摘 目 研究参麦注射液乳腺癌患者术患者血清PCTIL6TNFα水心肌功影响评价改善预效果方法 收集2014年3月2016年12月院90例乳腺癌患者抽签法分实验组组组45例两组患者术均进行化疗治疗静脉滴注环磷酰胺氟尿嘧啶表柔星实验组基础采参麦注射液治疗次50ml加入5葡萄糖注射液500ml中进行静脉滴注天1次观察两组治疗疗效床症状积分降钙素原(PCT)白细胞介素6(IL6)肿瘤坏死子α(TNFα)水肌钙蛋白(cTnI)肌酸激酶(CK)肌酸激酶工酶(CKMB)水超氧化物歧化酶(SOD)原型谷胱甘肽(GSH)丙二醛(MDA)水结果 实验组总缓解率显著高组[8666(3945)vs6666(3045)](P<005)乏力汗口咽干燥神疲积分均显著低组[(153±023)分 vs(310±063)分(140±032)分 vs(315±080)分(130±031)分 vs(304±070)分(152±027)分 vs(302±060)分](P<005)PCTIL6TNFα水显著低组[(162±032)μgL vs(583±105)μgL(572±098)pgmL vs(1089±152)pgmL(123±015)ngmL vs(279±023)ngmL](P<005)cTnICKCKMB水显著低组[(45076±5883)ngL vs(70217±8318)ngL(187±040)IUmL vs(520±134)IUmL(15890±4210)IU L vs(91038±9794)IU L](P<005)SODGSH水显著高组[(10989±1368)μIU L vs(7889±1029)μIU L(14083±2082)μgL vs(11749±1789)μgL](P<005)MDA水显著低组[(539±121)μmolL vs(1276±381)μmolL](P<005)结 参麦注射液乳腺癌患者术心肌保护具显著作降低炎症子PCTIL6TNFα水减少术感染发生利患者预
关键词参麦注射液 乳腺癌 心肌功 降钙素原 白细胞介素6 肿瘤坏死子α
中图分类号:R7379 文献标识码:A 文章编号:
Effect of Shenmai injection on serum PCT IL6 TNFα and myocardial function in postoperative patients with breast cancer
[Abstract] Objective To study the effects of Shenmai injection on serum PCT IL6 TNFα and myocardial function in postoperative patients with breast cancer and to evaluate its effect on prognosis Methods 90 patients of mammary cancer who received therapy from March 2014 to December 2016 in our hospital were selected as research objects According to draw method were divided into the experimental group and the control group Two groups of patients were treated with chemotherapy after operation Intravenous infusion of cyclophosphamide fluorouracil epirubicin The experimental group on this basis was treated with Shenmai Injection each 50ml add 5 Glucose Injection 500ml to the intravenous drip 1 times a day Then the curative effect clinical symptom score procalcitonin (PCT) and interleukin 6 (IL6) tumor necrosis factor alpha (TNF alpha) levels of troponin (cTnI) creatine kinase (CK) creatine kinase (CKMB) level superoxide dismutase (SOD) glutathione (GSH) malondialdehyde (MDA) level of two groups were compared Results The total remission rate of the experimental group was significantly higher than the control group[8666(3945)vs6666(3045)](P<005) Fatigue sweating dry mouth and throat spiritlessness scores were significantly lower than the control group[(153±023)scores vs(310±063)scores(140±032)scores vs(315±080)scores(130±031)scores vs(304±070)scores(152±027)scores vs(302±060)scores](P<005) PCTIL6TNFα level were significantly lower than the control group[(162±032)μgL vs(583±105)μgL(572±098)pgmL vs(1089±152)pgmL(123±015)ngmL vs(279±023)ngmL](P<005) cTnICKCKMB level were significantly lower than the control group[(45076±5883)ngL vs(70217±8318)ngL(187±040)IUmL vs(520±134)IUmL(15890±4210)IU L vs(91038±9794)IU L](P<005)SODGSH level were significantly higher than the control group[(10989±1368)μIU L vs(7889±1029)μIU L(14083±2082)μgL vs(11749±1789)μgL](P<005) MDA level were significantly lower than the control group[(539±121)μmolL vs(1276±381)μmolL](P<005)
