世界中医药

目的：观察参苓白术散治疗肺癌骨转移的临床疗效并分析其发挥作用的部分机制。方法：将本院2008年1月至2014年8月60例肺癌骨转移患者纳入研究，根据是否使用参苓白术散将常规组（31例）及中药组（29例），2组均接受含铂两药联合化疗，唑来磷酸4 mg+0.9%NaCl 100 mL静脉滴注,每3周1次，连续治疗15周。中药组在上述治疗基础上加用参苓白术散加味，1剂/d，连续治疗15周。治疗结束后比较2组患者骨痛、外周血Th17细胞百分率的变化。结果：1）经过治疗后2组骨痛VAS评分均较治疗前均有所下降，其中中药组下降的趋势更为明显，与常规组比较具有统计学意义（P<0.05）。2）随访过程中发现中药组发生SREs于首次出现处先叙述其中文全称，然后在其后括号内注明中文缩略语、英文全称及英文缩略语,三者间用“，”分开。的时间明显较常规组延长，2组比较差异具有统计学意义（t=4.39，P=0.034＜0.05）。中药组SREs发生率与常规组比较明显下降，差异具有统计学意义（χ2=5.01，P=0.01＜0.05）。3）经过治疗后2组Th17细胞百分比均较治疗前均有所下降，其中中药组下降的趋势更为明显，与常规组比较差异具有统计学意义（P<0.05）。结论：参苓白术散可明显缓解肺癌骨转移患者的临床症状，其作用机制可能与降低外周血Th17细胞从而促进免疫能力表达有关。

English Summary:

To observe the curative effect of modified Shenling Baizhu decoction in the treatment of bone metastases from lung cancer and to analyze its mechanism. Methods: Sixty cases of lung cancer patients with bone metastases(enrolled in our hospital from January 2008 to August 2014) were selected in the study. According to whether use modified Shenling Baizhu decoction, they are divided into the conventional group (31 cases) and TCM(Traditional Chinese Medicine) group (29 cases), and both of the two groups accepted chemotherapy of allied two medicines containing Pt. 4 mg zoledronic acid + 0.9% Nacl 100 mL intravenous drip, once every three weeks, lasting for 15 weeks. TCM group was given Shenling Baizhu decoction on the basis of the above treatment, 1 dose/day, lasting for 15 weeks. To compare bone pain, peripheral blood Th17 cell percentage changes between the two groups. Results: 1) After treatment, the bone pain VAS scores of the two groups decreased, the decline degree of TCM group is more obvious than that of the conventional group(P<0.05). 2) In the process of follow-up, it was found that the appearance of SREs in TCM group is significantly faster than that of the conventional group with statistical difference(t=4.39, P=0.034<0.05). The incidence of SREs in TCM group decreased obviously than the conventional group with statistical difference(χ2=5.01 P=0.01<0.05). 3)After treatment, the Th17 cells in the two groups decreased significantly than before, and the downward trend was more apparent than the conventional group with statistical differences(P<0.05). Conclusion: Shenling Baizhu power can obviously relieve the clinical symptoms of patients with bone metastases from lung cancer. This may due to the fact that it can decrease Th17 cells in peripheral blood and promote immunity.

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