艾灸对弥漫大B细胞淋巴瘤化疗患者骨髓抑制的影响.pdf

上海针灸杂志 2023 年 9 月第 42 卷第 9 期 895 文章编号:1005-0957(2023)09-0895-05 专题研究 艾灸对弥漫大 B 细胞淋巴瘤化疗患者骨髓抑制的影响 陈丽红,单坤生,陈雅铃,杨雪容,王玮 联勤保障部队第九九医院(厦门大学附属东南医院),漳州 363000 【摘要】目的 观察艾灸对弥漫大 B 细胞淋巴瘤化疗患者骨髓抑制、集落刺激因子水平和中医证候积分的影响。方法 回顾性分析联勤保障部队第九九医院收治的 126 例弥漫大 B 细胞淋巴瘤化疗患者,随机分为艾灸预治疗组(41 例)、艾灸治疗组(44 例)和对照组(41 例)。3 组均予化疗,艾灸预治疗组于化疗开始前 7 d 进行艾灸,每日 1 次,共 14 d;艾灸治疗组于化疗开始时进行艾灸,每日 1 次,共 7 d;对照组行常规化疗。比较 3 组治疗前后白细胞(white blood cell,WBC)计数、中性粒细胞(neutrophil,NEU)计数、血红蛋白(haemoglobin,Hb)、血小板(platelet,PLT)计数、粒细胞-巨噬细胞集落刺激因子(granulocyte-macrophage colony-stimulating factor,GM-CSF)水平、粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)水平、骨髓抑制分度及中医证候积分的变化。结果 治疗后,对照组和艾灸治疗组 WBC 计数、NEU 计数、Hb 和 PLT 计数低于艾灸预治疗组(P0.05);对照组低于艾灸治疗组(P0.05)。3 组治疗后骨髓抑制分度比较差异有统计学意义(P0.05)。对照组和艾灸治疗组治疗后 GM-CSF 和 G-CSF 水平低于艾灸预治疗组(P0.05),对照组低于艾灸治疗组(P0.05)。对照组治疗后重组人 G-CSF 使用率高于艾灸治疗组和艾灸预治疗组(P0.05)。对照组和艾灸治疗组治疗后中医证候积分高于艾灸预治疗组(P0.05);对照组高于艾灸治疗组(P0.05)。结论 艾灸对弥漫大 B 细胞淋巴瘤化疗患者骨髓抑制具有积极作用。【关键词】灸法;间接灸;温灸器灸;淋巴瘤,大 B 细胞,弥漫性;化疗;骨髓抑制【中图分类号】R246.5 【文献标志码】A DOI:10.13460/j.issn.1005-0957.2023.09.0895 Effect of moxibustion on myelosuppression in patients receiving chemotherapy for diffuse large B-cell lymphoma CHEN Lihong,SHAN Kunsheng,CHEN Yaling,YANG Xuerong,WANG Wei.No.909 Hospital of Peoples Liberation Army of China(Southeast Hospital Affiliated to Xiamen University),Zhangzhou 363000,China Abstract Objective To observe the effects of moxibustion on myelosuppression,colony-stimulating factor level,and symptom scores of traditional Chinese medicine(TCM)in patients undergoing chemotherapy for diffuse large B-cell lymphoma.Method A retrospective analysis was conducted amongst 126 patients receiving chemotherapy for diffuse large B-cell lymphoma admitted to No.909 Hospital of Peoples Liberation Army of China.The cases were randomized into a pre-moxibustion group(41 cases),a moxibustion group(44 cases),and a control group(41 cases).Chemotherapy was offered to all three groups.In addition,the pre-moxibustion group started to receive moxibustion 7 d before chemotherapy,once daily for 14 d;the moxibustion group started to receive moxibustion concurrently with chemotherapy,once daily for 7 d;the control group only received the conventional chemotherapy.Before and after the treatment,white blood cell(WBC)count,neutrophil(NEU)count,haemoglobin(Hb),platelet(PLT)count,granulocyte-macrophage colony-stimulating factor(GM-CSF)level,granulocyte colony-stimulating factor(G-CSF)level,myelosuppression degree,and TCM symptom scores were compared.Result After the