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Article(id=1322923204712465156, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.03.045, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339070728, onlineDateStr=2026-10-30, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339070728, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339070728, creator=13701087609, updateTime=1793339070728, updator=13701087609, issue=Issue{id=1322923011518628427, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='3', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1741536000000', pubDateStr='2025-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339024666, creator='13701087609', updateTime=1793340602374, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929628976906432, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929628981100737, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=231, endPage=234, ext={EN=ArticleExt(id=1322923204955734789, articleId=1322923204712465156, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Curative Effect of Interventional Radiofrequency Ultrasound Ablation Combined with Lianqi Decoction（莲芪煎剂）in Treatment of Primary Liver Cancer, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the effect of ultrasound interventional radiofrequency ablation combined with Lianqi Decoction（莲芪煎剂）on the short-term clinical efficacy，tumor marker levels and immune function indexes of patients with primary liver cancer.

Methods

A total of 90 patients with primary liver cancer who were treated in the hospital from June 2018 to June 2020 were retrospectively selected as the research subjects. According to the different treatment plans of the patients，they were divided into a routine group and an observation group with 55 cases in each group. The routine group was treated with radiofrequency ablation，and the observation group was treated with Lianqi Decoction on the basis of the routine group. The short-term efficacy，expression levels of serum T lymphocyte subsets，expression levels of serum seed bulb markers，liver function，liver hardness and safety of the two groups were observed and compared.

Results

The short-term clinical total effective rate of the observation group was significantly higher than that of the conventional group（P<0.05）. After treatment，the levels of alpha fetoprotein（AFP），carcinoembryonic antigen（CEA）and carbohydrate antigen 199（CA199）in the observation group were significantly lower than those in the conventional group（P<0.05）. After treatment，the levels of CD3+ and CD4+ in the observation group were higher than those in the conventional group，and CD8+ was lower than those in the conventional group（P<0.05）. After treatment，the levels of alanine transaminase（ALT），aspartate transaminase（AST）and total bilirubin（TBIL）in the observation group were lower than those in the conventional group（P<0.05）. The incidence of total adverse reactions in the observation group was significantly lower than that in the conventional group（P<0.05）. After treatment，the liver stiffness measurernents（LSM）value of the observation group was better than that of the conventional group（P<0.05）. The patients in the observation group were better than those in the conventional group at 2 years follow-up（P<0.05）.

Conclusion

Ultrasound interventional radiofrequency ablation combined with Lianqi Decoction has better short-term clinical treatment effect on patients with primary liver cancer，which can significantly improve the expression levels of tumor markers，liver elasticity and liver function，and has a good clinical effect. application prospects.

, authors=Wenjuan HE, Zhiyong GUO, Lei WU, Yingqi LI, authorsList=Wenjuan HE, Zhiyong GUO, Lei WU, Yingqi LI, authorCompany=null, correspAuthors=Yingqi LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322923206562153232, articleId=1322923204712465156, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=超声介入射频消融术联合莲芪煎剂治疗原发性肝癌疗效观察, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

探究超声介入射频消融术治疗联合莲芪煎剂对原发性肝癌患者的近期临床疗效、肿瘤标志物水平及免疫功能指标的影响。

方法

回顾性选取2018年6月—2020年6月医院收治的90例原发性肝癌患者，按照治疗方案不同分为常规组和观察组各55例，其中常规组采取射频消融术治疗，观察组在常规组的基础上联合使用莲芪煎剂治疗。观察对比两组患者的近期疗效情况、血清T淋巴细胞亚群表达水平、血清种球标志物表达水平、肝功能、肝脏硬度及安全性情况。

结果

观察组的近期临床总有效率显著高于常规组（P<0.05）。治疗后，观察组患者的甲胎蛋白（Alpha fetoprotein，AFP）、血清癌胚抗原（Carcinoembryonic antigen，CEA）、糖类抗原199（Carbohydrate antigen199，CA199）水平明显低于常规组患者（P<0.05）。治疗后，观察组患者的CD3+、CD4+高于常规组，CD8+低于常规组（P<0.05）。治疗后，观察组患者的ALT、AST、TBIL低于常规组（P<0.05）。观察组患者的总不良反应发生率显著低于常规组（P<0.05）。治疗后，观察组患者的LSM值优于常规组（P<0.05）。观察组患者两年内随访情况较常规组更佳（P<0.05）。

