周圍神經方手足浸泡聯合甲鈷胺片防治長春新堿所致周圍神經毒性臨床研究

藺莉 李婷 崔杰 李文英 姜俊峰 王玉虹 彭小娟

摘要：目的 觀察周圍神經方手足浸泡聯合甲鈷胺片防治長春新堿化療所致周圍神經毒性（CIPN）的臨床療效。方法 采用隨機數字表法將108例經長春新堿藥物化療的非霍奇金淋巴瘤患者分為治療組、對照組、聯合組各36例。3組均進行常規化療（均首次使用CHOP、R-CHOP、H-CAVD方案），共6個周期。對照組于化療同時予甲鈷胺片，每次0.5 mg，每日3次，口服；治療組在化療同時予周圍神經方手足浸泡，先手后足，每次20 min，每日2次；聯合組在化療同時予甲鈷胺片及周圍神經方，用法用量同前。均7 d為1個療程，連續治療6個療程。于化療2、4、6個周期評價3組CIPN發生率及程度，比較滿意度。篩選周圍神經毒性≥Ⅱ度、已暫停化療、自愿加入鞏固治療研究的患者50例，交替入鞏固治療組、鞏固對照組各25例，鞏固對照組口服甲鈷胺片，鞏固治療組予周圍神經方手足浸泡，用法用量同前，連續治療20 d，評價2組臨床療效及滿意度。結果 化療2個周期，治療組與聯合組CIPN發生率明顯低于對照組（P<0.05）。化療4個周期，聯合組CIPN發生率明顯低于對照組（P<0.01）；治療組與聯合組CIPN≥Ⅱ度的發生率明顯低于對照組（P<0.05）。化療6個周期，治療組與聯合組CIPN≥Ⅱ度的發生率明顯低于對照組（P<0.01）。治療組滿意率明顯高于對照組（P<0.01）。對CIPN≥Ⅱ度的患者鞏固治療，2組臨床療效比較差異無統計學意義（P>0.05）；鞏固治療組滿意率明顯高于鞏固對照組（P<0.01）。結論 周圍神經方手足浸泡聯合甲鈷胺片對減輕CIPN療效顯著，可提高患者生活質量。

關鍵詞：周圍神經方；甲鈷胺；長春新堿；化療所致周圍神經毒性；手足浸泡

DOI：10.3969/j.issn.1005-5304.2018.11.004

中圖分類號：R277.75 文獻標識碼：A 文章編號：1005-5304（2018）11-0015-04

Abstract： Objective To observe the clinical efficacy of prevention and treatment of chemotherapy induced peripheral neurpathy （CIPN） by vincristine via using TCM prescription of peripheral neuropathy hand-food soaking combined with mecobalamin. Methods Totally 120 patients with non-Hodgkin's lymphoma who all received chemotherapy drugs including vincristine were randomly divided into treatment group （36 cases）， control group （36 cases） and combined treatment group （36 cases）. All groups received routine treatment （all used CHOP， R-CHOP and H-CAVD plans for the first time）， for 6 cycles of chemotherapy. The control group was given mecobalamin at the same time， 0.5 mg each time， oral administration， three times a day. The treatment group was given TCM prescription of peripheral neuropathy hand-foot soaking at the same time， hands first and feet later， 20 minutes each time， twice a day. The combined treatment group was given TCM prescription of peripheral neuropathy and mecobalamin at the same time， the same as the former method. 7 days were set as one treatment course， and all the treatment lasted for 6 cycles of chemotherapy. The incidence and degree of CIPN were evaluated in 2， 4， and 6 cycles of chemotherapy， and the satisfaction was compared. 50 patients of CIPN degree ≥Ⅱ were screened， paused chemotherapy， and participated in consolidation treatment research. The 50 patients were assigned into treatment group （25 cases） and control group （25 cases）. The control group took oral mecobalamin， and the treatment group used TCM prescription of peripheral neuropathy hand-foot soaking； the methods were the same as former methods， for 20 d. Clinical efficacy and satisfaction of both groups were evaluated. Results After the second cycle of chemotherapy， the incidence of CIPN in the treatment group and the combined treatment group were obviously lower than the control group （P<0.05）. After the fourth cycle of chemotherapy， the incidence of CIPN in the combined treatment group were obviously lower than the control group （P<0.01）； the incidence of CIPN degree ≥Ⅱ in the treatment group and combined treatment group were obviously lower than the control group （P<0.05）. After the sixth cycle of chemotherapy， the incidence of CIPN degree ≥Ⅱ in the treatment group and combined treatment group were obviously lower than the control group （P<0.01）. The satisfaction rate of the treatment group was higher than the control group （P<0.01）. For the consolidation therapy to patients of CIPN degree ≥Ⅱ， there was no statistical significance in clinical efficacy between the treatment group and the control group （P>0.05）， but the satisfaction rate of the treatment group was higher than the control group （P<0.01）. Conclusion TCM prescription of peripheral neuropathy hand-food soaking combined with mecobalamin can obviously relieve CIPN degree induced by vincristine， and improve the life quality of patients.