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Objective

To analyze the clinical effect of Shenqi Fuzheng Kang’ai Decoction(参芪扶正抗癌汤)combined with bevacizumab in the treatment of advanced colorectal cancer with Qiand blood deficiency syndrome.

Methods

The clinical data of 98 patients with advanced colorectal cancer who were admitted to the Affiliated Hospital of Nantong University from January 2022 to January 2024 was retrospectively analyzed.According to the treatment methods,they were divided into the conventional group(48 cases)and the combined group(50 cases).Both groups were treated with XELOX chemotherapy.The conventional group was treated with bevacizumab,and the combined group was treated with Shenqi Fuzheng Kang’ai Decoction on this basis.The TCM syndrome score,tumor markers,T lymphocyte subsets,chemotherapy tolerance and quality of life score,clinical efficacy,adverse reactions and survival analysis of the two groups were observed.

RESULT

After treatment,the TCM syndrome score and the levels of carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),alpha-fetoprotein(AFP)and cytokeratin 19 fragment antigen 21-1(CYFRA21-1)in the combined group were lower than those in the conventional group(P<0.05).The levels of CD3+and CD4+,the ratio of CD4+/CD8+,the scores of Karnofsky performance scale(KPS)and World Health Organization Quality of Life-BREF(WHOQOL-BREF)and the total effective rate in the combined group were higher than those in the conventional group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).The progression-free survival(PFS)of the combined group was longer than that of the conventional group(P<0.05).

CONCLUSION

Shenqi Fuzheng Kang’ai Decoction combined with bevacizumab in the treatment of advanced colorectal cancer with Qi and blood deficiency syndrome can effectively relieve the clinical symptoms of patients,improve the immunity,reduce the levels of tumormarkers,improve the clinical efficacy and quality of life,prolong the survival of patients,and has high safety.

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目的

分析参芪扶正抗癌汤联合贝伐珠单抗在气血两虚证晚期肠癌中的临床效果。

方法

对南通大学附属医院2022年1月—2024年1月收治的98例晚期肠癌患者的临床资料进行回顾性分析,按照治疗方法分成常规组(48例)与联合组(50例)。两组患者均采用XELOX化疗方案,常规组接受贝伐珠单抗治疗,联合组在此基础上加用参芪扶正抗癌汤口服治疗。观察两组患者的中医证候积分、肿瘤标志物、T淋巴细胞亚群、化疗耐受性与生存质量评分、临床疗效、不良反应及生存分析。

结果

治疗后,联合组中医证候积分、甲胎蛋白(alpha-fetoprotein,AFP)、癌胚抗原(carcino-embryonic antigen,CEA)、糖类抗原125(Carbohydrate antigen 125,CA125)、细胞角蛋白19片段抗原21-1(Cytokeratin 19 fragment antigen 21-1,CYFRA21-1)水平均低于常规组(P<0.05);联合组CD3+、CD4+水平与CD4+/CD8+比值、卡氏评分(Karnofsky performance score,KPS)、世界卫生组织生存质量测定量表简表(World Health Organization Quality of Life-BREF,WHOQOL-BREF)评分及治疗总有效率均高于常规组(P<0.05);两组不良反应总发生率差异无统计学意义(P>0.05);联合组无进展生存期(Progression-Free Survival,PFS)长于常规组(P<0.05)。

结论

参芪扶正抗癌汤联合贝伐珠单抗治疗可有效改善气血两虚证晚期肠癌患者临床症状,提高免疫力,降低肿瘤标志物水平,提高生活质量,延长生存期限,疗效明确且安全性较高。

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陆芳芳(1983-),女,江苏南通人,副主任医师,博士,研究方向:中医内科肾脏病以及老年衰老性疾病。

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陆芳芳(1983-),女,江苏南通人,副主任医师,博士,研究方向:中医内科肾脏病以及老年衰老性疾病。

