1、世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1临床研究DOI:10 13935/j cnki sjzx 230127基金项目:广西壮族自治区中医药管理局自筹经费科研课题(GXZYZ20210202)作者单位:1 广西桂林市中医医院乳腺科，广西 桂林 541001;2 广西桂林市中医医院病理科，广西 桂林541001;3 广西桂林市中医医院放射科，广西 桂林 541001通信作者:林森，Email:562947791 qq com复康灵治
2、疗三阴性乳腺癌新辅助化疗患者的临床观察林森1王强1唐瑞俊2梁云3【摘要】目的探究中药复康灵对三阴性乳腺癌新辅助化疗的脾胃虚弱型患者的临床疗效、病理、化疗不良反应及中医症状的影响。方法选取2015 年12 月2021 年12 月期间广西桂林市中医医院收治的三阴性乳腺癌且新辅助化疗的脾胃虚弱型患者 120 例，按照随机数字表法分为对照组和观察组，每组各 60 例。对照组单纯使用Tcb(多西他赛+卡铂(docetaxel+carboplatin)方案化疗;治疗组给予 TCb 方案化疗同时使用中药复康灵。治疗6 个周期后，观察比较两组患者病理 MP(Miller Payne，MP)分级标准的改善率、血
3、清内分泌激素 雌二醇(Estra-diol，E2)、黄体酮(Progesterone，P)、泌乳素(Prolactin，PL)水平、骨髓抑制、中医症状量表评分及临床缓解率。结果治疗后治疗组疾病控制率 96 67%(58/60)高于对照组 91 67%(55/60)，差异有统计学意义(P 0 05)。治疗后两组患者病理 MP 改善率显示，治疗组病理总改善率 58 33%(35/60)高于对照组 51 67%(31/60)，差异有统计学意义(P 0 05);MP5 级(Pcp)率显示，治疗组 38 34%(23/60)优于对照组 30%(18/60)，差异有统计学意义(P 0 05)。治疗后两组患
4、者血清 E2 和 PL 水平较治疗前降低，血清 P 水平较治疗前升高，差异有统计学意义(P 0 05);且治疗组血清 E2 和 PL 水平低于对照组，血清 P 水平高于对照组，差异有统计学意义(P 0 05)。治疗后治疗组中性粒细胞、白细胞、血小板、血红蛋白的发生率均低于对照组，差异有统计学意义(P 0 05)。治疗后两组患者中医症状量表积分较治疗前降低，差异有统计学意义(P 0 05);且治疗组低于对照组，差异有统计学意义(P 0 05)。结论中药复康灵在三阴性乳腺癌新辅助化疗后脾胃虚弱型患者的应用，能改善临床缓解率、病理 MP 分级、中医症状，降低化疗后度骨髓抑制发生。【关键词】三阴性乳腺
5、癌;复康灵;新辅助化疗;临床缓解率【中图分类号】737 9【文献标识码】AClinical Application of Fukangling in Neoadjuvant Chemotherapy for Triple Nega-tive Breast Cancer Based on MP GradeLIN Sen1，WANG Qiang1，TANG ui jun2，LIANG Yun3(1 Galactophore Department，Guilin Municipal Hospital of Traditional Chinese Medicine，Guilin Guangxi 5410
6、01;2 De-partment of Pathology，Guilin Municipal Hospital of Traditional Chinese Medicine，Guilin Guangxi 541001;3 Department ofadiology，Guilin Municipal Hospital of Traditional Chinese Medicine，Guilin Guangxi 541001)【Abstract】ObjectiveTo explore Fukangling in neoadjuvant chemotherapy for triple negati
7、ve breast cancer pa-tients of spleen stomach weakness syndrome and to investigate the effect on the clinical conditions，pathological changes，adverse reactions，and traditional Chinese medicine(TCM)symptoms of the patients MethodsA total of 120 triple neg-ative breast cancer patients of spleen stomach
8、 weakness syndrome who were treated by neoadjuvant chemotherapy in Guil-in Municipal Hospital of Traditional Chinese Medicine from December 2015 to December 2021 were included and random-ized into the observation group(n=60)and the control group(n=60)The control group was treated by the Tcb(docetaxe