结论

超声介入射频消融术治疗联合莲芪煎剂对原发性肝癌患者的近期临床治疗效果更佳，能够显著改善患者的肿瘤标志物表达水平，改善肝脏弹性和肝功能情况，具有较好的临床应用前景。

, authors=贺文娟, 郭志勇, 武磊, 李瑛琪, authorsList=贺文娟, 郭志勇, 武磊, 李瑛琪, authorCompany=null, correspAuthors=李瑛琪, authorNote=

贺文娟（1982-），女，山西运城人，副主任医师，硕士，研究方向：超声引导下的介入治疗

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李瑛琪（1976-），男，山西运城人，副主任医师，硕士，研究方向：超声引导下的介入治疗。E-mail：。
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贺文娟（1982-），女，山西运城人，副主任医师，硕士，研究方向：超声引导下的介入治疗

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贺文娟（1982-），女，山西运城人，副主任医师，硕士，研究方向：超声引导下的介入治疗

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Cancers（Basel），2019，11（8）：1054., articleTitle=Astragalus polysaccharide（PG2）ameliorates cancer symptom clusters，as well as improves quality of life in patients with metastatic disease，through modulation of the inflammatory cascade, refAbstract=null)], funds=[Fund(id=1322923214015431496, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, awardId=2020XM59, language=CN, fundingSource=山西省医学重点科研项目(2020XM59), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322923206906086161, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, xref=null, ext=[AuthorCompanyExt(id=1322923206914474770, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, companyId=1322923206906086161, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Yuncheng Central Hospital，Yuncheng 044000，Shanxi，China), AuthorCompanyExt(id=1322923206935446291, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, companyId=1322923206906086161, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=运城市中心医院，山西 运城 044000)])], figs=[ArticleFig(id=1322923211066835767, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=EN, label=null, caption=null, figureFileSmall=xbWCngQD/WIoLo8RnlCLpg==, figureFileBig=6k/3jJ+bKu9qShQWJUipCw==, tableContent=null), ArticleFig(id=1322923211142333240, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=CN, label=图1, caption=两组原发性肝癌患者治疗随访24个月生存曲线情况, figureFileSmall=xbWCngQD/WIoLo8RnlCLpg==, figureFileBig=6k/3jJ+bKu9qShQWJUipCw==, tableContent=null), ArticleFig(id=1322923213033964347, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数CR/（例）PR/（例）SD/（例）PD/（例）有效率/（%）
观察组4518214239/45（86.67）
常规组45121611628/45（62.22）
χ2值5.923
P值0.007
), ArticleFig(id=1322923213130433339, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=CN, label=表1, caption=

两组原发性肝癌患者治疗后的临床疗效对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数CR/（例）PR/（例）SD/（例）PD/（例）有效率/（%）
观察组4518214239/45（86.67）
常规组45121611628/45（62.22）
χ2值5.923
P值0.007
), ArticleFig(id=1322923213197542204, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间AFP/（ng/mL）CEA/（ng/mL）CA199/（μ/mL）
观察组45治疗前834.72±105.426.92±1.9335.91±6.81
治疗后274.61+58.59*#2.36±0.92*#23.42±3.65*#
常规组45治疗前812.99±118.726.84±1.9638.47±7.32
治疗后456.71±89.35*4.13±1.18*28.74±4.25*
), ArticleFig(id=1322923213273039677, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=CN, label=表2, caption=

两组原发性肝癌患者治疗前后血清肿瘤标志物表达水平

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间AFP/（ng/mL）CEA/（ng/mL）CA199/（μ/mL）
观察组45治疗前834.72±105.426.92±1.9335.91±6.81
治疗后274.61+58.59*#2.36±0.92*#23.42±3.65*#
常规组45治疗前812.99±118.726.84±1.9638.47±7.32
治疗后456.71±89.35*4.13±1.18*28.74±4.25*
), ArticleFig(id=1322923213348537150, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间
观察组45治疗前50.37±6.2128.73±5.7227.45±3.27
治疗后67.47±4.96*#42.92±5.79*#18.73±1.95*#
常规组45治疗前50.92±6.3128.58±5.9127.61±3.18
治疗后58.76±5.42*37.14±4.94*22.48±2.46*
), ArticleFig(id=1322923213424034625, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=CN, label=表3, caption=

