采用前瞻性队列研究，收集初治的实体瘤化疗患者，将“是否在化疗期间连续至少4周期联合益气养血类中药”作为暴露因素分为2组，比较骨髓抑制发生率。结果显示，暴露组3~4级中性粒细胞减少、2级及以上血小板减少、2级及以上贫血的发生率明显低于非暴露组，差异均有统计学意义（P<0.001、P=0.002、P=0.007）。研究结果证明，化疗期间联合使用益气养血法为治则的汤剂、中成药可显著降低骨髓抑制的发生率。益气养血法可作为实体瘤化疗所致骨髓抑制的预防措施，在辨证论治的基础上前移至预防阶段与化疗同步使用。
Myelosuppression is one of the most common adverse reactions of chemotherapy, which leads to dose reduction, delays, or even interruptions of the treatment.This study adopted a prospective cohort design to collect data from chemotherapynaive patients with solid tumors.Patients were divided into two groups based on whether they continuously used Qi-invigorating and blood-nourishing traditional Chinese medicine (TCM) formulas for at least four cycles during the chemotherapy.The incidence rates of myelosuppression were compared between the two groups.Results showed that the incidence rates of grade 3~ 4 neutropenia, grade 2 or higher thrombocytopenia, and grade 2 or higher anemia were significantly lower in the exposure group compared to the non-exposure group, with all differences being statistically significant (P<0.001, P=0.002, P=0.007, respectively).The study demonstrated that the concurrent use of TCM formulas and patent medicines based on the principles of Qi-invigorating and blood-nourishing during chemotherapy can significantly reduce the incidence of myelosuppression.Qiinvigorating and blood-nourishing therapy can be used as a preventive measure for chemotherapy-induced myelosuppression in solid tumors, applied simultaneously with chemotherapy as a preventive strategy based on syndrome differentiation.
[1] Expert Committee of Integrated Chinese and Western Medicine, CSCO. 抗肿瘤药物引起骨髓抑制中西医结合诊治专 家共 识[J]. 临床 肿瘤 学杂 志, 2021, 26(11): 1020- 1027.
[2] 侯丽, 董青, 陈信义, 等. 肿瘤相关性贫血中医药防治专家共识[J]. 北京中医药, 2021, 40(1): 48-52.
[3] National Institutes of Health, National Cancer Institute. Common terminology criteria for adverse events (CTCAE) (version 5.0)[EB/OL]. (2021-06-15)[2024-03-01]. https:// ctep. cancel. gov/protocolDevelopment /electronics_applicatio ns/docs/CTCAE_ v5_ Quick_Reference _8. 5x11.
[4] Becker P S, Griffiths E A, Alwan L M, et al. NCCN guidelines insights: Hematopoietic growth factors, version 1.2020[J]. Journal of the National Comprehensive Cancer Network, 2020, 18(1): 12-22.
[5] 秦叔逵, 马军. 中国临床肿瘤学会(CSCO)肿瘤放化疗相关中性粒细胞减少症规范化管理指南(2021)[J]. 临床肿瘤学杂志, 2021, 26(7): 638-648.
[6] 许崇艳, 马志强, 牛占恩. 八珍汤对急性白血病化疗后骨髓抑制的疗效观察及部分机制探析[J]. 世界中医药, 2019, 14(8): 2077-2082.
[7] 淳泽. 八珍汤对小鼠造血功能影响的机制研究[D]. 成都: 四川大学, 2004.
[8] 杨晟, 何小慧, 刘鹏, 等. 聚乙二醇化重组人粒细胞集落刺激因子预防化疗后中性粒细胞减少的有效性分析[J]. 中国肿瘤临床, 2015, 42(12): 626-631.
[9] Kuter D J. Managing thrombocytopenia associated with cancer chemotherapy[J]. Oncology, 2015, 29(4): 282-294.
[10] Kaufman R M, Djulbegovic B, Gernsheimer T, et al. Platelet transfusion: A clinical practice guideline from the AABB[J]. Annals of Internal Medicine, 2015, 162(3): 205-213.
[11] 马军. 肿瘤化疗所致血小板减少症诊疗中国专家共识(2018版)[J]. 中华肿瘤杂志, 2018, 40(9): 714-720.
[12] Anti-Lymphoma Alliance in CSCO, Anti-Leukemia Alliance in CSCO, ASMC Group in CSCO. 重组人白介素- 11防治血小板减少症临床应用中国专家共识(2021)[J]. 临床肿瘤学杂志, 2020, 25(12): 1129-1137.
[13] Weycker D, Hatfield M, Grossman A, et al. Risk and consequences of chemotherapy-induced thrombocytopenia in US clinical practice[J]. BMC Cancer, 2019, 19(1): 151.
[14] National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology, cancer-and chemotherapy-induced anemia version 1.2018[EB/OL]. (2021-06- 30)[2024-03-01]. www. nccn. org/professionals/physician _gls/pdf/breast.
