徐琦　　邓德厚　钟方明

[摘要] 目的 探討生肌活血方外用治疗阿帕替尼引起手足综合征的临床效果。 方法 选取2017年11月至2019年10月我院收治的因阿帕替尼治疗引发手足综合征的肿瘤患者164例作为研究对象，采用随机数字表法将其分为试验组和对照组，每组各82例。对照组患者予以尿素霜涂抹患处进行治疗，给药剂量10 g/次。试验组患者则采用生肌活血方外用治疗。以治疗28 d为1个疗程，治疗1个疗程后，比较两组患者治疗前后的手足综合征分级和皮肤病生活质量指数的变化，统计其临床疗效。 结果 治疗后，两组患者的HFS分级情况较治疗前均有所好转（P<0.05），且治疗后试验组患者的HFS分级的情况优于对照组，差异有统计学意义（P<0.05）。试验组患者治疗的总有效率为80.49%，高于对照组的56.10%，差异有统计学意义（P<0.05）。治疗后，两组的皮肤病生活质量指数（DLQI）较治疗前均有明显降低（P<0.01），且试验组明显低于对照组，差异有统计学意义（P<0.01）。 结论 针对阿帕替尼引起手足综合征，采用生肌活血方外用治疗，能起到较好的临床效果，促进患者症状的改善。

[关键词] 生肌活血方;外用;阿帕替尼;手足综合征;HFS分级;皮肤病生活质量指数

[中图分类号] R758.2          [文献标识码] B          [文章编号] 1673-9701（2021）16-0137-05

Analysis on the clinical efficacy of Shengji Huoxue Prescription on hand-foot syndrome caused by apatinib

XU Qi1， 2 DENG Dehou2， 3 ZHONG Fangming4

1.Department of Abdominal Oncology， Cancer Hospital of the University of Chinese Academy of Sciences （Zhejiang Cancer Hospital）， Hangzhou   310022， China; 2.Institute of Cancer and Basic Medicine， Chinese Academy of Sciences， Hangzhou   310022， China; 3.Department of Traditional Chinese Medicine， Cancer Hospital of the University of Chinese Academy of Sciences （Zhejiang Cancer Hospital）， Hangzhou   310022， China; 4.Department of Chest Surgery， Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine， Hangzhou   310003， China

[Abstract] Objective To investigate and analyze the clinical efficacy of Shengji Huoxue Prescription on hand-foot syndrome （HFS） caused by apatinib. Methods A total of 164 cancer patients with HFS caused by apatinib admitted to our hospital from November 2017 to October 2019 were selected as the study objects， and they were divided into the experimental group and the control group，with 82 cases in each group according to the random number table method. Patients in the control group were treated with urea cream applied to the affected area with a dose of 10 g/time，while those in the experimental group were treated with Shengji Huoxue Prescription for external treatment. 28 days were taken as a course of treatment. After a course of treatment， the changes of HFS classification and quality of life （QoL） index of patients with skin disease before and after treatment were compared between the two groups， and the clinical efficacy was counted. Results After treatment， the HFS classification of patients in both groups were improved more significantly than that before treatment（P<0.05）. And after treatment， the HFS classification of patients in the experimental group was better than that in the control group， with statistically significant difference （P<0.05）. The total effective rate in the experimental group was 80.49%，which was higher than that of 56.10% in the control group， with statistically significant difference（P<0.05）. After treatment， the dermatology life quality index （DLQI） scores between the two group， were significantly lower than those before treatment（P<0.01）. Meanwhile， the DLQI score in the experimental group was significantly lower than that in the control group， with statistically significant difference（P<0.01）. Conclusion In view of the HFS caused by apatinib， the external application of Shengji Huoxue Prescription can achieve better clinical efficacy and promote the improvement of patients′ symptoms.

[Key words] Shengji Huoxue Prescription; External use; Apatinib; Hand-foot syndrome; HFS classification; Dermatology life quality index

阿帕替尼属于抗血管生成抑制剂新药，是临床常用的靶向治疗药物[1]。其能与血管内皮生长因子受体-2（Recombinant vascular endothelial growth factor receptor 2，VGEFR-2）竞争性的结合，抑制VGEFR-2酪氨酸激酶的活性，从而阻断其与VGEFR结合的信号转导通路，抑制血管生成，发挥抗肿瘤功效[2]。阿帕替尼自2014年获批上市以来，在晚期胃癌、原发性肝癌等各种恶性肿瘤疾病的治疗中均获得了良好的应用效果，尤其对于晚期胃癌三線及以上的治疗效果显著[3]。阿帕替尼虽然化疗效果可观，能有效延长肿瘤患者的生存期限，但其存在一定的神经毒性、细胞毒性及皮肤毒性。既往临床研究[4]显示，阿帕替尼在口服给药时存在诸多的不良反应，如高血压、腹泻以及手足综合征等。其中手足综合征（Hand-foot syndrome，HFS）是一种化疗药物引发的特殊毒副反应类型之一[5-6]，属于特异性的皮肤及神经损伤综合征[7]。……