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refAbstract=null), Reference(id=1256183465289106278, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, doi=null, pmid=null, pmcid=null, year=2022, volume=40, issue=2, pageStart=248, pageEnd=251, url=null, language=null, rfNumber=[24], rfOrder=23, authorNames=廖德贵, 曾嘉敏, 赖妙玲, journalName=中华中医药学刊, refType=null, unstructuredReference=廖德贵,曾嘉敏,赖妙玲,. 白花蛇舌草提取物通过下调Hippo-YAP信号通路促进结肠癌细胞凋亡[J]. 中华中医药学刊202240(2):248-251., articleTitle=白花蛇舌草提取物通过下调Hippo-YAP信号通路促进结肠癌细胞凋亡, refAbstract=null), Reference(id=1256183465645622124, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, doi=null, pmid=null, pmcid=null, year=2022, volume=54, issue=21, pageStart=149, pageEnd=155, url=null, language=null, rfNumber=[25], rfOrder=24, authorNames=朱丹烨, 吴美美, 邓娟, journalName=新中医, refType=null, unstructuredReference=朱丹烨,吴美美,邓娟,. 基于转录组测序探讨白花蛇舌草-半枝莲提取物抗结直肠癌作用机制[J]. 新中医202254(21):149-155., articleTitle=基于转录组测序探讨白花蛇舌草-半枝莲提取物抗结直肠癌作用机制, 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companyName=null, departmentName=null, remark=南通大学附属医院,江苏 南通 226300)])], figs=[ArticleFig(id=1256183423203459452, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=EN, label=null, caption=null, figureFileSmall=O4miy/OCpPiccEiaRYyphA==, figureFileBig=M3q+/aklhw24St6grUcwpA==, tableContent=null), ArticleFig(id=1256183424130400647, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=CN, label=图1, caption=两组晚期肠癌患者生存率曲线图, figureFileSmall=O4miy/OCpPiccEiaRYyphA==, figureFileBig=M3q+/aklhw24St6grUcwpA==, tableContent=null), ArticleFig(id=1256183428383424934, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症次症
治疗前治疗后治疗前治疗后
常规组4813.12±2.157.29±1.25*20.49±3.5413.37±2.26*
联合组5012.48±1.895.36±1.04*19.51±3.718.76±2.45*
t1.5678.3221.3379.671
P0.120<0.0010.184<0.001
), ArticleFig(id=1256183430069535153, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=CN, label=表1, caption=

两组晚期肠癌患者中医证候积分比较(

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数主症次症
治疗前治疗后治疗前治疗后
常规组4813.12±2.157.29±1.25*20.49±3.5413.37±2.26*
联合组5012.48±1.895.36±1.04*19.51±3.718.76±2.45*
t1.5678.3221.3379.671
P0.120<0.0010.184<0.001
), ArticleFig(id=1256183431373963712, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数AFP/(ng/mL)CEA/(μg/mL)CA125/(U/mL)CYFKA21-1/(μg/L)
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
常规组487.43±1.634.53±0.61*17.98±3.248.76±2.13*85.16±14.28 70.28±10.35*7.47±1.233.87±0.65*
联合组507.85±1.463.58±0.45*18.91±3.155.59±1.34*88.32±16.76 61.08±9.97*7.89±1.593.09±0.72*
t1.3458.7981.4418.8561.3204.4821.4585.622
P0.182<0.0010.153<0.0010.190<0.0010.148<0.001
), ArticleFig(id=1256183432074412487, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=CN, label=表2, caption=

两组晚期肠癌患者肿瘤标志物比较(

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数AFP/(ng/mL)CEA/(μg/mL)CA125/(U/mL)CYFKA21-1/(μg/L)
治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后
常规组487.43±1.634.53±0.61*17.98±3.248.76±2.13*85.16±14.28 70.28±10.35*7.47±1.233.87±0.65*
联合组507.85±1.463.58±0.45*18.91±3.155.59±1.34*88.32±16.76 61.08±9.97*7.89±1.593.09±0.72*
t1.3458.7981.4418.8561.3204.4821.4585.622
P0.182<0.0010.153<0.0010.190<0.0010.148<0.001
), ArticleFig(id=1256183432573534669, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数CD3+/(%)CD4+/(%)CD4+/CD8+
治疗前治疗后治疗前治疗后治疗前治疗后
常规组4847.39±4.5851.17±6.08*32.18±3.8935.31±5.16*1.27±0.201.54±0.26*
联合组5048.74±5.0256.95±6.25*30.97±4.0441.47±5.67*1.21±0.221.76±0.30*
t1.3894.6381.5095.6181.4113.873
P0.168<0.0010.134<0.0010.161<0.001
), ArticleFig(id=1256183433366258132, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=CN, label=表3, caption=