Conclusion Shenmai injection has remarkable effect on myocardial protection after operation for breast cancer patients It can reduce the levels of inflammatory factors PCT IL6 and TNF alpha reduce the incidence of postoperative infection and benefit the prognosis of patients
Key words Shenmai Injection mammary cancer myocardial function procalcitonin interleukin 6 tumor necrosis factor alpha
Chinese Library Classification(CLC) R7379 Document code A
Article ID
前言
乳腺癌床常见肿瘤疾病乳腺体重器官会生命造成较威胁癌细胞脱落血液游离身体部位形成癌细胞转移危生命[1]早期乳腺癌明显特征症状易发现着病情发展会出现乳头溢液乳头乳晕异常皮肤周围形成结节少数患者会感程度刺痛[2]目前床通常采手术化疗作治疗方法效缓解床症状延长患者生存期化疗药物产生毒副作患者心肌会造成损伤治疗效果带影响[3]寻找减少化疗药物毒性药物床热点参麦注射液种中药制剂具养阴生津功效减少化疗药物毒副作时增强化疗药物药效[4]研究旨探讨参麦注射液乳腺癌患者术心肌功保护作机制
1资料方法
11般资料
收集2014年3月2015年3月院90例乳腺癌术患者均符合中西医诊断标准[5]纳入标准:1患者均女性 2全乳切术均诊断浸润性导癌3评分01级预估存活时间长3月4纳入严重器官疾病者5期未中药治疗6 心肌病排标准:1患恶性肿瘤疾病患者2 肝肾功骨髓造血功存严重异常3患身免疫系统等疾病4试验药物严重良反应5患精神疾病6哺乳期妊娠期女性研究家属患者均签署知情意书西安交通学医学院附属3201医院伦理委员会许抽签法分组组年龄32~50岁均(4538±497)岁病程5~15月均(903±327)月中Ⅰ期10例Ⅱ期23例Ⅲ期12例实验组年龄31~50岁均(4608±490)岁病程6~15月均(921±334)月中Ⅰ期12例Ⅱ期21例Ⅲ期12例较两组性等差异(P>005)存性
12方法
两组患者术均进行化疗治疗第1天静脉滴注环磷酰胺(规格:100mgm²生产厂家:浙江海正药业股份限公司批号:20140102)500mgm²氟尿嘧啶(规格:100mgm²生产厂家:海南中化联合制药工业股份限公司批号:20131206)500mgm²静脉注射表柔星(规格:75 mgm²生产厂家:辉瑞制药(锡)限公司批号:20131220)75 mgm²3周疗程连续治疗少3疗程予实验组基础采参麦注射液(规格:50ml生产厂家:四川升药业股份限公司批号:20131218)50ml加入5葡萄糖注射液500ml中进行静脉滴注天次周疗程连续6疗程化疗前1天开始
13观察指标
131中医症状积分
分两组治疗前乏力汗口咽干燥神疲等床症状进行评估分值0~4分分数越表示患者症状越轻
132指标检测
治疗前采取患者静脉血离心分离血清电化学发光法测定IL6(试剂盒:均海南利康泰制药限公司)免疫浊法检测TNFα(试剂盒:广东联康药业限公司)采固相免疫色谱法测定PCT(试剂盒:海信裕生物科技限公司)采酶联免疫吸附法cTnI(试剂盒:北京索莱宝科技限公司)CK(试剂盒:海广锐生物科技限公司)CKMB(试剂盒:海高创化学科技限公司)SOD(试剂盒:贵州信邦远东药业限公司)GSH(试剂盒:海研卉生物科技限公司)MDA(试剂盒:重庆市正医药科技开发限公司)水进行检测
133床疗效观察
完全缓解(CR):基线评估目标病灶完全消失部分缓解(PR)基线期相目标病灶长径少缩30[6]疾病进展(PD)治疗开始记录长径相目标病灶长直径少增加20疾病稳定(SD)治疗开始长直径相符合部分缓释符合疾病进展评断标准
14统计学分析
选择SPSS180行数统计计量资料()表示组间较t检验计数资料[(例)]表示χ2检验较P<005统计学意义
2结果
21两组治疗疗效
实验组总缓解率8666显著高组6666(P<005)见表1
表1两组治疗疗效[(n)]
Table 1 Comparison of the therapeutic effect of two groups[(n)]
Groups
CR
PR
SD
PD
Total remission rate
Experimental group(n45)
29(6444)
10(2222)
4(888)
2(444)
39(8666)#
Control group(n45)
25(5555)
8(1777)
10(2222)
5(1111)
30(6666)
vs the control group after treatment#P<005
22两组床症状积分
两组治疗前床症状积分差异(P>005)治疗组症状积分升高实验组症状积分显著降低(P<005)见表2
表2两组床症状积分(分)
Table 2 Comparison of the clinical symptom score of two groups(score)
Groups
weak
Spontaneous sweating
Oropharyngeal dryness
spiritlessness
Experimental group(n45)
Before treatment
290±050
293±062
282±068
291±052
After treatment
153±023*#
140±032*#
130±031*#
152±027*#
