孙佩佩 綦丰光 张颖颖 孙向红

摘要 目的：观察用麦门冬汤合苇茎汤加减治疗阴虚肺热证肺癌化疗患者的临床效果，探讨其可能的部分作用机制。方法：选取2017年6月至2018年6月滨州市中医医院收治的肺癌患者104例作为研究对象，按照随机数字表法随机分为对照组和观察组，每组52例。对照组患者接受化疗干预，观察组患者在化疗干预的基础上给予麦门冬汤合苇茎汤加减方口服。观察近期疗效、患者生命质量、Th1/Th2细胞因子含量及外周血相关因子水平、不良反应的发生率。结果：观察组、对照组的近期疗效分别为65.38%、38.46%，以观察组近期疗效更好（P<0.05）;治疗后，观察组患者的生命质量FACT-L评分均高于本组治疗前及对照组患者（P<0.05）;对照组患者经化疗干预后免疫功能有所下降，而观察组患者免疫功能提高，外周血中Th1相关细胞因子IL-2、IFN-γ水平明显高于对照组，Th2相关细胞因子IL-4、IL-10水平明显低于对照组（P<0.05）;观察组患者的血清中VEGF、COX-2、CYFRA21-1、CA19-9水平均显著低于對照组（P<0.05）;观察组患者的不良反应较对照组明显减少（P<0.05）。结论：麦门冬汤合苇茎汤加减治疗阴虚肺热证肺癌化疗患者增效减毒作用明显，利于提高生命质量，其机制可能与纠正Th1/Th2细胞免疫失衡状态及抑制VEGF、COX-2表达而发挥抗血管增生作用有关。

关键词 麦门冬汤;苇茎汤;阴虚肺热证;肺癌;化疗;生命质量;Th1/Th2细胞免疫;VEGF;COX-2;CYFRA21-1;CA19-9;作用机制

Abstract Objective：To observe the clinical effects of Maimendong Decoction combined with Weijing Decoction in the treatment of patients with lung cancer with yin deficiency and lung heat syndrome，and to explore the possible mechanisms.Methods：A total of 104 patients with lung cancer admitted to the Binzhou Hospital of Traditional Chinese Medicine from June 2017 to June 2018 were selected as the research objects，and were randomly divided into a control group and an observation group according to random number table method，with 52 cases in each group.Patients in the control group were given chemotherapy intervention，and the patients in the observation group were given modified Maimendong Decoction combined with Weijing Decoction on the basis of chemotherapy intervention.The Short-term therapeutic effects，quality of life，Th1/Th2 cytokine content and peripheral blood related factor levels，and the incidence of toxic and side effects were observed.Results：The short-term therapeutic effects of the observation group and the control group were 65.38% and 38.46% respectively，and the short-term therapeutic effects of the observation group was better （P<0.05）.After treatment，the quality-of-life FACT-L scores of the observation group were higher than those of the control group and the observation group before treatment （P<0.05）.The immune function of patients in the control group decreased after chemotherapy intervention，while the immune function of patients in the observation group was improved.The levels of Th1 related cytokines IL-2 and IFN-γ in peripheral blood were significantly higher than those in the control group，and the levels of Th2 related cytokines IL-4 and IL-10 were significantly lower than those in the control group （P<0.05）.The serum levels of VEGF，COX-2，cyfra21-1 and CA19-9 in the observation group were significantly lower than those in the control group （P<0.05）.The toxic and side effects in the observation group were significantly reduced compared with the control group （P<0.05）.Conclusion：The effects of Modified Maimendong Decoction combined with Weijing Decoction in the treatment of lung cancer patients with heat syndrome of yin deficiency and lung cancer is obvious in enhancing efficacy and toxicity reducing，which is conducive to improving the quality of life.The mechanisms may be related to the correction of Th1/Th2 cell immune imbalance and the inhibition of VEGF and cox-2 expression to play a role of resistance to blood vessels.

Keywords Maimendong Decoction; Weijing Decoction; Yin deficiency of lung heat syndrome; Lung cancer; Chemotherapy; Quality of life; Th1/Th2 cellular immunity; VEGF; COX-2; CYFRA21-1; CA19-9; Mechanisms of action

中图分类号：R246.5;R259;R734.2文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.13.022

肺癌是目前全世界范围内发病率最高的肿瘤类型之一，也是临床致死的主要原因，因其发病隐匿，早期无特异性症状，易被忽视，故初诊时半数以上的患者处于Ⅲ、Ⅳ期[1]。化疗是中晚期肺癌的重要手段，吉西他滨与顺铂联合化疗方案可提高顺铂和DNA嵌合稳定性，增强DNA修复抑制的功效，诱导肿瘤细胞凋亡[2]，在延缓病灶进展、延长生存期等方面有一定效果，但有一定不良反应，且对免疫系统的损伤尤为显著，患者耐受性欠佳，影响预后[3]。近年来，中医药治疗肺癌积累了丰富的经验，尤其是在传统经方基础上结合长期临床经验加减化裁而成的效验经方，在稳定病灶、增效减毒、延长生存期、提高患者的生命质量等方面优势凸显[4]。……