对比两组晚期肠癌患者实验室指标(

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数CD3+/(%)CD4+/(%)CD4+/CD8+
治疗前治疗后治疗前治疗后治疗前治疗后
常规组4847.39±4.5851.17±6.08*32.18±3.8935.31±5.16*1.27±0.201.54±0.26*
联合组5048.74±5.0256.95±6.25*30.97±4.0441.47±5.67*1.21±0.221.76±0.30*
t1.3894.6381.5095.6181.4113.873
P0.168<0.0010.134<0.0010.161<0.001
), ArticleFig(id=1256183434276422107, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数KPSWHOQOL-BREF
治疗前治疗后治疗前治疗后
常规组4867.08±6.5976.28±5.25*65.59±6.1573.67±7.28*
联合组5068.99±6.9269.05±5.44*63.83±6.4384.74±7.85*
t1.3986.6901.3847.231
P0.165<0.0010.170<0.001
), ArticleFig(id=1256183435773788644, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=CN, label=表4, caption=

两组晚期肠癌患者化疗耐受性与生存质量评分比较(

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数KPSWHOQOL-BREF
治疗前治疗后治疗前治疗后
常规组4867.08±6.5976.28±5.25*65.59±6.1573.67±7.28*
联合组5068.99±6.9269.05±5.44*63.83±6.4384.74±7.85*
t1.3986.6901.3847.231
P0.165<0.0010.170<0.001
), ArticleFig(id=1256183437573145075, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数CRPRSDPDORRDCR
常规组48017(35.42)20(41.67)11(22.92)17(35.42)37(77.08)
联合组50024(40.00)22(44.00)4(8.00)24(40.00)46(92.00)
χ20.2384.204
P0.6260.040
), ArticleFig(id=1256183438449754623, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=CN, label=表5, caption=

两组晚期肠癌患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数CRPRSDPDORRDCR
常规组48017(35.42)20(41.67)11(22.92)17(35.42)37(77.08)
联合组50024(40.00)22(44.00)4(8.00)24(40.00)46(92.00)
χ20.2384.204
P0.6260.040
), ArticleFig(id=1256183439695462923, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数1~2级总发生
消化系统血液系统神经系统
常规组485(10.42)7(14.58)2(4.17)14(29.17)
联合组509(18.00)5(10.00)2(4.00)16(32.00)
χ20.093
P0.761
), ArticleFig(id=1256183440559489558, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1256183372074894199, language=CN, label=表6, caption=

两组晚期肠癌患者不良反应发生率情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数1~2级总发生
消化系统血液系统神经系统
常规组485(10.42)7(14.58)2(4.17)14(29.17)
联合组509(18.00)5(10.00)2(4.00)16(32.00)
χ20.093
P0.761
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参芪扶正抗癌汤联合贝伐珠单抗治疗气血两虚证晚期肠癌临床研究
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陆芳芳 , 郝传铮 , 沈晓笑
中华中医药学刊 | 省级项目平台 2025,43(12): 216-219
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中华中医药学刊 | 省级项目平台 2025, 43(12): 216-219
参芪扶正抗癌汤联合贝伐珠单抗治疗气血两虚证晚期肠癌临床研究
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陆芳芳, 郝传铮, 沈晓笑
作者信息
  • 南通大学附属医院,江苏 南通 226300
  • 陆芳芳(1983-),女,江苏南通人,副主任医师,博士,研究方向:中医内科肾脏病以及老年衰老性疾病。

Clinical Study of Shenqi Fuzheng Kang’ai Decoction(参芪扶正抗癌汤)Combined with Bevacizumab in Treatment of Advanced Colorectal Cancer with Qi and Blood Deficiency Syndrome
Fangfang LU, Chuanzheng HAO, Xiaoxiao SHEN
Affiliations
  • Affiliated Hospital of Nantong University,Nantong 226300,Jiangsu,China
出版时间: 2025-12-10 doi: 10.13193/j.issn.1673-7717.2025.12.038
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目的

