Article(id=1322923228146049100, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322923011518628427, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.03.033, 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=1793339076314, onlineDateStr=2026-10-30, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339076314, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339076314, creator=13701087609, updateTime=1793339076314, 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=178, endPage=181, ext={EN=ArticleExt(id=1322923228338987085, articleId=1322923228146049100, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Wenyang Sanjie Decoction(温阳散结汤)Combined with Immunotherapy on Clinical Prognosis of Advanced Non-Small Cell Lung Cancer Patients with Epidermal Growth Factor Receptor Mutation, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the clinical prognostic effect of Wenyang Sanjie Decoction(温阳散结汤)combined with immunotherapy on patients of epidermal growth factor receptor(EGFR)mutated advanced non-small cell lung cancer(NSCLC).

Methods

Ninety-three NSCLCpatients with EGFR mutation admitted to the hospital from January 2019 to January 2023 were selected as study subjects,and all patients received the same chemotherapy regimen. Forty patients treated with immune checkpoint inhibitors(ICIs)were selected as the control group,and the other 53 patients treated with Wenyang Sanjie Decoction combined with ICIs were selected as the observation group. Tumor response,tumor markers and quality of life before and after treatment were compared between the two groups. The occurrence of toxic and side effects was compared.

Results

The disease control rate(DCR)and objective response rate(ORR)of the observation group were 98.11% and 66.04%,respectively,and those of the control group were 95.00% and 65.00%,respectively. There was no significant difference in short-term efficacy between the groups(P>0.05). After treatment,the levels of carbohydrate antigen 125(CA125)and carcinoembryonic antigen(CEA)in both groups were significantly lower than those before treatment(P<0.05),but there was no statistical significance between two groups(P>0.05). After treatment,the total score of the observation group was significantly lower than that of the control group(P<0.05),and there was no significant difference between the two groups(P>0.05). The total incidence of toxic and side effects was 32.08% in observation group and 47.50% in control group(P>0.05).

Conclusion

Wenyang Sanjie Decoction combined with immunotherapy for advanced NSCLCwith EGFR mutation is effective in improving the symptoms of traditional Chinese medicine and has a high safety,suitable for promotion.

, authors=Jiajiang LUO, authorsList=Jiajiang LUO, authorCompany=null, correspAuthors=null, 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=1322923230792654932, articleId=1322923228146049100, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=温阳散结汤联合免疫治疗对表皮生长因子受体突变晚期非小细胞肺癌患者临床预后的作用分析, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

探讨温阳散结汤联合免疫治疗对表皮生长因子受体(epidermal growth factor receptor,EGFR)突变的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的临床预后效果。

方法

选择医院2019年1月—2023年1月收治的93例EGFR突变的NSCLC患者作为研究对象,所有患者均接受相同方案的化疗治疗,将接受免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗的40例患者作为对照组,将接受温阳散结汤联合ICIs治疗的53例患者作为观察组,比较两组肿瘤反应情况、治疗前后肿瘤标志物以及生活质量,比较不良反应发生情况。

结果

观察组疾病控制率(disease control rate,DCR)为98.11%,客观缓解率(Objective Response Rate,ORR)为66.04%,对照组DCR为95.00%,ORR为65.00%,组间近期疗效差别无统计学意义(P>0.05);治疗后两组血清癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原125(Carbohydrate antigen 125,CA125)均明显低于治疗前(P<0.05),但组间差异无统计学意义(P>0.05);治疗后观察组口干舌燥、气短懒言、总分评分明显低于对照组(P<0.05),其余评分组间差异无统计学意义(P>0.05);观察组不良反应总发生率为32.08%,对照组为47.50%(P>0.05)。

结论

温阳散结汤联合免疫治疗表皮生长因子受体突变的晚期非小细胞肺癌疗效确切,对于改善中医症状效果明显,且具有较高的安全性,适合推广。

, authors=罗家江, authorsList=罗家江, authorCompany=null, correspAuthors=null, authorNote=

罗家江(1985-),男,贵州兴义人,副主任中医师,硕士,研究方向:中医治疗肿瘤、中西医结合治疗肿瘤。

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罗家江(1985-),男,贵州兴义人,副主任中医师,硕士,研究方向:中医治疗肿瘤、中西医结合治疗肿瘤。

