加味四君子汤对直肠癌术后脾胃气虚证患者化疗减毒增效的临床研究

目的 研究直肠癌术后脾胃气虚证患者行FOLFOX-7化疗期间联合加味四君子汤治疗对化疗增效和毒副反应的影响。方法 将70例直肠癌脾胃气虚证患者随机分为观察组和对照组，每组各35例，两组均接受全直肠系膜切除术（total mesorectal excision，TME），术后观察组行FOLFOX-7化疗联合加味四君子汤治疗，对照组单纯行FOLFOX-7化疗。比较两组临床疗效和免疫功能指标，记录毒副反应发生情况，采用酶联免疫吸附法检测血管内皮生长因子（vascular endothelial growth factor，VEGF）、酸性成纤维细胞生长因子（acidity fibroblast growth factor，aFGF）及碱性成纤维细胞生长因子（basic fibroblast growth factor，bFGF）肿瘤生物学指标。结果 治疗后观察组腹胀、神疲、纳呆、便溏及中医证候总分均显著低于对照组（P<0.05）；观察组和对照组肿瘤控制率分别为97.14%和88.57%，差异无统计学意义（P>0.05）；观察组治疗后CD3⁺、CD4⁺及CD3⁺/CD4⁺显著高于治疗前和对照组，差异有统计学意义（P<0.05）；观察组治疗后VEGF、aFGF及bFGF水平显著低于治疗前和对照组，差异有统计学意义（P<0.05）；观察组胃肠道反应、白细胞降低及中性粒细胞降低毒副反应的严重程度较对照组显著减轻，差异有统计学意义（P<0.05）。结论 FOLFOX-7化疗期间联合加味四君子汤用于直肠癌脾胃气虚证TME术后治疗，能显著减轻毒副反应，提高治疗效果，这可能与加味四君子汤改善机体免疫功能有关。

Clinical Study on Jiawei Sijunzi Decoction on Synergism and Attenuation of Chemotherapy for Patients with Spleen and Stomach Qi Deficiency Syndrome after Rectal Cancer Operation

Objective To study the effects of FOLFOX-7 chemotherapy combined application of Jiawei Sijunzi Decoction on chemotherapy synergy and toxic side effects in patients with spleen-stomach Qi deficiency syndrome after rectal cancer operation. Methods A total of 70 patients with rectal cancer with spleen and stomach Qi deficiency were randomly divided into the observation group and the control group, with 35 cases in each group. Both groups underwent total mesorectal excision (TME). After operation, the observation group performed FOLFOX-7 chemotherapy combined with Jiawei Sijunzi Decoction, and the control group was treated with FOLFOX-7 chemotherapy alone. The clinical efficacy and immune function indexes of the 2 groups were compared, and the occurrence of toxic and side effects was recorded. The vascular endothelial growth factor (VEGF), acidity fibroblast growth factor (aFGF) and basic fibroblast growth factor (bFGF) tumor biological indicators were detected by enzyme-linked immunosorbent assay. Results After treatment, the abdominal distension, mental fatigue, anorexia, loose stool and TCM syndrome scores of the observation group were significantly lower than the control group (P<0.05). The tumor control rates of the observation group and the control group were 97.14% and 88.57%, respectively. There was no statistical significance (P>0.05). The CD3⁺, CD4⁺ and CD3⁺/CD4⁺ levels in the observation group were significantly higher than those before treatment and the control group (P<0.05). After treatment, the VEGF, aFGF and bFGF of the observation group was significantly lower than that before treatment and the control group, and the difference was statistically significant (P<0.05). The severity of gastrointestinal reactions, leukopenia and central neutropenia decreased significantly in the observation group compared with the control group, and the difference was statistically significant (P<0.05). Conclusion FOLFOX-7 combined with Jiawei Sijunzi Decoction for the treatment of rectal cancer with spleen and stomach Qi deficiency syndrome after TME can significantly reduce the toxic side effects and improve the therapeutic effect, which may be related to the improvement of immune function by Jiawei Sijunzi Decoction.