treatment,the WBC count,NEU count,Hb,and PLT count were lower in the control and moxibustion groups 基金项目:全军医药卫生科研项目(15MS108)作者简介:陈丽红(1985),女,主治医师,Email: 通信作者:王玮(1969),男,副主任医师,Email: 896 Shanghai J Acu-mox,Sep 2023,Vol 42,No 9 than in the pre-moxibustion group(P0.05),and the control group was lower than the moxibustion group(P0.05);there were significant differences in the myelosuppression degree amongst the three groups after the treatment(P0.05);the GM-CSF and G-CSF levels were lower in the control and moxibustion groups than in the pre-moxibustion group(P0.05),and the control group was lower than the moxibustion group(P0.05);the recombinant human G-CSF consumption rate was higher in the control group than in the moxibustion and pre-moxibustion groups(P0.05);the TCM symptom scores were higher in the control and moxibustion groups than in the pre-moxibustion group(P 0.05),and the control group was higher than the moxibustion group(P0.05).Conclusion Moxibustion can produce positive effects on myelosuppression in patients receiving chemotherapy for diffuse large B-cell lymphoma.Key words Moxibustion;Indirect moxibustion;Thermal box moxibustion;Lymphoma,Large B-cell,Diffuse;Drug therapy;Myelosuppression 弥漫大 B 细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)是常见的淋巴系统恶性肿瘤1。DLBCL 呈浸润性生长,病情进展快,患者预后较差2。利妥昔单抗联合环磷酰胺、长春新碱和阿霉素是常用的化疗方案3。但是部分患者治疗后会出现白细胞(white blood cell,WBC)降低、血小板(platelet,PLT)减少等骨髓抑制表现,甚至发生严重感染和出血,影响疗效和患者的预后4。中医学认为,治疗后骨髓抑制主要原因是脾肾两虚,并且与久病伤正、精气亏虚有关5。针灸大成记载:“针所不为,灸之所宜,阴阳皆虚,火自当之。”研究也证实艾灸能够有效缓解恶性肿瘤患者治疗后的骨髓抑制反应6-7。本研究观察艾灸对于DLBCL治疗后骨髓抑制的治疗效果,旨在为DLBCL化疗不良反应的预防和治疗提供新思路。1 临床资料 1.1 一般资料 收集联勤保障部队第九九医院 2020 年 1 月2021 年 12 月收治的 126 例 DLBCL 化疗患者,根据治疗方式不同分为艾灸预治疗组(41 例)、艾灸治疗组(44 例)和对照组(41 例)。3 组一般资料比较,差异无统计学意义(P0.05),详见表 1。表 1 3 组一般资料比较 组别 例数 年龄/岁(xs)性别/例 男/女 化疗方案/例 R-CHOP/CHOP 临床分期/例/结外受侵/例 否/是 脾肿大/例 否/是 艾灸预治疗组 41 5711 24/17 28/13 27/14 30/11 31/10 艾灸治疗组 44 5711 25/19 32/12 34/10 30/14 30/14 对照组 41 5413 26/15 30/11 33/8 27/14 30/11 1.2 纳入标准 首次诊断为 DLBCL;经组织病理学诊断为 DLBCL;接受化疗;临床资料完整。1.3 排除标准 既往其他恶性肿瘤者;血液系统其他疾病者;既往接受抗肿瘤治疗者;严重感染者;免疫系统疾病者。2 治疗方法 2.1 化疗 化疗方案采用环磷酰胺长春新碱表柔比星泼尼松方案(CHOP 方案)或者利妥昔环磷酰胺长春新碱表柔比星泼尼松方案(R-CHOP 方案),疗程为 68 个周期。2.2 灸法 穴位取足三里、大椎、膈俞和肾俞,观察穴位皮肤及周围皮肤有无红肿、破溃或皮疹,取 2 块无菌纱布平铺于穴位上,使穴位位于纱布正中心,取长3 cm艾段点燃后放入艾灸盒中,将艾灸盒置于纱布中央位置并固定,每个穴位艾灸时间为 30 min。艾灸过程中纱布覆盖部位出现皮肤微红并稍有灼热痛为正常现象,若出现难以克服灼热痛或皮肤出现水泡应及时停止艾灸。艾灸预治疗组于每次化疗开始前 7 d 进行艾灸,每日 1 次,共治疗 14 d;艾灸治疗组于每次化疗开始时进行艾灸,每日 1 次,共治疗 7 d;对照组行常规化疗。上海针灸杂志 2023 年 9 月第 42 卷第 9 期 897 3 治疗效果 3.1 观察指标 观察治疗前后 WBC 计数、中性粒细胞(neutrophil,NEU)计数、血红蛋白(haemoglobin,Hb)、PLT 计