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罗家江(1985-),男,贵州兴义人,副主任中医师,硕士,研究方向:中医治疗肿瘤、中西医结合治疗肿瘤。

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组别例数CRPRSDPDDCRORR
观察组532(3.77)33(62.26)17(32.08)1(1.89)98.1166.04
对照组401(2.50)25(62.50)12(30.00)2(5.00)95.0065.00
χ2值0.7080.011
P值0.4000.917
), ArticleFig(id=1322923232084500582, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923228146049100, language=CN, label=表1, caption=

两组肿瘤反映情况比较

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组别例数CRPRSDPDDCRORR
观察组532(3.77)33(62.26)17(32.08)1(1.89)98.1166.04
对照组401(2.50)25(62.50)12(30.00)2(5.00)95.0065.00
χ2值0.7080.011
P值0.4000.917
), ArticleFig(id=1322923232206135399, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923228146049100, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间CA125/(U/mL)CEA/(ng/mL)
观察组53治疗前135.26±22.69266.87±29.68
治疗后65.96±15.62126.57±18.92
t值18.31529.019
P值<0.001<0.001
对照组40治疗前138.05±21.05267.58±25.64
治疗后67.05±17.96127.96±17.93
t值16.22828.223
P值<0.001<0.001
), ArticleFig(id=1322923232285827176, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923228146049100, language=CN, label=表2, caption=

两组治疗前后肿瘤标志物水平比较()

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组别例数时间CA125/(U/mL)CEA/(ng/mL)
观察组53治疗前135.26±22.69266.87±29.68
治疗后65.96±15.62126.57±18.92
t值18.31529.019
P值<0.001<0.001
对照组40治疗前138.05±21.05267.58±25.64
治疗后67.05±17.96127.96±17.93
t值16.22828.223
P值<0.001<0.001
), ArticleFig(id=1322923232369713257, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923228146049100, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间咳嗽咳血胸痛口干舌燥气短懒言神疲乏力总分
观察组53治疗前3.58±1.251.38±0.231.55±0.332.78±0.671.60±0.341.88±0.4612.68±3.01
治疗后1.52±0.460.29±0.090.44±0.110.78±0.21*0.37±0.12*0.59±0.133.58±1.12*
t值11.25932.12923.23120.73724.83519.64620.628
P值<0.001<0.001<0.001<0.001<0.001<0.001<0.001
对照组40治疗前3.61±1.231.40±0.211.56±0.312.81±0.591.63±0.371.91±0.4312.71±3.11
治疗后1.49±0.420.31±0.100.46±0.121.34±0.331.12±0.280.63±0.156.48±1.69
t值10.31629.63920.92913.7536.95117.77611.132
P值<0.001<0.001<0.001<0.001<0.001<0.001<0.001
), ArticleFig(id=1322923232441016426, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923228146049100, language=CN, label=表3, caption=

两组治疗前后中医症状评分比较()

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组别例数时间咳嗽咳血胸痛口干舌燥气短懒言神疲乏力总分
观察组53治疗前3.58±1.251.38±0.231.55±0.332.78±0.671.60±0.341.88±0.4612.68±3.01
治疗后1.52±0.460.29±0.090.44±0.110.78±0.21*0.37±0.12*0.59±0.133.58±1.12*
t值11.25932.12923.23120.73724.83519.64620.628
P值<0.001<0.001<0.001<0.001<0.001<0.001<0.001
对照组40治疗前3.61±1.231.40±0.211.56±0.312.81±0.591.63±0.371.91±0.4312.71±3.11
治疗后1.49±0.420.31±0.100.46±0.121.34±0.331.12±0.280.63±0.156.48±1.69
t值10.31629.63920.92913.7536.95117.77611.132
P值<0.001<0.001<0.001<0.001<0.001<0.001<0.001
), ArticleFig(id=1322923232529096811, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923228146049100, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数腹泻皮疹转氨酶升高间质性肺炎总发生率
观察组535(9.43)5(9.43)4(7.55)3(5.66)(32.08)
对照组404(10.00)6(15.00)5(12.50)4(10.00)(47.50)
χ2值2.286
P值0.131
), ArticleFig(id=1322923232600399980, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322923228146049100, language=CN, label=表4, caption=

