1、收稿日期:2022 09 09作者单位:大连市妇女儿童医疗中心(集团)春柳妇产院区妇科肿瘤科，辽宁 大连 116033基金项目:大连市医学科学研究计划项目(19Z11017)*通信作者DOI:1014053/j cnki ppcr 202302009解氏祛浊解毒汤治疗紫杉醇化疗后外周神经毒性的研究朱成功，李煜俐，邹文君，焦澜舟，王秀莹*摘要 目的探讨解氏祛浊解毒汤对紫杉醇化疗所导致的外周神经毒性的治疗作用。方法将 2019年 7 月至 2021 年 2 月在大连市妇女儿童医疗中心(集团)春柳妇产院区妇科肿瘤科接受紫杉醇化疗并出现神经毒性症状的 60 例患者纳入研究。患者随机分为观察组(解氏祛浊
2、解毒汤口服+熏洗治疗)和对照组(甲钴胺口服治疗)，对两组患者治疗前后的神经毒性评估、生活质量评分及外周神经传导速度进行分析。结果观察组和对照组基线状况相当，具有可比性(P 0.05)。观察组总有效率高于对照组(76.7%vs.36.7%，P=0.002)。治疗后观察组总体健康状况评分高于对照组(80.6 11.2)分 vs.(71.4 14.3)分，P=0.019，观察组躯体功能评分高于对照组(90.4 9.0)分 vs.(81.3 14.9)分，P=0.017。观察组疼痛评分为(10.0 10.4)分，对照组疼痛评分为(17.8 15.1)分，观察组疼痛症状较对照组减轻(P=0.04)。通过
3、神经肌电图检测两组神经传导速度，治疗前观察组和对照组腓总神经感觉神经传导速度(Sensory nerve conduction velocity，SNCV)分别为(52.1 4.8)m/s 和(52.2 4.3)m/s，两组差异无统计学意义(P=0.892)。治疗后观察组 SNCV 为(55.6 3.2)m/s，对照组为(53.6 3.8)m/s，观察组较对照组有所提高(P=0.03)。治疗前后，观察组与对照组的腓总神经运动神经传导速度(Motor nerve conduction velocity，MNCV)差异均无统计学意义(P 0.05)。结论采用解氏祛浊解毒汤治疗紫杉醇化疗导致的外周神
4、经毒性具有良好的疗效。关键词 外周神经毒性;中药;化疗;紫杉醇;解氏祛浊解毒汤StudyofXieshiQuzhuoJieduDecoctiononpaclitaxel-inducedperipheralneurotoxicityZhu Chenggong，Li Yuli，Zou Wenjun，Jiao Lanzhou，Wang Xiuying*Department of Gynecolo-gy Oncology，Dalian Women and Childrens Medical Center(Group)Chunliu Obstetrics and Gynecology Hospital
5、Dis-trict，Dalian 116033，China*Corresponding author Abstract ObjectiveTo investigate the therapeutic effect of Xieshi Quzhuo Jiedu Decoction on paclitaxel-in-duced peripheral neurotoxicity MethodsSixty patients who received paclitaxel chemotherapy and developed neuro-toxic symptoms in the Department
6、of Gynecology Oncology，Dalian Women and Childrens Medical Center(Group)Chunliu Obstetrics and Gynecology Hospital Distric from July 2019 to February 2021 were included in this studyPatients were randomly divided into observation group(treated with Xieshi Quzhuo Jiedu Decoction and fumigationsoup)and
7、 control group(treated with oral mesocobalamin)The neurotoxicity assessment，quality of life scores，andperipheral nerve conduction speed before and after treatment in the two groups were analyzed esultsThe baselinecondition was comparable between the two groups(P 0.05)The total effective rate in the
8、observation group washigher than that in control group(76.7%vs 36.7%，P=0.002)After treatment，the overall health status score of theobservation group was 80.6 11.2，and the control group was 71.4 14.3 The overall health status score of the obser-vation group was higher than the control group(P=0.019)T
