章凯敏 徐晓娅

摘要目的：探究益氣活血中药对肝癌放疗后肝脏微循环及肝纤维化指标的影响。方法：选取2016年1月至2017年1月麻城市人民医院收治的原发性肝癌（PLC）患者62例，随机分为对照组和观察组，每组31例。对照组给予三维适形放疗，观察组在对照组的基础上联合益气活血中药治疗。统计2组近期临床疗效，评估治疗前后2组中医症候积分变化，检测并比较治疗前后2组甲襞微循环和肝纤维化指标的变化。结果：2组总缓解率比较，差异无统计学意义（P>005），观察组总稳定率为9677%高于对照组的7742%（P<005）；与治疗前比较，治疗后观察组腹胀、纳差、恶心呕吐、乏力、胁痛、黄疸等中医症候积分均显著下降，且观察组均低于对照组（P<005或P<001）；与治疗前比较，治疗后2组HA、PCⅢ、CⅣ及LN等肝纤维化指标水平均显著升高，观察组袢周状态、管袢形态、流态积分及总积分均显著降低，且观察组上述指标均显著低于对照组（P<005或P<001）。结论：益气活血中药联合放疗可明显改善PLC患者肝脏微循环，降低肝纤维化程度，提高病灶稳定率，减轻患者病痛。

关键词原发性肝癌；益气活血中药；放疗；肝纤维化；微循环

Effects of Yiqi Huoxue Herbs on Liver Microcirculation and Hepatic Fibrosis Indexes

for Primary Liver Cancer after Radiotherapy

Shi Xiangru1， Zhang Kaimin2， Xu Xiaoya1

（1 Department of Oncology， Hubei Macheng City People′s Hospital， Macheng 438300， China；

2 Department of Radiology， Hubei Xianning City Central Hospital， Xianning 437100， China）

AbstractObjective：To explore the effect of Yiqi Huoxue herbs on liver microcirculation and hepatic fibrosis indexes for primary liver cancer （PLC） after radiotherapy. Methods：A total of 62 cases of PLC patients in our hospital from January 2016 to January 2017 were selected and randomly divided into control group and treatment group， with 31 cases in each group. Control group was treated with three dimensional conformal radiotherapy， and treatment group was treated with Yiqi Huoxue herbs on the basis of control group. Recent clinical curative effect of 2 groups was statisticsed， and TCM symptoms integral change of 2 groups before and after treatment was evaluated. The change of nailfold microcirculation and hepatic fibrosis indexes of 2 groups before and after treatment was detected and compared. Results：The total remission rate of 2 groups had no significant difference （P>005）. The total stability rate of treatment group was 9677%， which was significantly higher than 7742% of control group （P<005）； Compared with before treatment， the TCM symptoms integral of abdominal distention， poor appetite， nausea， vomiting， fatigue， pain and jaundice of treatment group after treatment significantly declined， and which in treatment group were significantly lower than that in control group （P<005 or P<001）； Compared with before treatment， the hepatic fibrosis indexes of HA， PCⅢ， CⅣ and LN of 2 groups increased significantly， and the integral of week state of loops， tube shape of loops， flow pattern and total integral decreased significantly. The above indicators in treatment group were lower than that in control group （P<005 or P<001）. Conclusion：Yiqi Huoxue herbs combined with radiotherapy can obviously improve the liver microcirculation of the patients with PLC， reduce the degree of hepatic fibrosis， increase the stability rate of lesions， and reduce patients′ pain.

Key WordsPrimary liver cancer； Yiqi huoxue herbs； Radiotherapy； Hepatic fibrosis； Microcirculation

中图分类号：R273文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.05.018

原发性肝癌（Primary Liver Cancer，PLC）是消化系统常见恶性肿瘤之一，临床治疗以根治性切除术疗效最佳，但该病患者早期常无明显自觉症状，确诊时病情已至中、晚期，失去手术切除时机[1]。近年来，放疗作为非手术治疗PLC的一种重要手段，已获得长足发展，特别是三维适形放疗技术通过精确定位肿瘤病变后给予根治剂量，从而最大程度降低放疗对正常肝组织的不良影响，但有研究指出长时间放疗会造成放射性肝损伤，不利于PLC患者恢复[2]。中医认为PLC患者长期以来肝失疏泄、气滞血瘀，致使正虚邪实，治疗应以益气活血、培补正气为主[3]。有研究[4]表明，益气活血中药可减轻放疗不良反应，改善肝脏微循环，提高放疗的远期疗效。本研究旨在探讨益气活血中药对肝癌放疗后肝脏微循环及肝纤维化指标的影响，现报道如下。