两组不良反应情况比较

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组别例数腹泻皮疹转氨酶升高间质性肺炎总发生率
观察组535(9.43)5(9.43)4(7.55)3(5.66)(32.08)
对照组404(10.00)6(15.00)5(12.50)4(10.00)(47.50)
χ2值2.286
P值0.131
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温阳散结汤联合免疫治疗对表皮生长因子受体突变晚期非小细胞肺癌患者临床预后的作用分析
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罗家江
中华中医药学刊 | 国家项目点击 2025,43(3): 178-181
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中华中医药学刊 |国家项目点击 2025 , 43 (3) : 178 -181
温阳散结汤联合免疫治疗对表皮生长因子受体突变晚期非小细胞肺癌患者临床预后的作用分析
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罗家江(1985-),男,贵州兴义人,副主任中医师,硕士,研究方向:中医治疗肿瘤、中西医结合治疗肿瘤。

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罗家江(1985-),男,贵州兴义人,副主任中医师,硕士,研究方向:中医治疗肿瘤、中西医结合治疗肿瘤。

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罗家江
作者信息
  • 贵州省黔西南州中医医院,贵州 兴义 562400
作者简介:

罗家江(1985-),男,贵州兴义人,副主任中医师,硕士,研究方向:中医治疗肿瘤、中西医结合治疗肿瘤。

Effect of Wenyang Sanjie Decoction(温阳散结汤)Combined with Immunotherapy on Clinical Prognosis of Advanced Non-Small Cell Lung Cancer Patients with Epidermal Growth Factor Receptor Mutation
Jiajiang LUO
Affiliations
  • Qianxinan Prefecture Traditional Chinese Medicine Hospital,Xingyi 562400,Guizhou,China
出版时间: 2025-03-10 doi: 10.13193/j.issn.1673-7717.2025.03.033
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目的

探讨温阳散结汤联合免疫治疗对表皮生长因子受体(epidermal growth factor receptor,EGFR)突变的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的临床预后效果。

方法

选择医院2019年1月—2023年1月收治的93例EGFR突变的NSCLC患者作为研究对象,所有患者均接受相同方案的化疗治疗,将接受免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗的40例患者作为对照组,将接受温阳散结汤联合ICIs治疗的53例患者作为观察组,比较两组肿瘤反应情况、治疗前后肿瘤标志物以及生活质量,比较不良反应发生情况。

结果

观察组疾病控制率(disease control rate,DCR)为98.11%,客观缓解率(Objective Response Rate,ORR)为66.04%,对照组DCR为95.00%,ORR为65.00%,组间近期疗效差别无统计学意义(P>0.05);治疗后两组血清癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原125(Carbohydrate antigen 125,CA125)均明显低于治疗前(P<0.05),但组间差异无统计学意义(P>0.05);治疗后观察组口干舌燥、气短懒言、总分评分明显低于对照组(P<0.05),其余评分组间差异无统计学意义(P>0.05);观察组不良反应总发生率为32.08%,对照组为47.50%(P>0.05)。

结论

温阳散结汤联合免疫治疗表皮生长因子受体突变的晚期非小细胞肺癌疗效确切,对于改善中医症状效果明显,且具有较高的安全性,适合推广。

温阳散结汤  /  免疫  /  表皮生长因子受体  /  晚期非小细胞肺癌
Objective

To investigate the clinical prognostic effect of Wenyang Sanjie Decoction(温阳散结汤)combined with immunotherapy on patients of epidermal growth factor receptor(EGFR)mutated advanced non-small cell lung cancer(NSCLC).

Methods

Ninety-three NSCLCpatients with EGFR mutation admitted to the hospital from January 2019 to January 2023 were selected as study subjects,and all patients received the same chemotherapy regimen. Forty patients treated with immune checkpoint inhibitors(ICIs)were selected as the control group,and the other 53 patients treated with Wenyang Sanjie Decoction combined with ICIs were selected as the observation group. Tumor response,tumor markers and quality of life before and after treatment were compared between the two groups. The occurrence of toxic and side effects was compared.

Results

The disease control rate(DCR)and objective response rate(ORR)of the observation group were 98.11% and 66.04%,respectively,and those of the control group were 95.00% and 65.00%,respectively. There was no significant difference in short-term efficacy between the groups(P>0.05). After treatment,the levels of carbohydrate antigen 125(CA125)and carcinoembryonic antigen(CEA)in both groups were significantly lower than those before treatment(P<0.05),but there was no statistical significance between two groups(P>0.05). After treatment,the total score of the observation group was significantly lower than that of the control group(P<0.05),and there was no significant difference between the two groups(P>0.05). The total incidence of toxic and side effects was 32.08% in observation group and 47.50% in control group(P>0.05).