9、l+carboplatin)chemotherapy regimen，and the observation group was applied with the Tcb regimen and Fukangling After 6cycles of chemotherapy，the Miller Payne(MP)grade based pathological remission rate，serum levels of endocrine hor-mones estradiol(E2)，progesterone(P)，prolactin(PL)，myelosuppression，TCM
10、syndrome score and clinical remissionrate were compared between the two groups esultsAfter the 6 cycles of chemotherapy，the disease control rate was96 67%(58/60)in the observation group，higher than that 91 67%(55/60)in the control group(P 0 05)After treat-ment，the MP based pathological remission rat
11、e in the observation group(58 33%，35/60)was higher than that in the751世界中西医结合杂志 2023 年第 18 卷第 1 期World Journal of Integrated Traditional and Western Medicine2023，Vol.18，No.1control group(51 67%，31/60)(P 0 05)，and percentage of patients with MP5(Pcp)was higher in the observationgroup(38 34%，23/60)tha
12、n that in the control group(30%，18/60)(P 0 05)After treatment，serum levels of E2 andPL were lower than those before treatment and the level of P was higher than that before treatment in both groups(P 0 05)In addition，the levels of E2 and PL were lower in the observation group than in the control gro
13、up，and the level ofP was higher in the observation group than that in the control group(P 0 05)After the chemotherapy，the incidence oflow levels of neutrophils，white blood cells，platelets，and hemoglobin was lower in the observation group than those in thecontrol group(P 0 05)Moreover，the TCM syndrom
14、e score was lower than that before treatment in both groups(P 0 05)and lower in the observation group than in the control group(P 0 05)ConclusionFukangling can improve theclinical remission rate and MP grade，relieve TCM symptoms，and reduce the occurrence of grade myelosuppression ofpatients with tri
15、ple negative breast cancer of spleen stomach weakness syndrome It is safe and worthy of clinical promo-tion【Keywords】Triple negative Breast Cancer;Fukangling;Neoadjuvant Chemotherapy;Clinical emission ate近年来，随着乳腺癌发病率的逐年上升，已成为严重危害女性健康与生命之恶疾1。国内外专家均认为，根据免疫组化的分子分型为雌激素受体(Estrogen eceptor，E)阴性、孕激素受体(Prog
16、es-terone eceptor，P)阴性、人表皮生长因子受体 2(Human Epidermal Growth Factor eceptors 2，HE 2)阴性的可称为三阴性乳腺癌，三阴性乳腺癌是女性恶性肿瘤中的一种，约占所有乳腺癌病理类型的10 0%20 8%2。这类患者的局部复发率较其他类型相比较高，结束治疗后的 1 3 年内较容易复发3。新辅助化疗主要目的是将不可手术的乳腺癌降期为可手术乳腺癌，或将不可保乳降期为可保乳4。为患者争取手术机会，并能为临床提供疗效、预后、后续治疗方案选择等更多信息，新辅助化疗已成为乳腺癌治疗领域的新热点。目前已有多项研究指出，乳腺癌术后更易发生脾胃虚弱，气血生化无源，造成化疗骨髓抑制而严重影响患者的治疗效果和生活质量，是发生率特别高的副作用之一5。古代中医治疗与新辅助化疗的目的相同，加之现代药理学研究对中药抗肿瘤作用的肯定，开启中药联合新辅助化疗共同治疗乳腺癌的尝试6，7。临床工作中，进行新辅助化疗的患者大部分多为疾病中晚期，瘤体较大，发病较久，五脏六腑因失去气血津液濡润而机能低下或失调，因此在进行新辅助化疗前，患者是一个机体整体亏虚，与痰瘀毒