两组原发性肝癌患者治疗前后免疫功能对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间
观察组45治疗前50.37±6.2128.73±5.7227.45±3.27
治疗后67.47±4.96*#42.92±5.79*#18.73±1.95*#
常规组45治疗前50.92±6.3128.58±5.9127.61±3.18
治疗后58.76±5.42*37.14±4.94*22.48±2.46*
), ArticleFig(id=1322923213495337794, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间ALT/（U/L）AST/（U/L）TBIL/（μmol/L）
观察组45治疗前69.24±10.3944.49±4.2719.93±2.39
治疗后49.14±6.29*#26.18±1.97*#10.18±1.25*#
常规组45治疗前69.73±10.5244.52±4.2319.89±2.42
治疗后56.42±9.92*34.27±2.31*14.24±1.19*
), ArticleFig(id=1322923213579223875, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=CN, label=表4, caption=

两组原发性肝癌患者治疗前后肝功能情况对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间ALT/（U/L）AST/（U/L）TBIL/（μmol/L）
观察组45治疗前69.24±10.3944.49±4.2719.93±2.39
治疗后49.14±6.29*#26.18±1.97*#10.18±1.25*#
常规组45治疗前69.73±10.5244.52±4.2319.89±2.42
治疗后56.42±9.92*34.27±2.31*14.24±1.19*
), ArticleFig(id=1322923213667304260, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数肝区疼痛恶心呕吐上消化道出血发热总不良反应率/（%）
观察组451732224/45（53.33）
常规组452285237/45（82.22）
χ2值12.735
P值0.000
), ArticleFig(id=1322923213755384645, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=CN, label=表5, caption=

两组原发性肝癌患者治疗期间不良反应对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数肝区疼痛恶心呕吐上消化道出血发热总不良反应率/（%）
观察组451732224/45（53.33）
常规组452285237/45（82.22）
χ2值12.735
P值0.000
), ArticleFig(id=1322923213830882118, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后t值P值
观察组4534.23±4.8224.54±3.758.2120.000
常规组4533.98±4.7929.13±4.526.7210.009
t值0.4594.974
P值0.5510.001
), ArticleFig(id=1322923213914768199, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923204712465156, language=CN, label=表6, caption=

两组原发性肝癌患者治疗前后肝脏LSM值对比

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后t值P值
观察组4534.23±4.8224.54±3.758.2120.000
常规组4533.98±4.7929.13±4.526.7210.009
t值0.4594.974
P值0.5510.001
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超声介入射频消融术联合莲芪煎剂治疗原发性肝癌疗效观察
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贺文娟 , 郭志勇 , 武磊 , 李瑛琪
中华中医药学刊 | 省级项目平台 2025,43(3): 231-234
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中华中医药学刊 |省级项目平台 2025 , 43 (3) : 231 -234
超声介入射频消融术联合莲芪煎剂治疗原发性肝癌疗效观察
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贺文娟, 郭志勇, 武磊, 李瑛琪
作者信息
  • 运城市中心医院，山西 运城 044000
通讯作者:
李瑛琪（1976-），男，山西运城人，副主任医师，硕士，研究方向：超声引导下的介入治疗。E-mail：。
作者简介:

贺文娟（1982-），女，山西运城人，副主任医师，硕士，研究方向：超声引导下的介入治疗

Curative Effect of Interventional Radiofrequency Ultrasound Ablation Combined with Lianqi Decoction（莲芪煎剂）in Treatment of Primary Liver Cancer
Wenjuan HE, Zhiyong GUO, Lei WU, Yingqi LI
Affiliations
  • Yuncheng Central Hospital，Yuncheng 044000，Shanxi，China
出版时间: 2025-03-10 doi: 10.13193/j.issn.1673-7717.2025.03.045
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摘要
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目的