Conclusion

Wenyang Sanjie Decoction combined with immunotherapy for advanced NSCLCwith EGFR mutation is effective in improving the symptoms of traditional Chinese medicine and has a high safety,suitable for promotion.

Wenyang Sanjie Decoction(温阳散结汤)  /  immunity  /  epidermal growth factor receptor  /  advanced non-small cell lung cancer
罗家江. 温阳散结汤联合免疫治疗对表皮生长因子受体突变晚期非小细胞肺癌患者临床预后的作用分析. 中华中医药学刊, 2025 , 43 (3) : 178 -181 . DOI: 10.13193/j.issn.1673-7717.2025.03.033
Jiajiang LUO. Effect of Wenyang Sanjie Decoction(温阳散结汤)Combined with Immunotherapy on Clinical Prognosis of Advanced Non-Small Cell Lung Cancer Patients with Epidermal Growth Factor Receptor Mutation[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (3) : 178 -181 . DOI: 10.13193/j.issn.1673-7717.2025.03.033
肺癌是世界范围内较为常见的一种恶性肿瘤,也是癌症病死率较高的疾病。其中约有85%为非小细胞肺癌(non-small cell lung cancer,NSCLC)[1-2]。表皮生长因子受体(epidermal growth factor receptor,EGFR)是肺腺癌患者较为常见的一种突变种类[3]。多项研究表明[4-5],通过免疫治疗可有效改善患者的结局,但是随着患者年龄的增长,肺内浸润大量的中性粒细胞,患者流感相关病死率提升,这些因素造成患者免疫治疗的效果往往不理想,甚至增加相关不良反应的风险。古代医家关于肺癌也有其认识,如《医宗必读》中“积之成也,正气不足,而后邪气踞之”,古人对肺癌的认识为阴阳失和、正气损耗。将“邪实”与“正虚”关系处理好,是中医治疗肺癌的关键环节[6-7]。中医理论认为,肿瘤形成早期,正气虚衰尚不明显,治疗手段应从祛邪入手,同时以扶正作为辅助手段[8]。在疾病的中期,正邪相交愈加激烈,病情变化更加复杂,需针对实际情况进行治疗,主要选择扶正为主,祛邪为辅的治疗方法。本研究采用温阳散结汤联合免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗EGFR突变的晚期NSCLC患者,取得了满意的效果,具体报道如下。
选择我院2019年1月—2023年1月收治的93例EGFR突变的NSCLC患者作为研究对象,纳入标准:(1)符合西医诊断标准,依据2017年第8版国际抗癌联盟(Union Internationale Centre le Concer,UICC)[9]肺癌TNM分期病理确诊为ⅢB~Ⅳ期;(2)符合中医诊断标准,依据《中药新药临床研究指导原则(试行)》[10],同时具备2项主症及1项次症,即可判定为气阴虚证伴阳虚:主症:咳嗽痰少,乏力,气短,舌淡,口干,畏寒,肢冷,白痰;次症:心烦失眠,盗汗,脉细数,低热;(3)初治患者;(4)基因检测结果提示存在EGFR基因突变;(5)预计生存期不低于3个月;(6)健康状况评分(Karnofsky performance status,KPS)>60分。排除标准:(1)对研究相关药物过敏;(2)合并严重肝肾功能障碍;(3)继发性肺癌;(4)合并脑转移;(5)治疗依从性不佳。将接受免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗的40例患者作为对照组,将接受温阳散结汤联合ICIs治疗的53例患者作为观察组,对照组男22例,女18例,年龄18~68岁,平均(68.97±5.49)岁,TNM分期:Ⅲ期16例,Ⅳ期24例,吸烟史33例,KPS评分61~89分,平均(72.65±3.11)分,观察组男27例,女26例,年龄18~69岁,平均(69.12±5.58)岁,TNM分期:Ⅲ期22例,Ⅳ期31例,吸烟史41例,KPS评分63~89分,平均(73.22±3.19)分,两组基线资料差异无统计学意义(P>0.05)。本研究经医院伦理委员会批准。