分析参芪扶正抗癌汤联合贝伐珠单抗在气血两虚证晚期肠癌中的临床效果。

方法

对南通大学附属医院2022年1月—2024年1月收治的98例晚期肠癌患者的临床资料进行回顾性分析,按照治疗方法分成常规组(48例)与联合组(50例)。两组患者均采用XELOX化疗方案,常规组接受贝伐珠单抗治疗,联合组在此基础上加用参芪扶正抗癌汤口服治疗。观察两组患者的中医证候积分、肿瘤标志物、T淋巴细胞亚群、化疗耐受性与生存质量评分、临床疗效、不良反应及生存分析。

结果

治疗后,联合组中医证候积分、甲胎蛋白(alpha-fetoprotein,AFP)、癌胚抗原(carcino-embryonic antigen,CEA)、糖类抗原125(Carbohydrate antigen 125,CA125)、细胞角蛋白19片段抗原21-1(Cytokeratin 19 fragment antigen 21-1,CYFRA21-1)水平均低于常规组(P<0.05);联合组CD3+、CD4+水平与CD4+/CD8+比值、卡氏评分(Karnofsky performance score,KPS)、世界卫生组织生存质量测定量表简表(World Health Organization Quality of Life-BREF,WHOQOL-BREF)评分及治疗总有效率均高于常规组(P<0.05);两组不良反应总发生率差异无统计学意义(P>0.05);联合组无进展生存期(Progression-Free Survival,PFS)长于常规组(P<0.05)。

结论

参芪扶正抗癌汤联合贝伐珠单抗治疗可有效改善气血两虚证晚期肠癌患者临床症状,提高免疫力,降低肿瘤标志物水平,提高生活质量,延长生存期限,疗效明确且安全性较高。

参芪扶正抗癌汤  /  贝伐珠单抗  /  肠癌  /  气血两虚证  /  临床疗效
Objective

To analyze the clinical effect of Shenqi Fuzheng Kang’ai Decoction(参芪扶正抗癌汤)combined with bevacizumab in the treatment of advanced colorectal cancer with Qiand blood deficiency syndrome.

Methods

The clinical data of 98 patients with advanced colorectal cancer who were admitted to the Affiliated Hospital of Nantong University from January 2022 to January 2024 was retrospectively analyzed.According to the treatment methods,they were divided into the conventional group(48 cases)and the combined group(50 cases).Both groups were treated with XELOX chemotherapy.The conventional group was treated with bevacizumab,and the combined group was treated with Shenqi Fuzheng Kang’ai Decoction on this basis.The TCM syndrome score,tumor markers,T lymphocyte subsets,chemotherapy tolerance and quality of life score,clinical efficacy,adverse reactions and survival analysis of the two groups were observed.

RESULT

After treatment,the TCM syndrome score and the levels of carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),alpha-fetoprotein(AFP)and cytokeratin 19 fragment antigen 21-1(CYFRA21-1)in the combined group were lower than those in the conventional group(P<0.05).The levels of CD3+and CD4+,the ratio of CD4+/CD8+,the scores of Karnofsky performance scale(KPS)and World Health Organization Quality of Life-BREF(WHOQOL-BREF)and the total effective rate in the combined group were higher than those in the conventional group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).The progression-free survival(PFS)of the combined group was longer than that of the conventional group(P<0.05).

CONCLUSION

Shenqi Fuzheng Kang’ai Decoction combined with bevacizumab in the treatment of advanced colorectal cancer with Qi and blood deficiency syndrome can effectively relieve the clinical symptoms of patients,improve the immunity,reduce the levels of tumormarkers,improve the clinical efficacy and quality of life,prolong the survival of patients,and has high safety.

