护骨消积方联合唑来膦酸治疗骨转移癌痛疗效及NTx水平与中医肾虚证候的相关性研究
2017,49(10):117-120
摘要：目的:观察护骨消积方联合唑来膦酸治疗骨转移癌痛的临床疗效,并探讨骨转移患者中医证型与Ⅰ型胶原交联氨基末端肽(NTx)水平的关联性。方法:将48例既往未接受过唑来膦酸治疗的新发骨转移癌痛患者,采用流行病学方法采集中医证候信息,按肾虚诊断标准判断有无肾虚证候,并检测患者血清NTx水平,统计分析NTx水平与中医肾虚证候的关联性。其中符合纳入标准的32例患者中,轻度疼痛18例,中重度疼痛14例,随机分为中药组和对照组各16例。中药组给予护骨消积方联合唑来膦酸治疗,对照组单纯使用唑来膦酸。治疗过程中若出现中重度疼痛者加服吗啡,治疗2月后观察患者的镇痛效果及生存质量KPS评分的改善。结果:31例肾虚证型的骨转移患者中,血清NTx(17.39±9.31)nmol BCE/L,17例非肾虚证型患者血清NTx(12.93±1.83)nmol BCE/L,差异有统计学意义(P<0.05)。符合纳入标准的32例患者中,2组疼痛疗效比较,中药组患者止痛总有效率81.3%,高于对照组56.3%,2组比较,差异无统计学意义(P>0.05)。治疗后,2组KPS评分分别与治疗前比较,差异均有统计学意义(P<0.05);治疗后,2组KPS评分比较,差异有统计学意义(P<0.05)。结论:骨转移癌痛患者的中医证型以肾虚多见,且肾虚证型与NTx水平之间有一定的关联性。护骨消积方联合唑来膦酸治疗恶性肿瘤骨转移癌痛具有一定的协同作用。
关键词：骨转移癌痛; 唑来膦酸; 护骨消积方; Ⅰ型胶原交联氨基末端肽(NTx); 中医肾虚证候;
Abstract：Objective：To observe thObjective：To observe the clinical effect of Hugu Xiaoji prescription combined with zoledronic acid for bone metastatic cancer pain，and to discuss the correlation between the level of N-telopeptides of type I collagen(NTx)and Chinese medicine(CM)kidney deficiency syndrome.Methods：Epidemiological method was used to collect CM syndrome information of 48 cases of patients with new-onset bone metastatic cancer pain who had not been treated with zoledronic acid in the past，and the diagnostic criteria was employed to determine kidney deficiency syndrome in patients.Detected serum NTx levels of patients，and analyzed the correlation between the NTx level and CM kidney deficiency syndrome.Among the 32 cases of patients according with standards，there were 18 cases of mild pain and 14 cases of moderate pain.All the 32 cases of patients were divided into the CM group and the control group randomly，16 cases in each group.The CM group was treated with Hugu Xiaoji prescription combined with zoledronic acid，while the control group was only treated with zoledronic acid.Morphine would be added to the treatment if any case of severe pain occurred during the course.After two months of treatment，observed the analgesic effect and the improvement of Karnofsky performance status(KPS)score in both groups.Results：Among the 31 cases of patients with bone metastatic cancer pain with kidney deficiency syndrome，the serum NTx levels were(17.39±9.31)nmol BCE/L，and serum levels of 17 cases of patients without kidney deficiency syndrome were(12.93±1.83)nmol BCE/L，the difference being significant(P＜0.05).Among the 32 cases of patients accordingwith standards，the total effective rate of analgesia was 81.3%in the CM group，being higher than 56.3%in the control group，there being no significance in the difference(P＞0.05).After treatment，compared KPS scores in both groups with those before treatment，differences were significant(P＜0.05)；after treatment，the comparison of KPS score between the two groups showed significance in the difference(P＜0.05).Conclusion：Kidney deficiency is the major CM syndrome of patients with bone metastatic cancer pain，and the NTx level and CM kidney deficiency syndrome is correlative.The therapy of Hugu Xiaoji prescription combined with zoledronic acid for bone metastatic malignant cancer pain has certain synergistic effect.e clinical effect of Yanbu Ciying therapy for chronic pharyngitis.Methods：Divided 100 cases of patients with chronic hypertrophic pharyngitis into the observation group and the control group randomly，50 cases ineach group.The observation group was treated with Yanbu Ciying therapy(bloodletting after acupuncture at the affected area)，while the control group was treated with cefdinir capsules orally.Both groups received treatment for two courses.Observed changes of symptoms and signs as well as the clinical effect in both groups.Results：After treatment，compared the total effective rate of clinical effect between the two groups，the difference was significant(P＜0.05)，which indicated that the curative effect in the observation group was superior to that in the control group.After treatment，improvements of symptoms and signs in both groups were improved when compared with those before treatment，differences being significant(P＜0.05).Compared the improvements of symptoms and signs in the observation group with those in the control group，differences were significant(P＜0.05).The observation group was superior to the control group.Conclusion：Upon clinical observation，Yanbu Ciying therapy for chronic hypertrophic pharyngitis has exact curative effect and can be further applied in clinical practice.
Key words：Bone metastatic cancer pain；Zoledronic acid；Hugu Xiaoji prescription；N-telopeptides of type I collagen(NTx)；Chinese medicine kidney deficiency syndrome
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