参照2018版中国临床肿瘤学会(Chinese Society of Clinical Oncology,CSCO)关于原发性肺癌诊疗指南,采用紫杉类多西他赛(国药准字H20031244,齐鲁制药有限公司)100 mg/m2和白蛋白紫杉醇(国药准字H10980068,北京协和药厂)260 mg/m2,培美曲塞(国药准字H20080249,山西振东泰盛制药有限公司),500 mg/m2及铂类,卡铂(国药准字H20065621,扬子江药业)血药浓度-时间曲线下面积6 g/(L·min)、奈达铂(国药准字H20030884,南京先声东元制药)80~100 mg/m2和吉西他滨(H20020180,Lilly France S.A.S.)800~1250 mg/m2。具体方案为:紫杉醇联合卡铂或顺铂、培美曲塞联合卡铂或顺铂、多西他赛联合卡铂或顺铂、吉西他滨联合卡铂或顺铂。21 d为1个疗程,连续治疗2个疗程。
给予对照组程序性细胞死亡蛋白配体1(programmed deathligand 1,PD-L1)抑制剂,采用阿替利珠单抗(罗氏/基因泰克)1200 mg/次。
在对照组基础上,给予温阳散结汤。方剂组成:制附子(先煎)10~30 g,细辛3 g,杏仁15 g,厚朴10,炙麻黄5~10 g,生牡蛎(先煎)30 g,山慈菇15 g,生南星15 g,莪术15 g,蜈蚣2条,延胡索15 g,生黄芪30~60 g,全蝎10 g,茯苓15 g,鸡内金20 g、炒白术20 g,炙甘草15 g,以姜枣为引,1剂/日,分3次口服。21 d为1个疗程,连续治疗2个疗程。
(1)肿瘤反应:参照实体肿瘤疗效评价标准;完全缓解(Complete remission,CR),部分缓解(Partial Relief,PR),疾病稳定(Stable Disease,SD),疾病进展(Progressive disease,PD)。计算疾病控制率(disease control rate,DCR)和客观缓解率(Objective Response Rate,ORR)。DCR=(CR+PR+SD)/例数×100%,ORR=(CR+PR)/例数×100%;(2)肿瘤标志物:于治疗前后比较两组血清癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原125(Carbohydrate antigen 125,CA125)水平;(3)中医症状评分:参照《中医治疗晚期肺癌的疗效评价方法》[11]判定中医症状严重程度,主要症状分为无、轻、中、重各记“0”“2”“4”“6”分;次要症状计“0”“1”“2”“3”分,分数越高则症状越重;(4)不良反应。
本研究采用SPSS 23.0对数据进行统计学处理,计量资料以()表示,组内治疗前后比较采用配对样本t检验,组间采用独立样本t检验,计数资料以百分比(%)表示,组间以χ2检验进行比较,若P<0.05,则差异具有统计学意义。
对比分析两组治疗前后肺部病灶及转移病灶的影像学资料,观察组DCR为98.11%,ORR为66.04%,对照组DCR为95.00%,ORR为65.00%,组间近期疗效差别无统计学意义(P>0.05)。见表1。
两组治疗前无显著差异(P>0.05),治疗后两组CA125、CEA均明显低于治疗前(P<0.05),但组间差异无统计学意义(P>0.05)。见表2。
两组治疗前各项中医症状评分无显著差异(P>0.05),治疗后两组评分均较本组治疗前升高(P<0.05),观察组口干舌燥、气短懒言、总分评分明显低于对照组(P<0.05),其余评分组间差异无统计学意义(P>0.05)。见表3。
观察组不良反应总发生率为32.08%,对照组为47.50%(P>0.05)。见表4。
针对EGFR突变的NSCLC患者的一线标准治疗方案为EGFR酪氨酸激酶拮抗剂,但大多数患者在12个月内发生耐药的可能性较大,对于此类患者,若出现耐药,则治疗方法的选择就非常有限[12]。随着免疫治疗在肿瘤疾病中的应用越来越广泛,学者们试图对此类患者采用免疫治疗,但是前期相关研究表明,由于EGFR突变患者的生物学特性差异,驱动型癌基因造成免疫抑制激活通路增加,免疫微环境中有较多的抑制信号[13-14]。中医将肺癌归属于“咳嗽”“肺痿”“肺积”“癥瘕”等范畴[15-16]。传统中医认为,肺为娇脏,恶燥喜润,邪毒性燥,易损肺气,灼肺阴,阴虚之后易发生燥热阴虚,进一步对肺气造成损伤,出现明显的气阴两虚[17-18]。肺癌之病因总属标实本虚,邪毒入肺,肺气亏虚,气机不利,邪滞胸中,凝聚为痰,痰滞气虚,血行不畅,日久成为肺部肿瘤,肿瘤日久,阻滞阳气运行,进一步耗伤阳气[19-20]。肺癌乃因虚致实,病位在肺,但与脾、肾具有密切关系。针对肺脏生理特征,肺癌患者多数为内热阴虚、气阴两虚夹杂阳气亏虚的类型[21]。
