Effects of traditional Chinese medicine on cancer pain, fatigue, and mental resilience in lung cancer patients with bone metastasis
-
摘要:
目的 在肺癌伴骨转移患者中应用中医情志和汤药治疗，深入了解中医治疗在缓解肺癌伴骨转移患者疼痛、改善其生活质量和心理状况方面的作用, 为临床提供依据, 为患者提供更有针对性的治疗方案。 方法 将2022年8月—2023年8月衡水市中医医院收治的128例晚期肺癌伴骨转移患者纳入研究，按照随机数表法分为观察组(中医情志干预结合身痛逐瘀汤)和对照组(盐酸羟考酮缓释片治疗)各64例。比较2组患者干预4周后止痛效果，干预前及干预4周后癌因性疲乏[癌症疲乏量表(CFS)]、心理弹性[10条目心理弹性量表(CD-RISC10)]、生存质量[美国肺癌生存质量量表(FACT-L4.0)]、疼痛相关因子[β内啡肽(β-EP)、P物质]。 结果 干预4周后，观察组总缓解率(92.19%，59例)明显高于对照组(78.12%，50例，χ2=5.006，P < 0.05)；2组干预4周后CFS、P低于干预前，β-EP高于干预前，观察组干预4周后CD-RISC、FACT-L4.0高于干预前(P < 0.01)；干预前CFS、CD-RISC、FACT-L4.0、β-EP、P对干预4周后均有影响(P < 0.001)；干预4周后观察组CFS、P低于对照组，CD-RISC、FACT-L4.0、β-EP高于对照组，调整干预前CFS、CD-RISC、FACT-L4.0、β-EP、P水平后，2组比较差异均有统计学意义(P < 0.01)。 结论 中医情志干预结合身痛逐瘀汤可改善晚期肺癌伴骨转移患者癌痛、癌因性疲乏，提升心理弹性和生存质量，其镇痛机制可能是改善β-EP、P水平。 Abstract:Objective The application of traditional Chinese medicine (TCM) emotion and decoction in lung cancer patients with bone metastasis, and in-depth understanding of the role of TCM treatment in alleviating pain, improving quality of life and psychological status of lung cancer patients with bone metastasis, to provide clinical evidence for patients Provide more targeted treatment options. Methods A total of 128 advanced lung cancer patients with bone metastasis, admitted to Hengshui Hospital of Traditional Chinese Medicine from August 2022 to August 2023, were included in the study. They were divided into the observation group (n=64, receiving traditional Chinese medicine emotional intervention combined with Shentong Zhuyu Decoction) and the control group (n=64, receiving standard care) according to random number table method. The analgesic effect, cancer-related fatigue (cancer fatigue scale, CFS), mental resilience (10-item mental resilience scale, CD-RISC10), quality of life (American lung cancer quality of life scale, FACT-L4.0), and pain-related factors (β endorphin, β-EP, substance P) were measured before and 4 weeks after intervention. Results After 4 weeks of intervention, the total remission rate of the observation group was significantly higher [92.19% (59 cases) vs. 78.12% (50 cases), χ2=5.006, P < 0.05]. After 4 weeks of intervention, CFS and P in the observation group were significantly lower than before intervention, while β-EP were significantly higher (P < 0.05). After 4 weeks of intervention, CD-RISC and FACT-L4.0 in the observation group were higher than those before intervention (P < 0.01). Pre-intervention CFS, CD-RISC, FACT-L4.0, β-EP, and P had significant effects on the results after 4 weeks of intervention (P < 0.001). After 4 weeks of intervention, CFS and P in the observation group were lower than those in the control group, while CD-RISC, FACT-L4.0 and β-EP were higher. After adjusting the levels of CFS, CD-RISC, FACT-L4.0, β-EP, and P before intervention, the differences between the two groups were statistically significant (P < 0.01). Conclusion TCM emotional intervention combined with Shentong Zhuyu Decoction improves cancer pain, cancer-related fatigue, mental resilience, and quality of life in patients with advanced lung cancer and bone metastasis. The analgesic mechanism may be mediated through improvements β-EP and P levels. -
