王伟孔 刘明 姜明强

摘要目的：观察防己黄芪汤对乳腺癌术后水肿的临床疗效，同时评价其对患者免疫功能的影响。方法：选取2014年1月至2017年1月河南中医药大学第一附属医院收治的乳腺癌术后水肿患者60例纳入研究，随机分为对照组和观察组，每组30例。对照组患者口服呋塞米，20 mg/次，1次/d，地奥司明，045 g/片，2片/次，1次/d。观察组在对照组治疗基础上加服防己黄芪汤，200 mL早晚分服温服，1剂/d。2组均连续治疗14 d，比较治疗前后上臂周径、FCATB+4量表评分、临床总有效率、生命质量评分（QOL）以及CD4+、CD8+、CD4+/CD8+、Th17、IL17的水平变化。结果：1）治疗后观察组上臂周径为（1928±112）cm，与对照组（3312±253）cm比较，差异有统计学意义（t=219，P<005）。2）观察组临床总有效率为8667%，对照组为6666%，2组比较，差异有统计学意义（χ2=314，P<005）。3）观察组FCATB+4量表评分为（612±024）分，与对照组（802±101）分，2组比较差异有统计学意义（t=314，P<005）。4）治疗后观察组QOL各项评分明显高于对照组，差异有统计学意义（P<005）。5）2组CD4+及CD4+/CD8+比值均高于治疗前（P<005），CD8+、Th17与IL17的含量低于治疗前（P<005），治療后观察组与对照组差异均有统计学意义（P<005）。结论：防己黄芪汤可明显改善乳腺癌术后水肿，提高乳腺癌患者的生命质量，其作用机制可能与提高患者免疫能力有关。

关键词乳腺癌；水肿；免疫；术后；防己黄芪汤；生命质量

Effects of Fangji Huangqi Decoction on Edema and Immunity of Postoperative Breast Cancer

Wang Wei， Kong Liuming， Jiang Mingqiang

（First Affiliated Hospital of Henan University of Traditional Chinese Medicine， Zhengzhou 450003， China）

AbstractObjective：To observe the clinical effect of Fangji Huangqi decoction on postoperative edema of breast cancer， and to evaluate the effects on the immunity of patients. Methods：A total of 60 patients with postoperative edema of breast cancer included into the research， were randomly divided into the control group （30 cases） and the observation group （30 cases）. The patients of the control group had Furosemide， 20 mg/time， 1 time/day， oral furosemide， 20 mg/tablet， 1 time/day. The observation group had Fangji Huangqi decoction on the basis of control group， 200 mL warmtaken separately in the morning and evening， 1 agent/day， with continuous treatment for 14 d. Upperarm circumference， FCATB+4 scale scores， clinical total effective rate， quality of life scores （QOL） and the levels changes of CD4+， CD8+， CD4+/CD8+， Th17， IL17 of two groups before and after treatment were compared. Results：1） After treatment， the upperarm circumference of the observation group was （1928±112）cm. Compared with （3312±253） cm of the control group， the differences were statistically significant （P<005， t=219）. 2） The clinical total effective rate of observation group was 8667%， and that of control group was 6666 %. The differences were statistically significant （P<005， chisquare=314）. 3） FCATB+4 scale of the observation group graded （612±024） points， and the control group graded （802±101） points. The differences between the two groups had statistical significance （P<005， t=314）. 4） the QOL scores of the observation group was obviously higher than that of control group after treatment， and the differences were statistically significant （P<005）. 5） CD4+ and the ratio of CD4+ /CD8+ in the two groups were both higher than before treatment （P<005）， and the content of CD8+， Th17 and IL17 levels was lower than that before treatment （P<005）. The differences between the treatment group and control group were statistically significant （P<005）. Conclusion：The Fangji Huangqi decoction could obviously improve postoperative edema of breast cancer， improve the quality of life in patients with breast cancer， and the mechanism may be related to the improvement of the patients′ immunity.

Key WordsPostoperative breast cancer； Edema； Immunity；Postop；Fangji huangqi decoction；Quality of life

中图分类号：R273文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.05.017

乳腺癌是临床常见女性恶性肿瘤之一，发病率呈逐年上调趋势，手术仍是乳腺癌的首选治疗方案，但患侧上肢肿胀是乳腺癌术后常见并发症之一，导致患侧肢体不同程度肿胀、疼痛等，甚至出现反复感染，严重影响疗效及生命质量[12]。术后水肿属于中医“水肿”“脉痹”等范畴，对其病机的描述始载于《素问·至真要大论》，书中描述：“诸湿肿满，皆属于脾”，《丹溪心法》中认为：“水肿因脾虚不能制水，水渍妄行”，于是我们认为脾虚湿盛是乳腺癌术后上肢水肿的根本原因，故健脾祛湿是关键[34]。防己黄芪汤源自《金匮要略》，以健脾利水为著，临床不乏其可改善水肿的报道，但其作用机制目前尚无定论，有文献证实改善癌症患者的免疫能力可有效改善相关并发症，基于此我们设想，防己黄芪汤可改善乳腺癌术后上肢水肿是否与改善患者的免疫能力有关？……