探究超声介入射频消融术治疗联合莲芪煎剂对原发性肝癌患者的近期临床疗效、肿瘤标志物水平及免疫功能指标的影响。

方法

回顾性选取2018年6月—2020年6月医院收治的90例原发性肝癌患者，按照治疗方案不同分为常规组和观察组各55例，其中常规组采取射频消融术治疗，观察组在常规组的基础上联合使用莲芪煎剂治疗。观察对比两组患者的近期疗效情况、血清T淋巴细胞亚群表达水平、血清种球标志物表达水平、肝功能、肝脏硬度及安全性情况。

结果

观察组的近期临床总有效率显著高于常规组（P<0.05）。治疗后，观察组患者的甲胎蛋白（Alpha fetoprotein，AFP）、血清癌胚抗原（Carcinoembryonic antigen，CEA）、糖类抗原199（Carbohydrate antigen199，CA199）水平明显低于常规组患者（P<0.05）。治疗后，观察组患者的CD3+、CD4+高于常规组，CD8+低于常规组（P<0.05）。治疗后，观察组患者的ALT、AST、TBIL低于常规组（P<0.05）。观察组患者的总不良反应发生率显著低于常规组（P<0.05）。治疗后，观察组患者的LSM值优于常规组（P<0.05）。观察组患者两年内随访情况较常规组更佳（P<0.05）。

结论

超声介入射频消融术治疗联合莲芪煎剂对原发性肝癌患者的近期临床治疗效果更佳，能够显著改善患者的肿瘤标志物表达水平，改善肝脏弹性和肝功能情况，具有较好的临床应用前景。

原发性肝癌  /  超声介入治疗  /  射频消融术  /  莲芪煎剂  /  肿瘤标志物  /  肝弹性
Objective

To investigate the effect of ultrasound interventional radiofrequency ablation combined with Lianqi Decoction（莲芪煎剂）on the short-term clinical efficacy，tumor marker levels and immune function indexes of patients with primary liver cancer.

Methods

A total of 90 patients with primary liver cancer who were treated in the hospital from June 2018 to June 2020 were retrospectively selected as the research subjects. According to the different treatment plans of the patients，they were divided into a routine group and an observation group with 55 cases in each group. The routine group was treated with radiofrequency ablation，and the observation group was treated with Lianqi Decoction on the basis of the routine group. The short-term efficacy，expression levels of serum T lymphocyte subsets，expression levels of serum seed bulb markers，liver function，liver hardness and safety of the two groups were observed and compared.

Results

The short-term clinical total effective rate of the observation group was significantly higher than that of the conventional group（P<0.05）. After treatment，the levels of alpha fetoprotein（AFP），carcinoembryonic antigen（CEA）and carbohydrate antigen 199（CA199）in the observation group were significantly lower than those in the conventional group（P<0.05）. After treatment，the levels of CD3+ and CD4+ in the observation group were higher than those in the conventional group，and CD8+ was lower than those in the conventional group（P<0.05）. After treatment，the levels of alanine transaminase（ALT），aspartate transaminase（AST）and total bilirubin（TBIL）in the observation group were lower than those in the conventional group（P<0.05）. The incidence of total adverse reactions in the observation group was significantly lower than that in the conventional group（P<0.05）. After treatment，the liver stiffness measurernents（LSM）value of the observation group was better than that of the conventional group（P<0.05）. The patients in the observation group were better than those in the conventional group at 2 years follow-up（P<0.05）.

Conclusion

Ultrasound interventional radiofrequency ablation combined with Lianqi Decoction has better short-term clinical treatment effect on patients with primary liver cancer，which can significantly improve the expression levels of tumor markers，liver elasticity and liver function，and has a good clinical effect. application prospects.