表 1 2组晚期肺癌伴骨转移患者止痛效果比较[例(%)]
Table 1. Comparison of analgesic effects between the two groups of advanced lung cancer patients with bone metastasis [cases (%)]
组别 例数 治疗效果 总缓解 完全缓解 部分缓解 轻度缓解 无缓解 观察组 64 12(18.75) 13(20.31) 34(53.13) 5(7.81) 59(92.19) 对照组 64 6(9.38) 12(18.75) 32(50.00) 14(21.88) 50(78.12) 统计量 2.143a 5.006b P值 0.032 0.025 注：a为Z值，b为χ2值。 
下载: 导出CSV
表 2 2组晚期肺癌伴骨转移患者CFS评分比较(x±s，分)
Table 2. Comparison of CFS scores between the two groups of advanced lung cancer patients with bone metastasis (x±s, points)
组别 例数 躯体疲乏 t值 P值 情绪疲乏 t值 P值 认知疲乏 t值 P值 干预前 干预4周后 干预前 干预4周后 干预前 干预4周后 观察组 64 17.95±3.66 13.36±2.00 12.975 ＜0.001 9.25±2.22 6.80±1.21 11.429 ＜0.001 10.20±2.13 7.17±1.63 12.894 ＜0.001 对照组 64 18.07±3.50 15.55±2.63 6.577 ＜0.001 9.36±2.15 7.71±1.37 7.500 ＜0.001 10.32±2.19 8.52±1.79 7.236 ＜0.001 统计量 0.190a 4.284b 0.285a 3.058b 0.314a 3.751b P值 0.850 ＜0.001 0.776 0.003 0.754 ＜0.001 注：a为t值，b为F值。
下载: 导出CSV
表 3 2组晚期肺癌伴骨转移患者CD-RISC评分比较(x±s，分)
Table 3. Comparison of CD-RISC scores between the two groups of advanced lung cancer patients with bone metastasis (x±s, points)
组别 例数 坚韧性 t值 P值 自强 t值 P值 乐观 t值 P值 干预前 干预4周后 干预前 干预4周后 干预前 干预4周后 观察组 64 30.46±2.24 32.60±2.19 7.729 ＜0.001 19.11±2.55 21.07±2.59 6.101 ＜0.001 8.28±1.58 10.05±2.04 7.823 ＜0.001 对照组 64 30.33±2.17 30.86±2.41 1.852 0.069 19.37±2.40 19.61±2.38 0.803 0.425 8.33±1.50 8.60±1.42 1.479 0.145 统计量 0.333a 3.504b 0.594a 2.796b 0.184a 3.623b P值 0.739 ＜0.001 0.554 0.007 0.855 ＜0.001 注：a为t值，b为F值。
下载: 导出CSV
表 4 2组晚期肺癌伴骨转移患者FACT-L4.0评分比较(x±s，分)
Table 4. Comparison of FACT-L4.0 scores between the two groups of advanced lung cancer patients with bone metastasis (x±s, points)
组别 例数 生理状况 t值 P值 社会家庭 t值 P值 情感状况 t值 P值 干预前 干预4周后 干预前 干预4周后 干预前 干预4周后 观察组 64 19.93±2.92 22.21±3.02 6.141 ＜0.001 19.07±4.01 21.71±3.39 5.708 ＜0.001 17.09±2.46 18.95±2.43 6.086 ＜0.001 对照组 64 20.01±2.69 20.47±3.15 1.260 0.213 19.13±4.44 19.26±3.85 0.251 0.803 17.10±2.69 17.52±2.25 1.360 0.179 统计量 0.161a 2.533b 0.080a 3.821b 0.022a 2.887b P值 0.872 0.014 0.936 0.005 0.983 0.006 组别 例数 功能状况 t值 P值 附加关注 t值 P值 干预前 干预4周后 干预前 干预4周后 观察组 64 14.06±2.44 16.41±2.53 7.565 ＜0.001 21.53±2.03 22.91±2.74 4.629 0.002 对照组 64 14.01±2.59 14.24±2.12 0.781 0.438 21.41±1.96 21.59±2.67 0.622 0.536 统计量 0.112a 4.353b 0.340a 2.115b P值 0.911 ＜0.001 0.734 0.039 注：a为t值，b为F值。
下载: 导出CSV
表 5 2组晚期肺癌伴骨转移患者β-EP、P水平比较(x±s)
Table 5. Comparison of β-EP and P levels between the two groups of advanced lung cancer patients with bone metastasis (x±s)
组别 例数 β-EP(ng/L) t值 P值 P(ng/L) t值 P值 干预前 干预4周后 干预前 干预4周后 观察组 64 40.56±12.44 58.01±11.53 11.648 ＜0.001 77.53±15.23 47.51±11.04 18.284 ＜0.001 对照组 64 41.71±11.59 49.24±12.12 5.081 ＜0.001 78.41±16.06 56.19±10.97 13.153 ＜0.001 统计量 0.541a 3.286b 0.318a 3.559b P值 0.589 0.002 0.751 ＜0.001 注：a为t值，b为F值。
