张帆　陈斌　伍玉南　彭建平　景婧　孙克伟

〔摘要〕 目的 觀察黄芩汤治疗索拉非尼所致腹泻的临床疗效。方法 将30例服用索拉非尼后出现腹泻的原发性肝癌患者随机分为治疗组和对照组，各15例。治疗组给予黄芩汤煎服，对照组给予胃黏膜保护剂蒙脱石散及肠道菌群调节剂地衣芽孢杆菌活菌胶囊口服治疗，两组患者均治疗4周。观察两组患者腹泻持续时间、腹泻程度、肠道菌群变化、不良反应的发生情况及中医证候积分。结果 治疗后治疗组腹泻持续时间明显短于对照组（P<0.05），腹泻程度改善明显优于对照组（P<0.05），不良反应发生率明显低于对照组（P<0.05）;在调节肠道菌群方面，治疗组肠球菌、肠杆菌数较治疗前及对照组均有所下降（P<0.05），对照组无明显变化;证候总积分治疗组下降幅度明显大于对照组（P<0.05），治疗组总有效率93.3%明显优于对照组60.0%（P<0.05）。结论 黄芩汤能明显改善索拉非尼所致腹泻，可调节肠道菌群稳态，维护肠道正常功能。

〔关键词〕 腹泻;索拉非尼;原发性肝癌;黄芩汤

〔中图分类号〕R256.3       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.09.021

Clinical Study on Huangqin Decoction in Sorafenib-induced Diarrhea

ZHANG Fan1， CHEN Bin2， WU Yunan2， PENG Jianping2， JING Jing3， SUN Kewei2*

（1. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China; 2. The First Affiliated Hospital of Hunan University of Chinese Medicine， Changsha， Hunan 410007， China; 3， The Fifth Medical Center， Chinese PLA General

Hospital， Beijing 100070， China）

〔Abstract〕 Objective To observe clinical efficacy of Huangqin Decoction on sorafenib-related diarrhea. Methods A total of 30 patients with primary hepatic carcinoma and diarrhea after taking sorafenib were randomly divided into a treatment group and a control group， with 15 cases in each group. The control group received gastric mucosal protective agent-Montmorillonite Powder and intestinal flora conditioning agent-Live Bacillus Licheniformis Capsules orally， while the treatment group received Huangqin Decoction orally. The intervention lasted for 4 weeks. Duration time of diarrhea， severity of diarrhea， changes of intestinal flora， incidence of adverse reactions and syndrome score of traditional Chinese medicine （TCM） in both groups were observed. Results After the treatment， the duration time of diarrhea in the treatment group was significantly shorter than that in the control group （P< 0.05）， the improvement of severity of diarrhea was obviously better than that in the control group （P<0.05）， and the incidence of adverse reactions was significantly lower than that in the control group （P<0.05）; In the aspect of regulating intestinal flora， the amounts of enterococci and enterobacteria were obviously decreased in the treatment group compared with those before the treatment and those in the control group （P<0.05）， while there was no obvious change in the control group; the total syndrome score in the treatment group was more significantly decreased than that in the control group （P<0.05）. The total effective rate in the treatment group （93.3%） was obviously better than that in the control group （60.0%） （P<0.05）. Conclusion Huangqin Decoction can significantly improve sorafenib-induced diarrhea， regulate intestinal flora homeostasis and maintain normal function of intestinal tract.

〔Keywords〕 diarrhea; sorafenib; hepatoeellular carcinoma; Huangqin Decoction

原发性肝癌是临床上最常见的恶性肿瘤之一，全球发病率逐年增长，已超过62.6万/年，居于恶性肿瘤的第5位;死亡接近60万/年，位居肿瘤相关死亡的第3位[1]。原发性肝癌在我国高发，发病人数约占全球的55%，在肿瘤相关死亡中仅次于肺癌，位居第二[2]。近年来发病率有增高趋势，预后极差，分子靶向药物索拉非尼（Sorafenib）是迄今为止被证实可显著延长晚期肝细胞癌患者总生存期的重要药物[3]。……