Shenqi Fuzheng Kang’ai Decoction(参芪扶正抗癌汤)  /  bevacizumab  /  bowel cancer  /  Qi and blood deficiency syndrome  /  clinical efficacy
陆芳芳, 郝传铮, 沈晓笑. 参芪扶正抗癌汤联合贝伐珠单抗治疗气血两虚证晚期肠癌临床研究. 中华中医药学刊, 2025 , 43 (12) : 216 -219 . DOI: 10.13193/j.issn.1673-7717.2025.12.038
Fangfang LU, Chuanzheng HAO, Xiaoxiao SHEN. Clinical Study of Shenqi Fuzheng Kang’ai Decoction(参芪扶正抗癌汤)Combined with Bevacizumab in Treatment of Advanced Colorectal Cancer with Qi and Blood Deficiency Syndrome[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (12) : 216 -219 . DOI: 10.13193/j.issn.1673-7717.2025.12.038
肠癌是指发生在结肠或直肠内的恶性肿瘤,属消化系统肿瘤的一种,也是恶性肿瘤之一,且病死率较高[1],其主要症状包括腹痛、便血、便秘、腹泻、贫血、体质量减轻等,西医治疗手段主要包括手术切除肿瘤、化疗、放疗和靶向治疗等[2]。手术是治疗肠癌的主要方式,但早期肠癌可能无明显症状,许多患者在就诊时已是晚期,错过手术治疗的最佳时机。化疗是晚期肠癌的主要治疗方式之一,能够缓解症状,延长生存期,但无法彻底清除肿瘤,且不良反应较大[3]。随着中医学的不断发展,中医药手段治疗晚期肠癌逐渐显现出其独特优势。肠癌属中医“肠覃”“积聚”等范畴,气血两虚证是晚期肠癌常见证型,肠癌患者正气大伤,脏腑功能衰退,气血生化无源,晚期癌毒内蕴,进一步耗伤气血,形成恶性循环,气血两虚,难以抗邪,因此治疗当以益气养血、扶正祛邪为主要原则[4]。南通大学附属医院依据本病病因病机,自拟由人参、黄芪等多味中药组成的参芪扶正抗癌汤,可补益气血、补虚扶正,本研究回顾性分析98例晚期肠癌患者的临床资料,旨在观察参芪扶正抗癌汤联合贝伐珠单抗在气血两虚证晚期肠癌中的临床效果,现报道如下。
选取南通大学附属医院2022年1月—2024年1月收治的98例晚期肠癌患者的临床资料进行回顾性分析,按照治疗方法分成常规组(48例)与联合组(50例)。常规组中女25例,男23例;年龄42~75岁,平均(58.17±7.95)岁;体质量指数18~28 kg/m2,平均(22.98±2.42)kg/m2;TNM分期:Ⅲ期29例,Ⅳ期19例;原发部位:结肠23例,直肠25例。联合组中女22例,男28例;年龄40~78岁,平均(59.81±8.96)岁;体质量指数18~27 kg/m2,平均(22.64±2.15)kg/m2;TNM分期:Ⅲ期32例,Ⅳ期18例;原发部位:结肠24例,直肠26例。两组基线资料具有可比性(P>0.05)。本研究经南通大学附属医院医学伦理委员会批准。
符合[5]中晚期结直肠癌诊断标准,并经病理学检查确诊。
符合[6]中气血两虚证的辨证标准。主症:乏力懒言、头晕目眩、心神疲倦;次症:面色淡白或萎黄、失眠、心悸心慌、自汗,舌淡,苔薄白,脉细弱或缓而无力。
①符合上述中、西医诊断标准与辨证标准;②年龄40~80岁;③肿瘤分期Ⅲ~Ⅳ期;④有完整的临床、影像资料及随访资料;⑤预计生存期≥3个月;⑥患者及家属自愿签署知情同意书。
①合并其他恶性肿瘤者;②合并肠梗阻、吞咽障碍等疾病无法服药者;③无可测量病灶者;④对本研究药物过敏者;⑤患有精神疾病、意识不清或沟通障碍者;⑥合并免疫缺陷及其他系统功能严重障碍者。
两组患者均采用XELOX化疗方案,第1天,奥沙利铂(国药准字H20000686,南京制药厂有限公司,5 mg)130 mg/m2静注2 h,第1~14天,卡培他滨(国药准字H20073023,上海罗氏制药有限公司,0.5 g)早、晚餐后0.5 h口服,每次1000 mg/m2,第15~21天休息,每21天为1个周期,连续治疗6个周期。