primary liver cancer  /  ultrasound interventional therapy  /  radiofrequency ablation  /  Lianqi Decoction  /  tumor markers  /  liver elasticity
贺文娟, 郭志勇, 武磊, 李瑛琪. 超声介入射频消融术联合莲芪煎剂治疗原发性肝癌疗效观察. 中华中医药学刊, 2025 , 43 (3) : 231 -234 . DOI: 10.13193/j.issn.1673-7717.2025.03.045
Wenjuan HE, Zhiyong GUO, Lei WU, Yingqi LI. Curative Effect of Interventional Radiofrequency Ultrasound Ablation Combined with Lianqi Decoction（莲芪煎剂）in Treatment of Primary Liver Cancer[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (3) : 231 -234 . DOI: 10.13193/j.issn.1673-7717.2025.03.045
正文
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近年来，伴随着环境恶化和人们生活方式的改变，临床中各类恶性肿瘤的发病率呈现逐年上升的趋势[1]，其中肝癌是临床中较为常见的疾病类型，在我国男性和女性中的发病率均排名靠前[2]，严重威胁着人们的生命安全和生存质量。在肝癌的诸多临床分型中，原发性肝癌最为多见，发病初期病情隐匿，因此早期诊断较为困难，患者就医时多数已经进入中晚期[3]，错过了最佳手术治疗时期。现阶段，介入治疗是临床中肝癌治疗的有效手段，主要包括动脉化疗灌注、经导管动脉化疗栓塞、动脉放疗栓塞、门静脉栓塞及非血管途径介入治疗等，均能在一定程度上起到治疗效果，帮助患者缓解疾病带来的痛苦[4-8]。超声介入射频消融术治疗是目前国外临床推荐的不可切除肝癌根治性治疗手段[9]，具有较好的操作性和安全性，且有研究认为其在患者术后长期生存方面与根治性切除术效果相当[10-11]。但随着在临床广泛开展应用，局部射频消融术治疗的弊端也随之越发明显，如较高的复发率、免疫功能下降、肝区疼痛等[12]，是影响患者预后生存质量的因素。本研究旨在探究超声介入射频消融术联合莲芪煎剂对原发性肝癌患者临床疗效情况的影响，现将相关情况汇报如下。
1　资料与方法
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1.1　一般资料
本研究符合《世界医学赫尔辛基宣言》对伦理学的相关要求。回顾性选取2018年6月至2020年6月我院收治的90例原发性肝癌患者，按照治疗方案的不同分为常规组和观察组各45例。其中观察组患者年龄35～70岁，平均（54.6±6.3）岁；男27例，女18例；病程0.75～5.5a，平均（2.75±1.29）a；肝功能Child分级A级12例，B级22例，C级11例；临床分型为弥漫型7例，结节型7例，巨块型31例。常规组患者年龄35～70岁，平均（53.5±6.6）岁；男25例，女20例；病程0.7～5.5a，平均（2.81±1.32）a；肝功能Child分级A级11例，B级24例，C级10例；临床分型为弥漫型8例，结节型7例，巨块型30例。两组一般资料比较均未见显著差异（P>0.05），具有可比性。
1.2　纳入标准
所有患者均符合《内科学》[13]对原发性肝癌的确诊要求，经病理细胞学检查、B超检查及MRI、生化等检查后进一步明确诊断，病灶数1～3个且单发病灶直径<5 cm，多发病灶直径<3 cm，初次发病，未接受过任何抗肿瘤治疗，半年内无手术史或长期住院史，预计生存周期6个月以上，卡氏评分≥60分，耐受性良好且符合肝癌介入治疗指征，不存在其他器质性疾病或全身疾病，无顽固性大量腹腔积液，免疫功能正常，具有良好的认知功能，随访依从性良好。排除标准：影像学检查发现患者存在血管侵袭或肝脏外转移者；不可纠正的凝血造血功能异常、严重感染、皮肤或黏膜损伤者；存在肝功能衰竭征象者；对本研究涉及的药物存在过敏史或使用禁忌证者；处在妊娠期或哺乳期的女性患者；存在精神病史或药物依赖史者。