本研究在免疫治疗的基础上,联合应用温阳散结汤,治疗后观察组口干舌燥、气短懒言、总分评分明显低于对照组(P<0.05)。方中制附子具有温肺阳,温脾肾阳以散结聚;蜈蚣解毒散结;细辛发挥温肺化饮效果;炙麻黄具有润肺平喘止咳之功效;生牡蛎软坚散结;生南星化痰燥湿,止痉祛风,具有散结消肿之功效;延胡索行气止痛,散瘀活血;厚朴温中下气除满;杏仁则可润肺止咳;白术健脾益气,山慈菇有消肿散结、清热解毒之功效;莪术行气消积;炙甘草和中润肺,并防附子毒性;全蝎通络止痛;生黄芪补肺气;鸡内金健脾消食[22-23]。本研究结果表明,温阳散结汤功效主要在于改善患者口干、气短、畏寒,肢冷等气阴两虚夹阳虚证,说明其是具有明显疗效的。在肿瘤反应方面,观察组DCR为98.11%,ORR为66.04%,对照组DCR为95.00%,ORR为65.00%,组间近期疗效差别无统计学意义(P>0.05)。从结果可见,两组均有较为满意的疗效,虽然无显著差异,但观察组在一定程度上优于对照组,说明温阳散结汤联合免疫治疗能缩小肿瘤,在稳定病灶方面发挥了一定的作用。本研究CR患者较少,考虑原因可能与治疗时间较短,或晚期患者多数合并有转移灶,达到CR治疗效果难度较大,也可能与病例数较少有关。治疗后两组CA125、CEA均明显低于治疗前(P<0.05),但组间差异无统计学意义(P>0.05),但可发现观察组下降趋势要大于对照组,CEA是肿瘤疾病的广谱标志物,尤其腺癌中具有较高的敏感度,CA125为大分子糖蛋白,产生于体腔上皮细胞,当组织发生病变,其水平显著升高,相关研究显示,血清肿瘤标志物可有效反映晚期NSCLC患者的治疗效果[24-25],说明温阳散结汤联合免疫治疗比单纯免疫治疗可能有更大的帮助。观察组不良反应总发生率为32.08%,对照组为47.50%(P>0.05)。本研究大部分不良反应为轻微程度,不需要停药处理,从本研究结果可见,温阳散结汤联合免疫治疗比单纯免疫治疗可能对药物不良反应发生情况有一定的帮助,但差异不显著。
中医治疗疾病的基本原则是辨证论治,关于肺癌的中医证型,目前还没有统一的标准,肺癌多为标实本虚,当邪毒袭肺后,瘀滞肺脏,极易损伤肺气,肺阴,久则进一步损伤肺阳,肾阳,温阳散结汤是针对气阴两虚型肺癌晚期,夹杂阳气受损患者的选方[26]。从结果看,该方对患者多数症状有明显的改善作用,说明其具有明显的效果。总体上论证了中医药联合免疫治疗在晚期肺癌中起到的积极改善作用,综上所述,温阳散结汤联合免疫治疗表皮生长因子受体突变的晚期非小细胞肺癌疗效确切,对于改善中医症状效果明显,且具有较高的安全性,适合推广。
  • 国家中医药管理局项目(20172019)
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doi: 10.13193/j.issn.1673-7717.2025.03.033
  • 首发时间:2026-10-30
  • 出版时间:2025-03-10
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国家中医药管理局项目(20172019)
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    贵州省黔西南州中医医院,贵州 兴义 562400
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
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Number of
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Percentage of
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属
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Number of
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Percentage of total
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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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