常规组给予贝伐珠单抗[Roche Pharma(Switzerland)Ltd,国药准字SJ20210036,100 mg/4 mL]7.5 mg/kg,溶于250 mL 0.9%氯化钠溶液,静脉滴注1.5 h,每3周1次,每21天为1个周期,连续治疗6个周期。
联合组患者在常规组的基础上加用参芪扶正抗癌汤口服治疗,药用:人参10 g,黄芪30 g,当归12 g,熟地黄15 g,白芍15 g,茯苓15 g,白术12 g,麦冬15 g,石斛15 g,川芎10 g,桃仁10 g,三棱10 g,莪术10 g,白花蛇舌草30 g,半枝莲20 g,败酱草15 g,甘草6 g。每份药物浸泡30 min后,每次加水500~700 mL煎煮2次,每次取汁200 mL混合为1剂,每剂400 mL,1剂/d,分早、晚2次服用,连续治疗4个月。
分别记录两组患者治疗前、治疗后主症与次症情况,按照等级症状积分法分为无(0分)、轻(2分)、中(4分)、重(6分);舌质、舌苔、脉象分为有(1分)、无(0分),记录各证候积分。
于治疗前、后分别抽取两组患者清晨空腹静脉血6 mL,离心后分离上清,对糖类抗原125(Carbohydrate antigen125,CA125)癌胚抗原(Carcinoembryonic antigen,CEA)、细胞角蛋白19片段抗原21-1(cytokeratin 19 fragment antigen21-1)、甲胎蛋白(Alpha fetoprotein,AFP)水平采用电化学发光免疫分析法进行测定。
于治疗前、后分别抽取两组患者清晨空腹静脉血4 mL,离心后取上清,对外周血T淋巴细胞亚群:CD3+、CD4+水平采用流式细胞术进行检测,计算CD4+/CD8+比值。
分别在治疗前后采用卡氏评分(Karnofsky performance score,KPS)从活动能力、体力消耗、症状和生活自理能力等方面评价两组患者对化疗耐受性。使用世界卫生组织生存质量测定量表简表(World Health Organization Quality of Life-BREF,WHOQOL-BREF)评分,评价两组患者治疗前后生活质量。
使用实体瘤疗效评价标准[7]于治疗后分别评估两组患者治疗效果。①患者基线病灶及其他肿瘤症状完全消失并稳定4周及以上为完全缓解(complete response,CR);②肿瘤体积减小≥30%并稳定4周及以上为部分缓解(partial response,PR);③肿瘤体积变化<30%为疾病稳定(stable disease,SD);④肿瘤体积增大≥30%或有新病灶出现为疾病进展(progressivedisease,PD)。疾病控制率(disease control rate,DCR)=(CR+PR+SD)/总例数×100%,客观有效率(objective response rate,ORR)=(CR+PR)/总例数×100%。
使用美国国立癌症研究所不良事件通用术语标准3.0版[8]分别评价两组患者治疗中出现的不良反应,共4级,等级越高则代表不良反应越严重。
通过电话随访的方式对两组患者进行为期6个月的随访,对两组患者无进展生存期(Progression-Free Survival,PFS)进行统计,PFS:自患者接受本研究治疗时至随访期内疾病进展、死亡或最后一次随访的时间。
采用SPSS 26.0软件进行统计学分析,计量资料符合正态分布者,用t检验,计数资料以例(%)表示,行χ2检验,若两样本不满足正态性和方差齐性用秩和检验;两组PFS使用Kaplan-Meier生存分析进行比较。P<0.05为差异有统计学意义。
治疗后,两组中医证候积分均降低,联合组低于常规组(P<0.05)。见表1
两组AFP、CEA、CA125、CYFRA21-1水平治疗后均降低,联合组更低(P<0.05)。见表2
治疗后,两组患者CD3+、CD4+水平与CD4+/CD8+比值均升高,且联合组高于常规组(P<0.05)。见表3
治疗后,两组KPS、WHOQOL-BREF评分均升高,联合组高于常规组(P<0.05)。见表4
联合组ORR及DCR均高于常规组(P<0.05)。见表5
两组均未见3~4级不良反应,1~2级不良反应总发生率差异无统计学意义(P>0.05)。见表6
