华琼博 牟海波 郭勇

[摘要]目的 探討水木两滋汤加味对中晚期原发性肝癌肝肾阴亏证患者TACE后的疗效及其外周血T淋巴细胞亚群的影响。 方法 选取2015年5月至2017年5月浙江省中医院收治的中晚期原发性肝癌患者88例，按随机数字表法将其分为对照组和观察组，每组各44例。对照组患者在TACE术后接受常规对症支持治疗，观察组在对照组治疗基础上给予水木两滋汤加味治疗。治疗12周后，比较两组肝肾阴亏证症状评分、近期实体瘤疗效、复发率以及外周血T淋巴细胞亚群CD3+、CD4+、CD8+。 结果 治疗后，观察组患者的肝肾阴亏证症状评分明显低于对照组（P<0.01）;对照组治疗前后肝肾阴亏证症状评分比较，差异无统计学意义（P>0.05）;观察组和对照组的近期实体瘤总有效率分别为88.64%和68.18%，组间比较差异有统计学意义（P<0.05）;随访1年发现，观察组复发率为13.64%，对照组复发率为36.36%，观察组的复发率明显低于对照组（P<0.05）;治疗后，观察组患者的CD3+、CD4+较治疗前显著升高，CD8+明显降低，上述指标改善均优于对照组（P<0.01）;对照组治疗前后CD3+、CD4+、CD8+比较，差异无统计学意义（P>0.05）。 结论 水木两滋汤加味可明显改善中晚期原发性肝癌肝肾阴亏证患者TACE后的中医证候，提高临床疗效，降低复发率，且可增强患者的免疫功能。

[关键词] 原发性肝癌;水木两滋汤加味;肝肾阴亏证;T淋巴细胞亚群

[Abstract] Objective To investigate the impacts of modified Shui Mu Liang Zi Decoction on T lymphocyte subsets in peripheral blood of patients with liver and kidney yin deficiency type of advanced primary liver cancer after TACE. Methods A total of 88 patients with advanced primary liver cancer admitted to Zhejiang Provincial Hospital of Traditional Chinese Medicine from May 2015 to May 2017， were selected. According to the random number table method， they were divided into the control group and the observation group， with 44 cases in each group. The control group was given routine supportive treatment after TACE， and the observation group was treated with modified Shui Mu Liang Zi Decoction on the basis of what was given to the control group. After 12 weeks of treatment， the symptom score of liver and kidney yin deficiency syndrome， the efficacy on recent solid tumor， relapse rate and peripheral blood T lymphocyte subsets CD3+， CD4+， CD8+ were compared between the two groups. Results After treatment， the symptom score of liver and kidney yin deficiency syndrome in the observation group was significantly lower than that in the control group（P<0.01）. There was no statistically significant difference in symptom scores of liver and kidney yin deficiency syndrome before and after treatment in the control group（P>0.05）. The total efficacy rates of recent solid tumors between the observation group and the control group were 88.64% and 68.18%， respectively， with statistically significant difference between the two groups（P<0.05）. After the follow-up for one year， it was found that the relapse rate in the observation group was 13.64%， which was higher than that of 36.36% in the control group（P<0.05）. After treatment， CD3+ and CD4+ subsets in the observation group increased more significantly than those before treatment， while CD8+ decreased more significantly than those before treatment. The improvement of the above indice in the observation group was better than that in the control group（P<0.01）. There was no statistically significant difference in CD3+， CD4+， CD8+ before and after treatment in the control group（P>0.05）. Conclusion Modified Shui Mu Liang Zi Decoction can significantly improve TCM syndromes and clinical efficacy and reduce relapse rate of after-TACE patients with advanced primary liver cancer of liver and kidney yin deficiency syndrome， which can also enhance the immune function of patients.

[Key words] Primary liver cancer; Modified Shui Mu Liang Zi Decoction; Liver and kidney yin deficiency syndrome; T lymphocyte subsets

原发性肝癌是临床上最常见的恶性肿瘤之一，发现时往往已进入中晚期，失去了最佳手术时机[1]。目前，对于失去手术时机或无法接受手术的中晚期原发性肝癌患者主要给予放化疗、射频消融、经导管动脉化疗栓塞术（Transcatheter arterial chemoembolization，TACE）、局部介入治疗或其他非手术治疗[2-3]。TACE治疗具有创伤小、短期疗效明显等优势，已成为不适合手术的中晚期原发性肝癌患者临床常用治疗手段之一，但TACE在阻断肿瘤组织血供的同时也增加了肿瘤血管再生及形成侧支循环的风险，加之肝血窦较为丰富，患者在TACE后常发生癌细胞转移或肝癌复发[4-5]。……