上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (7): 778-.doi: 10.3969/j.issn.1674-8115.2019.07.016

• 论著·临床研究 • 上一篇    下一篇

温经祛瘀蠲痹方联合甲钴胺对化学治疗药物导致的周围神经病变的疗效观察

祝利民，毛竹君，姚琼，郭玲建，沈克平   

  1. 上海中医药大学附属龙华医院肿瘤科，上海 200032
  • 出版日期:2019-07-28 发布日期:2019-08-26
  • 通讯作者: 同上。
  • 作者简介:祝利民 (1977—)，女，副主任医师，博士生；电子信箱： zhulimin2000@sina.com。
  • 基金资助:
    上海市自然科学基金（16ZR1437500）；上海市卫生和计划生育委员会中医药科技创新项目（ZYKC201701009）

Clinical effect of Wenjing-Quyu-Juanbi Prescription combined with methylcobalamin in treatment of chemotherapy-induced peripheral neuropathy

ZHU Li-min, MAO Zhu-jun, YAO Qiong, GUO Ling-jian, SHEN Ke-ping   

  1. Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
  • Online:2019-07-28 Published:2019-08-26
  • Supported by:
    Shanghai Natural Science Foundation, 16ZR1437500; Science and Technology Innovation Project for Chinese Medicine of Shanghai Health and Family Planning Commission, ZYKC201701009

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摘要： 目的 ·观察温经祛瘀蠲痹方联合甲钴胺片口服治疗恶性肿瘤化学治疗（简称化疗）导致的周围神经病变（ chemotherapy-induced peripheral neuropathy，CIPN）的临床效果。方法 ·采用随机数字表法将 133例 CIPN患者随机分为治疗组 67例和对照组 66例。对照组采用甲钴胺口服治疗，治疗组在甲钴胺口服治疗基础上，每日服用温经祛瘀蠲痹方水煎剂。治疗 4周后分析 2组患者中医临床症状积分及周围神经损伤分级的情况和治疗总有效率，比较 2组的周围神经传导速度。结果 ·最终究成该研究患者 123例，治疗组 63例，对照组 60例。2组治疗后手足麻木、时有疼痛、屈伸不利、神疲乏力、面色白或畏寒肢冷等症状积分均显著低于治疗前（均 P<0.05），且治疗后治疗组各项症状积分均显著低于对照组（均 P<0.05）。对周围神经损伤的治疗总有效率治疗组高于对照组（P<0.05）。2组治疗后正中神经和腓总神经的感觉神经传导速度及运动神经传导速度均显著快于治疗前（均 P<0.05），且治疗后治疗组显著快于对照组（均 P<0.05）。结论 ·温经祛瘀蠲痹方联合甲钴胺治疗 CIPN的疗效优于单纯使用甲钴胺。

关键词: 温经祛瘀蠲痹方, 甲钴胺, 恶性肿瘤, 化学治疗导致的周围神经病变

Abstract:

Objective · To observe the clinical effect of Wenjing-Quyu-Juanbi Prescription combined with methylcobalamin on chemotherapy-induced peripheral neuropathy (CIPN). Methods · A total of 133 CIPN patients were dividedrandom number method into two groups, i.e. treatment group (n67) and control group (n66). Control group received oral methylcobalamin therapy, and treatment group received water decoction of WenjingQuyu-Juanbi Prescription on the basis of oral methylcobalamin therapy every day. After 4 weeks of treatment, the patients symptom scores in traditional Chinese medicine and peripheral nerve injury grades in two groups were observed and total effective rates were calculated. The peripheral nerve conductive velocities between the two groups were compared. Results · The study was completed in 123 patients, 63 in the treatment group and 60 in the control group. After treatment, symptom scores of numbness of the extremities, pain, inconvenient flexion, mental fatigue, pale appearance and cold limbs were significantly lower than those before treatment (all P<0.05). And the symptom scores of treatment group after treatment were significantly lower than those of control group (all P<0.05). The total effective rate of treatment for peripheral nerve injury in treatment group was also higher than that in control group (P<0.05). Sensory nerve conduction velocity and motor nerve conduction velocity of median nerves and common peroneal nerves after treatment were all significantly faster than those before treatment (all P<0.05). And between the two groups they were faster in treatment group after treatment (P<0.05). Conclusion · The therapeutic effect of Wenjing-Quyu-Juanbi Prescription combined with methylcobalamin on CIPN is better than that of methylcobalamin only.

Key words: Wenjing-Quyu-Juanbi Prescription, methylcobalamin, malignant tumor, chemotherapy-induced peripheral neuropathy随着恶性肿瘤发病率逐年上升, 临床抗肿瘤化学治成为主要不良反应之一, 临床表现为肢体对称性的感觉异疗（简称化疗）药物的应用也愈发广泛, 在提高抗肿常、麻木如蚁爬、疼痛、发凉或伴有腱反射消失、运动失瘤疗效的同时也带来了许多不良反应。因使用奥沙利调等, 严重者甚至直接影响到化疗的顺利完成 [1]。甲钴胺铂、紫杉醇、长春新碱等化疗药物导致的周围神经病变是西医防治 CIPN的常用药物之一, 作为维生素 B12的衍（chemotherapy-induced peripheral neuropathy, CIPN）已经生物, 外源性用药可进入神经细胞, 提高甲硫氨酸合成

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