| Background:Breast cancer is one of the most common malignant tumors in women worldwide,and its incidence ranks first among female malignancies,and it is increasing year by year.With the development of modern medical research,although multidisciplinary comprehensive treatment has improved the survival rate of breast cancer patients,the adverse reactions caused by various treatment methods cannot be ignored.The economic burden of the treatment of malignant tumors on patients,the lack of secondary sexual characteristics of women caused by surgery,postoperative chemotherapy-induced hair loss,nausea,vomiting,bone marrow suppression and other adverse reactions,skin itching and even ulceration caused by radiotherapy,endocrine Bone pain,perimenopausal symptoms,etc.brought by the treatment,bring physical,psychological and social life pain and huge pressure to patients,and prolonged depression,anxiety and other bad emotions,greatly reducing the quality of life of breast cancer patients.Studies have shown that 20%-57%of breast cancer patients have depression and anxiety,and the pathogenesis is still unclear,which may be related to 5-HT release,negative feedback regulation of HPA axis,and inflammatory factor levels.In terms of treatment,western medicine takes the diagnostic criteria of depression as the principle of treatment,mainly tricyclic antidepressants,serotonin reuptake inhibitors,norepinephrine reuptake inhibitors,etc.,although they have certain effects,but because of their side effects,It has a large impact on the digestive system,cardiovascular system,liver and kidney functions,and poor patient compliance,which limits clinical applications.Due to its unique overall concept and diagnosis and treatment thinking based on dialectical treatment,Chinese medicine has achieved remarkable results in clinical practice.Traditional Chinese medicine theory believes that breast cancer depression and anxiety are closely related to the liver.In addition,patients with malignant tumors have injured the spleen and stomach after various treatments.Combined with current research on breast cancer depression and anxiety TCM syndrome types,liver depression and spleen deficiency syndrome are more common.Taking the method of relieving liver and strengthening the spleen as the main principle,especially in regulating mood,improving depression,anxiety symptoms,and improving the immune function of patients,it has shown good clinical effects and has certain clinical value.Objective:To evaluate the clinical efficacy of Shugan Jianpi Recipe in the treatment of depression and anxiety in patients with liver stagnation and spleen deficiency type after breast cancer surgery,and to observe the changes in syndrome scores and cytokines of liver stagnation and spleen deficiency before and after treatment,and to explore the effects of Effect of Jianpi Recipe on clinical symptoms and immune function of patients.Methods:A single-arm clinical trial was used to evaluate the patients who met the inclusion criteria in the oncology clinic of***Hospital of China Academy of Chinese Medical Sciences from April 2019 to February 2020.(GAD-7),Self-rating Depression Rating Scale(PHQ-9),and the method for filling out the quantitative grading scale of symptoms of liver depression and spleen deficiency,according to the scale scoring criteria,are divided into depression group,anxiety group,depression anxiety group.Before treatment,the cytokine levels(IL-1β,IL-10,IL-6,IL-8,IL-2R,TNF-α)in peripheral blood were measured,and Shugan Jianpi Recipe was added and subtracted to different groups.Patients should intervene,and other antidepressant and anxiety treatments should not be combined while taking Chinese medicine.GAD-7,PHQ-9,liver depression and spleen deficiency quantification scale and cytokine levels should be re-measured after 8 weeks.Jianpi Decoction can improve depression,anxiety and liver depression and spleen deficiency in postoperative patients with breast cancer,and observe whether the changes in cytokine levels have improved before and after treatment.Results:A total of 55 patients were included in this study.55 patients completed all follow-ups,including 15 in the depression group,18 in the anxiety group,and 22 in the anxiety and depression group.(1)Basic information:55 cases were all female married patients,aged from 28-74 years,with a median age of 52 years;most of their education was high school,college or undergraduate;radical surgery Improved radical mastectomy is the main type;42 cases of invasive carcinoma are the most common pathological type(76.4%);stage Ⅰ to Ⅱ are the highest proportion(72.7%)of pathological stages;all cases received standard comprehensive treatment of breast cancer Scenario,the tumor condition is relatively stable;statistics of each group are compared and compared between groups.Chi-square test is used to compare count data between groups.Measurement data uses analysis of variance,which does not meet the normal distribution using rank sum test.The three groups of patients were statistically analyzed in terms of age,surgical method,pathological type,pathological stage,and previous treatment.There was no significant difference(P>0.05).The general data were consistent with the baseline,so the three groups were comparable.(2)Evaluation of the efficacy of Shugan Jianpi Decoction in improving depression and anxiety:The interventional treatment of Shugan Jianpi Decoction significantly reduced the depression and anxiety scale scores of the three groups of subjects.The pre-treatment PHQ-9 of the depression and anxiety group was significantly reduced.And GAD-7 scores were higher than the PHQ-9 score before treatment in the depression group and the GAD-7 score before treatment in the anxiety group,indicating that the patients in the depression and anxiety group had higher levels of depression and anxiety than the other two groups;three groups After treatment,the symptoms of liver depression and spleen deficiency were significantly improved compared with before treatment.Compared between the groups,the depression and anxiety group and the anxiety group had statistically significant differences in chest pain,less appetite,unpleasant stools,emotional depression or irritability,and too much interest before and after treatment.The difference indicates that the symptoms of depression and anxiety are more obvious in the anxiety group than in the anxiety group,and the improvement is more significant after treatment;compared with the efficacy of the three groups of liver stagnation and spleen deficiency syndrome,the effective rate of the three groups is the highest(73.3%,55.6%,63.6%)It indicates that Shugan Jianpi Decoction is effective in all groups,and can alleviate the corresponding symptoms of liver stagnation and spleen deficiency syndrome.After the end of 8 weeks of treatment,the levels of TNF-α,IL-2R,and IL-8 in the three groups were significantly higher than before treatment.Decrease,comparison between groups,cytokine water in depression and anxiety group The level of TNF-α in the depression and anxiety group is significantly different from that in the anxiety group,and the level of IL-2R in the depression and anxiety group is significantly different from that in the depression and anxiety group.There was no significant difference between IL-8 level and depression group and anxiety group.The correlation test between PHQ-9 and GAD-7 scores and cytokines showed that TNF-α and PHQ-9 scores were positively correlated before and after treatment.IL-2R and GAD-7 scores were positively correlated.Conclusion:(1)Shugan Jianpi Recipe can effectively improve the depression and anxiety symptoms of breast cancer patients with liver depression and spleen deficiency as the core pathogenesis,and it has good clinical efficacy and high safety,and has certain clinical value.(2)The study was divided into depression group,anxiety group,and depression and anxiety group.Analysis of liver depression and spleen deficiency syndrome and cytokine levels showed that the symptoms of depression and anxiety in the depression and anxiety group were more severe than those in the other two groups,and depression and anxiety The levels of TNF-α and IL-2R in the group were higher than those in the other two groups.(3)Shugan Jianpi Recipe can inhibit the levels of TNF-α,IL-2R,and IL-8,improve depression,anxiety and immune function in patients.(4)There is a correlation between PHQ-9 and TNF-α,and there is a correlation between GAD-7 and IL-2R.Due to the limitations of the study design,further rigorous clinical trials are needed to confirm it. |
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