan Tang in assisting hepatic artery chemoembolization(TACE)for the treatment of primary liver cancer(PLC)of liver blood stasis type.Methods:121 patients with advanced PLC admitted to our hospital from January 2020 to June 2022 were selected.They were divided into two groups by random number table method,and both groups were given routine liver protection and antiviral treatment.Sixty patients in the control group were treated with TACE,and 61 patients in the observation group were treated with Lianhua Qinggan Tang combined with TACE.Both groups were treated for 12 weeks,and were followed up for 2 years after the first TACE.The efficacy and side effects of the two groups were evaluated.Before and after treatment,Traditional Chinese medicine(TCM)syndrome score,serum alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),carbohydrate antigen-125(CA-125),serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),prothrombin time(PT),prothrombin activity(PTA)and survival during follow-up were observed.Results:There was no significant difference in the objective remission rate between the two groups of PLC(P>0.05),and the disease control rate in the observation group was higher than that in the control group(P<0.05).The TCM syndrome score,serum AFP,CA125 and CEA levels in the observation group were(10.4±1.6)points,(518.3±88.0)μg/L,(17.8±4.5)kU/L and(27.2±9.3)kU/L,respectively,which were lower than those in the control group[(13.1±1.3)points,(830.5±92.5)μg/L,(23.4±4.2)kU/L,(35.4±10.2)kU/L,P<0.05].The serum levels of ALT,AST,and TBiL in the observation group were(40.7±5.2)μmol/L,(48.5±9.3)U/L,and(18.2±2.5)U/L,respectively,which were lower than those in the control group[(52.2±6.5)μmol/L,(56.3±10.2)U/L,and(22.6±3.1)U/L,P<0.05].The PT of the observation group was(12.4±1.8)s lower than that of the control group[(17.3±1.8)s,P<0.05],and the PTA was(86.1±7.2)%higher than that of the control group[(71.5±8.6)%,P<0.05].There was no significant difference in the incidence of toxic side effects between the two groups during treatment(P>0.05).During the postoperative follow-up period,the cumulative survival rate of the observation group was higher than that of the control group(P<0.05).Conclusion:Lianhua Qinggan Tang,with modifications,can assist TACE in the treatment of advanced liver hot blood stasis type PLC by reducing the TCM syndrome score and tumor marker levels in patients,improving liver function and coagulation function,effectively increasing disease control rate,improving patient survival rate,and not increasing toxic side effects.
作者
张慧
钱洪
ZHANG Hui;QIAN Hong(Department of Oncology,Anqing 116 Hospital,China Rongtong Healthcare Group Corporation Limited,Anhui Anqing,246000,China)
出处
《中西医结合肝病杂志》
2026年第2期164-168,共5页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
关键词
原发性肝癌
肝热血瘀证
肝动脉化疗栓塞术
莲花清肝汤
primary liver cancer
liver-heat blood stasis syndrome
hepatic artery chemoembolization
Lianhua Qinggan Tang