Control group(n45)
Before treatment
288±048
290±060
285±065
290±050
After treatment
310±063
315±080
304±070
302±060
vs before treatment*P<005vs the control group after treatment#P<005
23两组血清PCTIL6TNFα水
两组治疗前PCTIL6TNFα水差异(P>005)治疗两组PCTIL6TNFα水均降低实验组降低程度更显著(P<005)见表3
表3两组血清PCTIL6TNFα水()
Table 3 Comparison of the serum PCTIL6TNFα level of two groups()
Groups
PCT (μgL)
IL6 (pgmL)
TNFα(ngmL)
Experimental group(n45)
Before treatment
1103±201
1860±286
450±041
After treatment
162±032*#
572±098*#
123±015*#
Control group(n45)
Before treatment
1127±213
1907±290
447±040
After treatment
583±105*
1089±152*
279±023*
vs before treatment*P<005vs the control group after treatment#P<005
24两组cTnICKCKMB水
两组治疗前cTnICKCKMB水差异(P>005)治疗组cTnICKCKMB水升高实验组cTnICKCKMB水显著降低(P<005)见表4
表4两组cTnICKCKMB水()
Table 4 Comparison of the cTnICKCKMB level of two groups()
Groups
cTnI(ngL)
CK(IUmL)
CKMB(IU L)
Experimental group(n45)
Before treatment
69072±8027
438±130
90276±9880
After treatment
45076±5883*#
187±040*#
15890±4210*#
Control group(n45)
Before treatment
69105±8105
435±132
90305±9832
After treatment
70217±8318*
520±134*
91038±9794*
vs before treatment*P<005vs the control group after treatment#P<005
25两组SODGSHMDA水
两组治疗前SODGSHMDA水差异(P>005)治疗两组SODGSH水升MDA水降低实验组改善程度更显著(P<005)见表5
表5两组SODGSHMDA水()
Table 5 Comparison of the SODGSHMDA level of two groups()
Groups
SOD(μIU L)
GSH(μgL)
MDA(μmolL)
Experimental group(n45)
Before treatment
7348±972
11398±1603
958±248
After treatment
10989±1368*#
14083±2082*#
539±121*#
Control group(n45)
Before treatment
7405±980
11406±1621
1060±245
After treatment
7889±1029*
11749±1789*
1276±381*
vs before treatment*P<005vs the control group after treatment#P<005
3讨
目前床乳腺癌发病机制尚明确研究发现存定规律性具乳腺癌危险素女性更易发病[7]根统计显示[8]50~55岁间乳腺癌发病高峰时期遗传乳腺腺体致密初潮早绝推迟肥胖量饮酒未婚未孕等均乳腺癌发病着医疗发展乳腺癌治疗根患者机体情况选择合理效手术化疗方案治疗肿瘤重手段具定治愈率时会机体造成损伤毒副作治疗效果带影响[9]研究予乳腺癌患者术采常规化疗发现两组患者均出现程度心肌损伤
中医认乳腺癌属乳石痈范畴气虚病变基础患者术处邪滞气阴两虚状态引起心脉闭阻心阴耗五脏肺腑失养[10]术进行化疗会耗气伤阴机体处虚弱床益气养阴治疗契机参麦注射液红参麦冬组成中红参具益气摄血补气滋阴补虚等功效药理学显示[11]直接作心肌血促进机体心肌代谢具增强心肌收缩力耐氧力作麦冬具养阴生津作稳定心肌细胞膜[12]两种药物合显著增强患者心肌收缩力保护心肌细胞化疗药物作效保护[13]研究中采联合参麦注射液治疗患者床症状积分cTnICKCKMB水治疗疗效显著优采单独化疗治疗患者说明参麦注射液乳腺癌患者术化疗心肌损伤中具显著效果减少患者心肌损伤提高治疗疗效
基础研究认[14]乳腺癌手术程中会局部淋巴回流血液循环出现障碍加术化疗作机体产生量氧基引起心脏毒性心肌组织造成损伤SOD体重抗氧化酶清氧基具抗衰老美容消副作作机体中具重意义[15]GSH体重抗氧化剂基清剂增强体免疫力清化疗药物产生低毒产物具修复保护受损细胞功效[16]MDA脂质氧化产物会心肌组织造成损害通检测反应机体脂质氧化损害程度[17]研究显示采联合参麦注射液治疗患者SODGSH水显著高采单独化疗治疗患者MDA水显著低采单独化疗治疗患者说明参麦注射液够效清氧基降低氧化反应心肌损伤提高患者心功利预
国外研究发现[18]乳腺癌患者PCTIL6TNFα水显著高正常机体处感染炎性反应状态时炎性子会出现波动PCT种蛋白质够反映患者全身炎症活跃程度IL6常见炎症子具定促炎作刺激炎性子释放诱导血膜新生加乳腺癌身会引起机体免疫紊乱促进IL6水升[19]TNFα恶性肿瘤发展具密切关系异常升高促进肿瘤血形成乳腺癌表达中显著高良性乳腺疾病床证实会着病情发展升高[20]研究显示采联合参麦注射液治疗患者PCTIL6TNFα水显著低采单独化疗治疗患者说明参麦注射液够调控感染改善患者术微循环炎症子低表达
综述参麦注射液乳腺癌患者术心肌保护具显著作降低炎症子PCTIL6TNFα水减少术感染发生利患者预
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