1.3　方法
常规组患者采用经皮超声引导射频消融治疗，根据选择的穿刺位点，患者取平卧位或左侧卧位，根据术前超声、MRI检查等结果确定最佳穿刺点，常规消毒铺巾，1%利多卡因局部麻醉，待麻醉诱导成功后做2 mm左右的切口，然后进行介入穿刺，选用南京康友医疗科技有限公司的射频消融仪（输出功率0～100 W，可连续调节，配备5 mm和11 mm一次性水冷微波针，微波针表面覆盖特氟龙涂层）和深圳开立生物医疗科技股份有限公司的SSI-5500超声仪进行治疗，在超声影像指导下，沿病灶最边缘内侧0.5 mm处穿刺进入病灶，微波针略超过肿瘤远端，将射频消融机功率调至80～100 W进行消融治疗，保持1 cm的安全边界。术后口服还原型谷胱甘肽片1200 mg/d。
观察组在常规组的基础上给予莲芪煎剂，每日1剂，分三次于饭后口服。配伍组成：半枝莲20 g，黄芪15 g，人参12 g，莪术12 g，浙贝母12 g，白术12 g，当归10 g，女贞子12 g，三棱12 g，败酱草15 g，薏苡仁15 g，甘草8 g，水蛭8 g。每剂药用水1000 mL煎煮三次，最终得到了500 mL的混合药液，晾凉服用。
1.4　观察指标
分别于患者治疗前和治疗3个月后抽取外周空腹静脉血7 mL，EDTA抗凝管储存，3000 r/min分离，采用化学发光法测定血清癌胚抗原（Carcinoembryonic antigen，CEA）表达水平。采用酶联免疫吸附法测定糖类抗原199（Carbohydrate antigen199，CA199）和甲胎蛋白（Alpha fetoprotein，AFP）含量水平。采用双抗体夹心酶联免疫吸附法测定外周血清谷丙转氨酶（alanine transaminase，ALT）、谷草转氨酶（aspartate transaminase，AST）和总胆红素（total bilirubin，TBIL）含量水平。采用流式细胞学检测治疗前后两组血清中CD3+、CD4+、CD8+含量水平。采用武汉盛世达医疗设备有限公司提供的瞬时弹性成像扫描仪进行检测患者的肝弹性情况，以肝硬度值（LSM）表示肝脏弹性程度，LSM值越高表示肝脏弹性越差。记录两组患者治疗期间的不良反应和安全性情况。
1.5　疗效判断标准
根据实体瘤疗效评价标准评价患者的近期疗效情况，将其分为完全缓解（CR）、部分缓解（PR）、稳定（SD）、进展（PD），其中CR：影像学检查发现患者的全部病灶消失且维持4周以上；PR：影像学检查发现肿瘤体积缩小30%以上且持续4周以上；SD：影像学检查发现肿瘤体积减小不足30%或增大不超过20%；PD：影像学检查提示肿瘤体积增大超过20%。近期临床有效率＝（CR+PR）/总患者数×100%。
1.6　统计学方法
采用SPSS 22.0软件进行统计学分析。呈正态分布的计量资料以表示，呈偏态分布的计量资料以中位数（范围）表示，计数资料以［例（%）］表示，均以P<0.05表示差异存在统计学意义。
2　结果
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2.1　两组患者治疗后近期疗效情况
观察组的临床总有效率显著高于常规组，差异对比具有统计学意义（P<0.05）。详见表1。
2.2　两组患者术前术后血清肿瘤标志物水平对比
治疗后，两组患者的AFP、CEA、CA199水平较治疗前显著降低，同时观察组低于常规组患者，差异具有统计学意义（P<0.05）。见表2。
2.3　两组患者治疗前后免疫功能情况对比
治疗后两组患者的CD3+、CD4+均明显升高，CD8+显著降低，且观察组的升高或降低幅度较常规组更明显，差异对比具有统计学意义（P<0.05）。详见表3。
2.4　两组患者治疗前后肝功能情况
治疗后，两组患者的ALT、AST、TBIL均得到了显著的降低，其中观察组较常规组更低，差异对比具有统计学意义（P<0.05）。见表4。