98例患者,常规组失访2例,余46例,联合组失访3例,余47例,患者随访时间为6个月,常规组共35进展;联合组共19进展,经Kaplan-meier分析,联合组PFS长于常规组(Log Rankχ2=12.359,P=0.000)。见插页ⅩLⅠ图1
近年来,肠癌的发病率在全球范围内居高不下,中国肠癌发病率呈上升趋势[9-10],其发病机制涉及遗传、环境、饮食习惯和生活方式等多种因素[11]。晚期肠癌是指肠癌病变在发展过程中已经进展到晚期阶段的情况,肿瘤扩散到邻近组织、淋巴结或其他器官,甚至出现了远处转移的情况,治疗相对复杂,治愈难度大[12-13]。贝伐珠单抗是一种靶向血管内皮生长因子的单克隆抗体药物,被广泛应用于晚期肠癌的治疗,可通过结合和中和血管内皮生长因子,减少肿瘤血管密度,使肿瘤缺氧、营养不足,并降低肿瘤的生长和扩散能力,与化疗联合使用,能够协同增强治疗效果,但部分患者可能会产生对贝伐珠单抗的耐药性,导致治疗效果下降,且可能导致高血压病、蛋白尿、出血倾向、血栓等不良反应[14-15]。因此,探究更为安全、有效治疗手段对晚期肠癌患者具有重要意义。
在中医学体系中,肠癌通常归属于“积聚”“肠覃”“脏毒”等范畴,气血两虚证患者由于长期饮食偏嗜、情志不畅或外邪侵袭,导致脏腑功能失调,气血运行不畅,进而形成积聚之病,肠癌晚期,癌毒内蕴,进一步耗伤气血,正气大伤,气血生化无源,无以濡养脏腑经络,难以抗邪。因此,治疗当以益气养血、补虚扶正为主要原则[16-17]。本研究中,联合组患者治疗后中医证候积分显著降低,KPS评分与WHOQOL-BREF评分明显增高,治疗总有效率与PFS均优于常规组,表明参芪扶正抗癌汤联合贝伐珠单抗治疗气血两虚证晚期肠癌可有效缓解患者临床症状,提高临床疗效与生活质量,延长患者生存期。参芪扶正抗癌汤中人参大补元气、回阳救逆,为君药;臣以黄芪、白术健脾益气,当归、熟地黄、白芍补血养血;茯苓健脾渗湿,麦冬、石斛养阴生津,川芎、桃仁、三棱、莪术活血行气,白花蛇舌草、半枝莲、败酱草抗癌解毒,共为佐药,甘草益气复脉兼调和药性,为佐使药,诸药合用,共奏益气养血、补虚扶正、抗癌解毒之功。本研究中,联合组患者治疗后肿瘤标志物水平降低,CD3+、CD4+水平与CD4+/CD8+比值升高,且改善幅度均优于常规组,表明参芪扶正抗癌汤与贝伐珠单抗联合应用可有效降低肿瘤标志物水平,提高免疫。有研究表明,黄芪所含有效成分具有免疫调节、抗肿瘤等作用,可增加CD8+T细胞浸润,与人参、白术合用在抗肿瘤、调节免疫等方面具有协同增效作用[18-21];败酱草、半枝莲、白花蛇舌草均可通过抑制肿瘤血管生成、调控C-MYC、CCND1等相关蛋白表达等途径,抑制结直肠癌细胞增殖、迁移和侵袭并诱导其凋亡,多成分、多靶点和多通路发挥抗结直肠癌作用[22-25]
两组患者在治疗过程中均出现不良反应,但均为1~2级,且组间差异不明显,表明参芪扶正抗癌汤与贝伐珠单抗联合应用不会使不良反应发生风险增加,安全性较高。本研究样本量较少,随访时间较短,后续仍需延长随访时间,进行大样本、多中心的深入研究,对本研究结果进行进一步证实。
综上所述,参芪扶正抗癌汤联合贝伐珠单抗治疗气血两虚证晚期肠癌可有效缓解临床症状,提高患者免疫力,降低肿瘤标志物水平,延长生存期,提高生活质量,疗效明确且安全性较高。
  • 江苏省卫生健康委员会科技项目(M2021061)
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doi: 10.13193/j.issn.1673-7717.2025.12.038
  • 首发时间:2026-04-29
  • 出版时间:2025-12-10
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江苏省卫生健康委员会科技项目(M2021061)
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    南通大学附属医院,江苏 南通 226300
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
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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