理气化痰方辅助枸橼酸他莫昔芬片治疗乳腺癌术后肺小结节临床研

Clinical Study on Liqi Huatan Prescription as an Adjuvant to Tamoxifen Citrate Tablets in the Treatment of Pulmonary Micronodules After Breast Cancer Surgery

摘要:

目的：观察理气化痰方辅助枸橼酸他莫昔芬片治疗乳腺癌术后肺小结节的临床疗效。方法：回顾性选取2023年1月—2024年6月于平湖市中医院就诊的85例乳腺癌术后并发肺小结节的患者为研究对象，按照治疗方式不同分为对照组42例和观察组43例。对照组给予枸橼酸他莫昔芬片治疗，观察组在对照组基础上予理气化痰方治疗。2组均治疗6个月。比较2组治疗前后的肺结节直径、中医证候积分、肺功能指标［用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、FEV1/FVC］、血清肿瘤标志物［癌胚抗原（CEA）、糖类抗原125 （CA125）、糖类抗原15-3 （CA15-3）］、血清炎症因子水平［肿瘤坏死因子-α （TNF-α）、白细胞介素-6 （IL-6）、白细胞介素-1β （IL-1β）］、免疫功能指标［T淋巴细胞CD4+、CD8+、CD4+/CD8+、免疫球蛋白G（IgG） 和免疫球蛋白A（IgA）］ 的变化。结果：治疗后，2组肺结节直径较治疗前缩小（P＜0.05），且观察组肺结节直径小于对照组（P＜0.05）。治疗后，2组中医证候积分较治疗前下降（P＜0.05），且观察组中医证候积分低于对照组（P＜0.05）。治疗后，2组FEV1、FVC、FEV1/FVC水平较治疗前升高（P＜0.05），且观察组高于对照组（P＜0.05）。治疗后，2组CEA、CA125、CA15-3、TNF-α、IL-1β、IL-6水平较治疗前下降（P＜0.05），且观察组低于对照组（P＜0.05）。治疗后，2组IgG、IgA、CD4+、CD4+/CD8+较治疗前升高（P＜0.05），且观察组IgG、IgA、CD4+、CD4+/CD8+高于对照组（P＜0.05）；2组CD8+较治疗前下降（P＜0.05），且观察组CD8+低于对照组（P＜0.05）。2组不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：理气化痰方辅助枸橼酸他莫昔芬片治疗乳腺癌术后肺小结节患者疗效较好，能缩小肺结节，改善肺功能，调节机体免疫功能，减轻炎症反应。

Abstract:

Abstract： Objective： To observe the clinical efficacy of Liqi Huatan Prescription as an adjuvant to Tamoxifen Citrate Tablets in the treatment of pulmonary micronodules after breast cancer surgery. Methods：A retrospective study was conducted on 85 patients with pulmonary micronodules after breast cancer surgery who were treated at Pinghu Hospital of Chinese Medicine from January 2023 to June 2024. They were divided into the control group （42 cases） and the observation group（ 43 cases） based on the treatment methods. The control group received Tamoxifen Citrate Tablets， while the observation group received Liqi Huatan Prescription in addition to the treatment given to the control group. Both groups were treated for six months. The following parameters were compared between the two groups before and after treatment：pulmonary nodule diameter，traditional Chinese medicine syndrome scores，pulmonary function indicators [forced vital capacity（ FVC），forced expiratory volume in one second（ FEV1），FEV1/FVC ratio]，serum tumor markers [carcinoembryonic antigen （CEA）， carbohydrate antigen 125 （CA125）， carbohydrate antigen 15-3 （CA15-3）]， serum inflammatory factor levels [tumor necrosis factor-alpha（ TNF-α），interleukin-6（ IL-6），interleukin-1β（ IL-1β）]， and immune function indicators [T lymphocyte CD4+ ， CD8+ ， CD4+/CD8+ ratio， immunoglobulin G （IgG）， immunoglobulin A （IgA）]. Results： After treatment， the pulmonary nodule diameter in both groups decreased compared with that before treatment （P＜0.05）， and the pulmonary nodule diameter in the observation group was smaller than that in the control group （P＜0.05）. After treatment，traditional Chinese medicine syndrome scores in both groups decreased compared with those before treatment （P＜0.05），and the scores in the observation group were lower than those in the control group （P＜0.05）. After treatment，levels of FEV1，FVC，and FEV1/FVC ratio in both groups increased compared with those before treatment （P＜0.05）， and the observation group showed higher levels than the control group （P＜0.05）. After treatment， levels of CEA， CA125， CA15-3， TNF-α， IL-1β， and IL-6 in both groups decreased compared with those before treatment （P＜0.05），and the observation group had lower levels than the control group （P＜0.05）. After treatment，levels of IgG，IgA，CD4+，and CD4+/CD8+ ratio in both groups increased compared with those before treatment （P＜0.05）， and the observation group had higher levels of IgG， IgA， CD4+， and CD4+/CD8+ ratio than the control group （P＜0.05）； CD8+ levels in both groups decreased compared with those before treatment （P＜0.05），and the observation group had lower CD8+ levels than the control group （P＜0.05）. There was no statistically significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. Conclusion： Liqi Huatan Prescription as an adjuvant to Tamoxifen Citrate Tablets demonstrates certain clinical efficacy in patients with pulmonary micronodules after breast cancer surgery， reducing pulmonary nodule size， improving pulmonary function，regulating immune function，and alleviating inflammatory responses.