2.5　治疗期间两组不良反应对比
观察组患者的总不良反应发生率显著低于常规组，差异对比具有统计学意义（P<0.05）。见表5。
2.6　两组患者治疗前后肝脏弹性情况对比
治疗后两组患者的LSM值均在一定程度上得到了改善，其中观察组较常规组改善情况更佳，差异对比具有统计学意义（P<0.05）。见表6。
2.7　随访情况及生存曲线
本研究对两组患者进行了为期24个月的随访，观察组失访12例，常规组失访13例，治疗后6个月内两组随访病例生存状况良好，观察组的一年内生存率、二年内生存率分别为100%、84.85%，常规组一年内生存率、二年内生存率分别为81.25%、78.13%，差异对比具有统计学意义（P=0.012、0.007）。患者的生存情况见插页ⅩⅩⅩⅥ图1。
3　结论与讨论
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肝癌具有较高的恶化程度和较低的完全治愈率，多数患者往往错过了最佳手术治疗时期，不得不选择化疗、放疗、介入治疗等手段进行干预。介入治疗中的消融治疗通过极性分子的高速运行产生的局部高温对癌细胞进行消融破坏，以此抑制肿瘤的生长[14]。临床研究发现，虽然多数符合米兰标准的肝细胞癌症的患者在接受消融治疗后能取得一定的临床疗效，但患者术后仍具有较高的复发率，3年内生存率仅约49%～77%[15-17]。中医认为本病主要由脏腑气血虚亏，脾虚湿聚，痰凝血瘀；六淫邪毒入侵，邪凝毒结，七情内伤，情志抑郁等，可使气、血、湿、热、瘀、毒互结而成肝癌。本病病位在肝，与脾、胆、胃密切相关，主要病机是正虚于内，邪毒蕴结。中医的治疗主要是以扶正散结为主，通过一些活血化瘀，消痛散结等的疗法，抑制肿瘤的生长速度。
对于肝癌等恶性肿瘤患者而言，尽可能获得长期生存是其最大诉求。消融治疗的总生存率与外科切除并无明显差异，尤其是早期小肝癌。尽管外科手术一直视为肝癌局部治愈的首选方式，但其术后较重的并发症和手术相关病死率明显高于消融治疗。从治疗后患者的生活质量来看，局部消融的优势更为显著。在影像（超声/CT）引导下，我们可以通过经皮穿刺快速完成整个医疗消融过程，即患者当天入院、当天治疗，次日无特殊情况后即出院。这不仅大大降低了治疗费用，同时也显著提高了病床使用率和周转率。消融治疗在减少复发和残留的同时，最大限度保留了患者赖以生存的肝脏组织。当然，消融治疗也存在不少缺陷，如目前很多医院消融治疗技术、辅助手段以及全程临床管理模式较为单一，并未将消融治疗作为一个体系加以建设，因此在技术手段等较为单薄条件下，很难达到肝癌、高危部位肿瘤、多发性肿瘤等复杂肿瘤的安全、彻底消融，因此未来必须持续加强临床治疗的体系化建设。
近年来中医药在癌症的治疗方面的疗效也愈发显著，虽然中医学并无癌症或肿瘤的病名，但在临床实践中发现固本扶正、清热解毒、活血化瘀等类型的中药，多在抗肿瘤方面具有药理毒理作用[18-19]。莲芪煎剂主要由黄芪、人参、半枝莲、当归、白术、女贞子、莪术、水蛭、莪术、薏苡仁、甘草等中药组成，主要疗效为补气行血、活血化瘀、散结解毒等，能够调整机体的阴阳平衡并扶正祛邪，既往临床中有团队运用成药莲芪胶囊治疗肺癌、食道癌等疾病，具有一定的临床应用效果[20-22]，但针对肝癌患者的临床疗效及肿瘤指标的相关研究较少。
CEA是一种非器官特异性肿瘤标志物，研究发现CEA在多种肿瘤患者体内的表达上调；而CA199作为类黏蛋白中糖蛋白成分，在肝癌及肝良性病变和多种癌症、机体炎症时表达会提升；AFP则是一种诊断肝癌最常用的肿瘤标志物，已有大量研究和文献指出这3种肿瘤标志物的检测对肝癌的诊断、预后研究具有重要价值[23]。作为肝脏功能情况的主要监测指标，ALT、AST、TBIL能较为客观地反映肝脏功能情况，且与肝癌的预后具有相关性[24]。T淋巴细胞亚群的分布水平，是反映患者机体免疫情况的指标[25]。由于癌症患者多自身免疫功能存在下降问题，在接受治疗后免疫功能也会受到不同程度的影响，因此癌症患者的免疫情况需格外重视。