9、he somatic function score of the observation group was90.4 9.0，the control group was 81.3 14.9，and the observation group was higher than the control group(P=0.017)The pain score of the observation group was 10.0 10.4，while the control group was 17.8 15.1，andthe pain score of the observation group we
10、re lower compared with the control group(P=0.04)The nerve conductionvelocity of the two groups was detected by nerve electromyography The common peroneal nerve sensory nerve conduc-tion velocity(SNCV)in the observation group and control group was(52.1 4.8)m/s and(52.2 4.3)m/s，respec-tively;there was
11、 no statistical difference between the two groups(P=0.892)After treatment，the SNCV was(55.6 3.2)m/s in the observation group，and(53.6 3.8)m/s in the control group The SNCV of observation group was im-proved compared with control group(P=0.03)There was no statistical difference in motor nerve conduct
12、ion velocity(MNCV)of common peroneal nerve between the observation group and the control group before or after treatment(P 0.05)ConclusionXieshi Quzhuo Jiedu Decoction has good efficacy in the treatment paclitaxel-induced peripheralneurotoxicityKey words:Peripheral neurotoxicity;Traditional Chinese
13、medicine;Chemotherapy;Paclitaxel;Xieshi Quzhuo JieduDecoction0引言化疗药物所致外周神经毒性是指使用某种化疗药物后引起患者外周神经受损，主要表现为手足末梢的麻木和刺痛，甚至引起肢体运动障碍，严631实用药物与临床 2023 年第 26 卷第 2 期Practical Pharmacy And Clinical emedies，2023，Vol26，No 2重影响患者的生活质量1。紫杉醇是妇科肿瘤化疗最常用的药物，其最大的副作用即为外周神经毒性，许多患者因为神经毒性无法耐受需要药物减量，甚至停药，严重影响治疗效果。目前，西医治疗紫杉醇引
14、起的外周神经毒性主要是应用抗抑郁药物或营养神经药物等，但效果不佳。中医药治疗是我国特有的治疗模式，在管理化疗诱导的外周神经病变上具有较好的疗效2。本研究采用解氏祛浊解毒汤治疗紫杉醇化疗导致的外周神经病变，取得了较好的临床疗效，现报道如下。1资料与方法1.1一般资料选择 2019 年 7 月 11 日至 2021年 2 月 22 日在大连市妇女儿童医疗中心(集团)春柳妇产院区妇科肿瘤中心接受含紫杉醇方案化疗并出现1 级外周神经毒性症状的患者 60 例。采用随机数字表法进行分组，观察组和对照组各30 例。患者年龄 30 69 岁，中位年龄 55.5 岁。入组患者卵巢癌 37 例，子宫内膜癌 19
15、例，子宫颈癌 4 例。患者化疗所致神经毒性多在第 1 或第 2疗程出现，以 1 2 级神经毒性为主。两组患者基线资料，包括年龄、肿瘤类型、神经毒性出现时间及神经毒性程度差异无统计学意义(P 0.05)，见表 1。本研究经大连市妇女儿童医疗中心(集团)春柳妇产院区医学伦理委员会批准，批件号:2019024，所有患者均签署了知情同意书。1.2诊断标准3(NCI-CTCAE V5.0 版)级:肢体轻度麻木、刺痛感或出现腱反射消失，不影响正常功能;级:中度症状，影响工具性日常活动，个人生活自理能力不受限;级:重度症状，个人生活自理能力受限，需要辅助装置;级:危及生命，需紧急处理;级:死亡。1.3入组标
16、准年龄18 75 岁;初次使用紫杉醇化疗并出现1 级外周神经病变;美国东部肿瘤协作组(ECOG)体能状态评分:0 1 分。1.4排除标准化疗前即存在四肢末梢感觉及运动障碍;曾使用过其他可能导致外周神经病变的化疗药物;无法按照项目要求顺利完成治疗的患者。1.5治疗方法观察组:中药内服加熏洗治疗。内服方由白术 15 g、党参 20 g、黄芪 20 g、鸡血藤20 g、伸筋草 20 g、黄精 15 g、苦参 15 g、生地15 g、麦冬 15 g、苍术 12 g 等 14 味中药组成。上述药物水煎剂 300 ml，每日分 2 次口服。熏洗方组成:艾叶 20 g，黄芪 15 g，牛膝 15 g，鸡血藤 20 g，川芎15 g，干姜 15 g，桂枝 15 g，桑枝 15 g，杜仲25 g，芍药 15 g。将中药加水 2 000 ml 文火煮沸后煎20 min。将煎好的药液趁热倒入浴具内，先用药物热气熏蒸患肢 5 10 min，当药液温度降至40 左右时，将患肢放入药液内浸泡 15 min，每日熏洗1 次 药物由大连市妇女儿童医疗中心(集团)春柳妇产院区药房提供。对照组:维生素 B12(甲钴胺片)
