当归四逆汤对化疗后神经毒性反应患者神经毒性反应及卡氏功能状态评分的影响

Effects of Danggui Sini Decoction on Neurotoxicity Response and Karnofsky Performance Status Score in Patients with Chemotherapy-Induced Neurotoxicity

关键词:  当归四逆汤  化疗  神经毒性  卡氏功能状态  神经传导速度

Key words:  Danggui Sini Decoction  chemotherapy  neurotoxicity  karnofsky  nerve conduction velocity

摘要:

[目的] 探讨当归四逆汤对化疗所致神经毒性（CIPN）患者神经毒性反应及卡氏功能状态（KPS）评分的影响。[方法] 选择2021年10月—2023年10月在本院开展化疗且出现神经毒性的88例患者，将其按随机数字表法分成西药组（脱落1例，n=43，应用甲钴胺治疗）和中西药组（脱落2例，n=42，在西药组基础上加用当归四逆汤）。比较两组治疗前、治疗4周后美国国立癌症研究所的常规毒性判定标准（NCI-CTCAE）分级变化、神经传导速度[包括运动神经传导速度（MNCV）、感觉神经传导速度（SNCV）]、血清神经生长因子（NGF）水平、KPS评分、不良反应情况及生活质量。[结果] 治疗4周后，两组NCI-CTCAE分级均优于治疗前（P<0.05），且中西药组NCI-CTCAE分级和西药组相比更优（P<0.05）；两组正中神经、腓总神经的MNCV、SNCV均较治疗前加快（P<0.05），且中西药组神经传导速度快于西药组（P<0.05）；两组血清NGF水平、KPS评分及躯体功能、情绪功能、社会功能评分均高于治疗前（P<0.05），且中西药组和西药组相比更高（P<0.05）。中西药组不良反应总发生率（11.90%比6.98%）和西药组比较无差异（P>0.05）。[结论] 对CIPN患者应用当归四逆汤治疗的效果更佳，可有效上调血清NGF水平，明显改善神经传导速度及病情，显著提高健康水平及生活质量。

Abstract:

[Objective] To explore the effects of Danggui Sini Decoction on neurotoxicity response and Karnofsky Performance Status（KPS）score in patients with chemotherapy-induced neurotoxicity（CIPN）. [Methods] From October 2021 to October 2023，88 patients who underwent chemotherapy and developed neurotoxicity in our hospital were randomly divided into Western medicine group（1 case dropped out，n=43，treated with methylcobalamin）and Chinese-Western medicine group（2 cases dropped out，n=42，treated with Danggui Sini Decoction in addition to the Western medicine group）using a random number table method. The changes in National Cancer Institute Common Terminology Criteria for Adverse Events（NCI-CTCAE）grading，nerve conduction velocity（including motor nerve conduction velocity（MNCV）and sensory nerve conduction velocity（SNCV）），serum nerve growth factor（NGF） level，KPS score，adverse reactions and quality of life were compared between the two groups before and after 4 weeks of treatment. [Results] After 4 weeks of treatment，the NCI-CTCAE grading of both groups was better than before treatment（P<0.05），and the NCI-CTCAE grading of the Chinese-Western medicine group was better than that of the Western medicine group（P<0.05）；the MNCV and SNCV of the median nerve and common peroneal nerve in both groups were faster than those before treatment（P<0.05），and the nerve conduction velocity in the Chinese-Western medicine group was faster than that in the Western medicine group（P<0.05）；the serum NGF level，KPS score，physical function，emotional function and social function scores of both groups were higher than before treatment（P<0.05），and the Chinese-Western medicine group was higher than the Western medicine group （P<0.05）. There was no difference in the total incidence of adverse reactions between the Chinese-Western medicine group and the Western medicine group（11.90% vs. 6.98%，P>0.05）. [Conclusion] The application of Danggui Sini Decoction has a better therapeutic effect on CIPN patients，which can effectively upregulate serum NGF level，obviously improve nerve conduction velocity and condition，and significantly enhance health level and quality of life.