结合本次研究结果来看，观察组的近期临床总有效率显著高于常规组（P<0.05）。治疗后，观察组患者的AFP、CEA、CA199水平明显低于常规组患者（P<0.05）。治疗后，观察组患者的CD3+、CD4+高于常规组，CD8+低于常规组（P<0.05）。治疗后，观察组患者的ALT、AST、TBIL低于常规组（P<0.05）。观察组患者的总不良反应发生率显著低于常规组（P<0.05）。治疗后，观察组患者的LSM值优于常规组（P<0.05）。观察组患者两年内随访情况较常规组更佳（P<0.05）。说明了观察组患者治疗效果更佳，患者受益效果更好。从现代药理研究角度来看，观察组应用的莲芪煎剂中，人参含有人参皂苷Rg3，具有抗肿瘤的药理活性，黄芪中含有的黄芪多糖也具有辅助治疗癌症的效果[26-27]。
莲芪煎剂作为治疗肺癌、肝癌、食道癌属毒蕴血瘀兼正虚证患者放、化疗时的合并用药，可以减轻放、化疗引起的免疫功能低下，白细胞降低，并具有一定的增效作用。莲芪煎剂含有半枝莲，可清热、解毒、散瘀、止血、利尿消肿，定痛。据研究发现，半枝莲抗癌的作用是比较强的，在肿瘤组织培养液内对从人体采取的直肠癌、结肠癌等的癌组织均有意气风发癌作用；水煎剂对培养稳定宫颈癌细胞株分离的Hela细胞有破坏作用。黄芪有效成分可显著降低蛋白尿，减少肾小球滤过屏障的免疫损伤。人参味甘，大补元气，止渴生津，调营养卫。莪术具有行气破血，消积止痛。浙贝母苦泻寒清，清热化痰，开郁散结。白术增强益卫固表之功，可抗氧化、抗炎改善组织损伤。当归可养血活血，养血与祛瘀同施，使活血而无耗血之虑。女贞子具有滋补肝肾、明目乌发的功效。三棱能破血行气、消积止痛，用于癥瘕痞块、瘀血经闭、食积胀痛；且三棱及其提取物具有抗血栓、抑制血小板聚集和镇痛等多种药理活性。败酱草含败酱皂苷和β-甾醇葡萄糖苷，有抗炎、抗菌、镇静、保肝和强心利尿的作用。薏苡仁健脾泄热、燥湿解毒。甘草调和诸药。诸药合用，药效相应，共奏益气养阴、清热解毒、利水消肿之功。水蛭是最强的凝血酶特效抑制剂之一，它与凝血酶迅速结合，抑制血液凝固，同时降低全血黏度、纤维蛋白原、高血脂等。原发性肝癌患者服用莲芪煎剂，可使病灶局限，有效控制肿瘤生长、转移和扩散，促肿瘤细胞凋亡的同时引导肿瘤细胞向正常细胞分化，调动机体自身免疫功能杀伤肿瘤；稳定病情，改善患者的恶病质状态，提高生存质量，延长生存期。
但本研究也具有一定的局限性，作为单一中心小样本研究，数据可能存在较大的偏差性。研究尚未展开双盲试验进行真实性研究。研究未进行3年以上的长期随访。这些将是本研究团队未来开展纵向研究的方向。
综上所述，超声介入射频消融术治疗联合莲芪煎剂对原发性肝癌患者的近期临床治疗效果更佳，能够显著改善患者的肿瘤标志物表达水平，改善肝脏弹性和肝功能情况，具有较好的临床应用前景。
基金
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  • 山西省医学重点科研项目(2020XM59)
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2025年第43卷第3期
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doi: 10.13193/j.issn.1673-7717.2025.03.045
  • 首发时间：2026-10-30
  • 出版时间：2025-03-10
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山西省医学重点科研项目(2020XM59)
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    运城市中心医院，山西 运城 044000

通讯作者:

李瑛琪（1976-），男，山西运城人，副主任医师，硕士，研究方向：超声引导下的介入治疗。E-mail：。
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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