摘要目的 观察中医辨证论治联合吉非替尼治疗晚期肺腺癌的疗效.方法 全部患者均选自2008年2月至2010年2月湖南省肿瘤医院,56例患者均符合晚期肺腺癌诊断标准.按随机数字表法将肺腺癌患者随机分为治疗组(中药+吉非替尼)30例和对照组(单纯吉非替尼)26例.对照组口服吉非替尼(阿斯利康公司,国药准字J20070047)250 mg/d,持续用药至疾病进展或出现不能耐受的严重不良反应.治疗组在此基础上配合中医辨证分型治疗.结果 治疗后治疗组临床综合疗效总有效率为90.00％,优于对照组的65.38％ (x2=5.40,P＜0.05);治疗后,两组患者症状积分均明显下降,与同组治疗前比较,差异均有统计学意义(t治疗组=9.2446,t对照组=2.7778,P均＜0.01)；两组治疗后比较,差异有统计学意义(t=5.6272,P＜0.01).治疗组半年、1、2年无进展生存率分别为66.67％、50.00％、30.00％;1、2年的生存率分别为73.33％、46.67％;对照组半年、1、2年无进展生存率分别为38.46％、23.08％、7.69％:1、2年的总生存率分别为46.15％、19.23％,两组间比较治疗组半年、1、2年无进展生存率、1、2年的总生存率均优于对照组,差异均有统计学意义(x2值分别为4.46、4.31、5.44、4.31、5.27,P值分别为0.03、0.04、0.02、0.04、0.02).两组生存质量比较,治疗组卡氏(KPS)评分有效率为76.67％,优于对照组的46.15％,差异有统计学意义(x2=6.24,P＜0.05).近期疗效比较,治疗组疾病控制率为80.00％,高于对照组的53.85％,差异有统计学意义(x2=4.93,P＜0.05).不良反应方面,治疗组Ⅱ～Ⅲ度皮疹发生率及腹泻发生率均明显降低,与对照组比较,差异有统计学意义(x2值分别为4.49、4.37,P＜0.05).结论 中医辨证施治联合吉非替尼可改善患者的生存质量,控制病情恶化、进展,延长患者生存期.

abstractsObjective To investigate the therapeutic effects of advanced lung adenocarcinoma treated with TCM treatment based on syndrome differentiation combined with Gefitinib.Methods All cases were recruited from adenocarcinoma of lung patients in Hunan Province Cancer Hospital from February 2008 to February 2010.These 56 adenocarcinoma of lung patients were randomly divided into a treatment group (30cases) and a control group (26 cases).The control group was treated with Gefitinib,250 mg/d,until the disease getting progress or the patient showing intolerable untoward reaction; while the treatment group was treated with TCM syndrome differentiation based on the control group.Results After the treatment,the total therapeutic effects was 90.00％ in the treatment group than 65.38％ in the control group (x2=5.40,P＜0.05); symptoms score in both group decreased after the treatment,comparing with the same group before the treatment,with the difference was statistical significance (tthe treatment group=9.2446,tthe control group=2.7778,both P＜0.01) ;non-progressive survival rate of half year,1year and 2year was 66.67％,50.00％ and 30.00％ respectively,and survival rate of lyear and 2yenr was 73.33％ and 46.67％ respectively,in the treatment group,while non-progressive survival rate of half year,lyear and 2year was 38.46％,23.08％ and 7.69％ respectively,and survival rate of 1year and 2year was 46.15％ and 19.23％ respectively,in the control group,showing statistical difference between the two groups (x2 value was 4.46、4.31、5.44、4.31、5.27,P value was 0.03、0.04、0.02、0.04、0.02,all P＜0.05 ) ; the effective power of KPS was 76.67％ and 46.15％ in the treatment and the control group respectively,showing statistical difference (x2=6.24,P＜0.05) ; both groups were absent of such side effects of hematology,heart,liver and kidney toxicity,and interstitial pneumonia,but the incidence rate of Ⅱ ～ Ⅲ degree rash and diarrhea was significantly decreased in the treatment group,comparing with the control group (x2=4.49、4.37,P＜0.05 ).Conclusion The therapy of TCM treatment based on syndrome differentiation combined with Gefitinib can improve living quality,control aggravation of disease,prolong life span and enhance survival rate of the patients with advanced lung adenocarcinoma.