下载: 导出CSV
-
[1] 高庆龄, 常燕, 王晶妮, 等. 表皮生长因子受体酪氨酸激酶抑制剂单药或组合联合化疗对表皮生长因子受体突变晚期非小细胞肺癌患者无进展生存期的影响[J]. 实用临床医药杂志, 2023, 27(24): 1-6.GAO Q L, CHANG Y, WANG J N, et al. Effects of individual or combination medication of epidermal growth factor receptor tyrosine kinase inhibitor combined with chemotherapy on progression-free survival in advanced non-small cell lung cancer patients with epidermal growth factor receptor mutation[J]. Journal of Clinical Medicine in Practice, 2023, 27(24): 1-6. [2] 鲁叶云, 周柳柳, 熊映棋, 等. 骨痛灵方改善晚期非小细胞肺癌骨转移患者临床观察[J]. 辽宁中医杂志, 2023, 50(9): 80-83.LU Y Y, ZHOU L L, XIONG Y Q, et al. Clinical observation on improving bone metastasis of advanced non-small cell lung cancer by tonifying kidney and nourishing essence[J]. Liaoning Journal of Traditional Chinese Medicine, 2023, 50(9): 80-83. [3] RUANO A, GARCIA-TORRES F, GALVEZ-LARA M, et al. Psychological and non-pharmacologic treatments for pain in cancer patients: a systematic review and meta-analysis[J]. J Pain Symptom Manage, 2022, 63(5): e505-e520. doi: 10.1016/j.jpainsymman.2021.12.021 [4] 任莉莉, 姚庆华, 曹文明, 等. 三黄三仙汤治疗脾肾亏虚型晚期乳腺癌患者癌因性疲乏的效果观察[J]. 中华全科医学, 2022, 20(4): 673-677. doi: 10.16766/j.cnki.issn.1674-4152.002427REN L L, YAO Q H, CAO W M, et al. Effect of Sanhuang Sanxian Decoction on cancer-related fatigue in patients with advanced breast cancer of spleen and kidney deficiency type[J]. Chinese Journal of General Practice, 2022, 20(4): 673-677. doi: 10.16766/j.cnki.issn.1674-4152.002427 [5] 魏莉, 李良松, 梁壮. 《黄帝内经》心性思想与情志理论对中医心质学理论构建的影响[J]. 中华中医药杂志, 2020, 35(12): 5978-5981.WEI L, LI L S, LIANG Z. Influence of mind-nature thought and emotion theory from Huangdi Neijing on construction of the theory of TCM mind-nature science[J]. Chinese Journal of Traditional Chinese Medicine, 2020, 35(12): 5978-5981. [6] 赖桂花, 王菲, 聂多锐, 等. 骨转移癌痛发病机制及中医药防治研究进展[J]. 中国实验方剂学杂志, 2023, 29(11): 231-239.LAI G H, WANG F, NIE D R, et al. Pathogenesis of bone metastasis-caused pain and its prevention and treatment with traditional chinese medicine: a review[J]. Journal of Chinese Experimental Formulae, 2023, 29(11): 231-239. [7] 中华人民共和国国家卫生健康委员会, 赫捷, 吴一龙, 等. 原发性肺癌诊疗指南(2022年版)[J]. 中国合理用药探索, 2022, 19(9): 1-28.National Health Commission of the People's Republic of China, HE J, WU Y L, et al. Guidelines for the diagnosis and treatment of primary lung cancer (2022 edition)[J]. China Licensed Pharmacist, 2022, 19(9): 1-28. [8] 中国中医药研究促进会肿瘤专业委员会. 癌性疼痛中医外治诊疗规范专家共识意见[J]. 北京中药, 2014, 33(4): 305-307.China Association for the Promotion of Traditonal Chinese Medicine Cancer Committee. Consensus opinion of experts on TCM external treatment of cancer pain[J]. Beijing traditional Chinese medicine, 2014, 33(4): 305-307. [9] 张凤玲, 丁玥, 韩丽沙. 癌症疲乏量表中文版的信效度[J]. 中国心理卫生杂志, 2011, 25 (11): 810-813.ZHANG F L, DING M, HAN L S. Reliability and validity of the Chinese version of cancer fatigue scale[J]. Chinese Mental Health Journal, 2011, 25(11): 810-813. [10] CONNOR K M, DAVIDSON J R T. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)[J]. Depress Anxiety, 2003, 18(2): 76-82. doi: 10.1002/da.10113 [11] 张作记. 行为医学量表手册[M]. 北京: 中华医学电子音像出版社, 2005: 111-114.ZHANG Z J. Manual of behavioral medicine scales[M]. Beijing: China Medical Electronic Audio-Visual Publishing House, 2005: 111-114. [12] 王泽坤, 臧云彩, 王俊涛, 等. 郑玉玲运用补肾护骨方治疗恶性肿瘤骨转移经验[J]. 中医杂志, 2022, 63(14): 1323-1326.WANG Z K, ZANG Y C, WANG J T. Experience of ZHENG Yuling in treating bone metastasis from malignant tumors with Bushen Hugu Formula[J]. Journal of Traditional Chinese Medicine, 2022, 63(14): 1323-1326. [13] 易腾达, 李玉丽, 梁宇, 等. 经典名方身痛逐瘀汤的古今文献分析[J]. 中国实验方剂学杂志, 2021, 27(2): 28-36.YI T D, LI Y L, LIANG Y, et al. Textual research on ancient and modern literature analysis and research of classical prescriptions for Shentong Zhuyu Decoction[J]. Journal of Chinese Experimental Formulae, 2021, 27(2): 28-36. [14] 霍艳, 陈萍, 朱俊楠, 等. 腕踝针治疗产后腹痛的临床疗效及对产妇血清β-EP水平的影响[J]. 中国针灸, 2023, 43(11): 1257-1260.HUO Y, CHEN P, ZHU J N, et al. Curative effect of wrist-ankle acupuncture on postpartum abdominal pain and its influence on serum β-EP level in puerpera[J]. Chinese Acupuncture & Moxibustion, 2023, 43(11): 1257-1260. [15] 林晓芳, 王冬梅. P物质在病理性痛中的研究进展[J]. 神经解剖学杂志, 2022, 38(3): 354-358.LIN X F, WANG D M. Research progress of substance P in pathologic pain[J]. Chinese Journal of Neuroanatomy, 2022, 38(3): 354-358. [16] 王琳, 蒋燕萍, 江华娟, 等. 经典名方身痛逐瘀汤物质基准UPLC指纹图谱建立及其5种成分含量测定[J]. 中国中药杂志, 2022, 47(2): 334-342.WANG L, JIANG Y P, JIANG H J, et al. UPLC fingerprint and determination of five components of substance benchmark of classical prescription Shentong Zhuyu Decoction[J]. China Journal of Chinese Materia Medica, 2022, 47(2): 334-342. [17] 谷珊珊, 许云, 付力, 等. 癌因性疲乏的中医证候特征及其与甲状腺功能水平的相关性研究[J]. 中国全科医学, 2024, 27(21): 2623-2629, 2638.GU S S, XU Y, FU L, et al. Study on the traditional Chinese medicine syndrome characteristics of cancer-related fatigue and their correlation with thyroid function level[J]. Chinese General Practice, 2024, 27(21): 2623-2629, 2638. [18] CAMPBELL R, BULTIJNCK R, INGHAM G, et al. A review of the content and psychometric properties of cancer-related fatigue (CRF) measures used to assess fatigue in intervention studies[J]. Support Care Cancer, 2022, 30(11): 8871-8883. [19] 胡玲, 张贤峰, 宋子正, 等. 家属协同健康教育对老年肺癌患者癌因性疲乏, 心理弹性及自我效能感的影响[J]. 中国老年学杂志, 2023, 43(12): 3047-3050.HU L, ZHANG X F, SONG Z Z, et al. Effects of family coordinated health education on cancer-related fatigue, mental resilience and self-efficacy in elderly patients with lung cancer[J]. Chinese Journal of Gerontology, 2023, 43(12): 3047-3050. [20] 袁培, 周昌乐, 许家佗. 中医情志疗法在抑郁症诊疗中的应用[J]. 中华中医药杂志, 2021, 36(8): 4853-4856.YUAN P, ZHOU C L, XU J T. Application of traditional Chinese emotional therapy in the diagnosis and treatment of depressive disorder[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2021, 36(8): 4853-4856. -
点击查看大图
表(5)
计量
- 文章访问数: 9
- HTML全文浏览量: 7
- PDF下载量: 2
- 被引次数: 0
