| BackgroundWith the development of new drugs and treatment standardization, tumor Tumor associated symptoms, such as vomit, pain gradually get effective treatment. The cancer related fatigue (CRF) has gradually become the main factor that influence the patient’s quality of life(QOL), and has adverse impact on the life and the rehabilitation of the patient’s, more and more doctors began to pay attention to improving it. CRF is different from the traditional concept of disease, which generally exist in cancer patients in various stages of various types, of all ages, even exist in survivors free of tumor for a long time, but no objective index to assist diagnosis. It is a complex, multi dimensions of individual subjective experience, not only relates to tumor, but also associated with physiological, psychological, spiritual, social and cultural background and so on, has the obvious individual differences, the etiology, pathogenesis is complex, so often needs individualized and comprehensive treatment model, modern medicine are lack of effective drug treatment and means. Traditional Chinese medicine has always attached importance to the subjective sensation of patients, emphasizing the combination of syndrome differentiation and disease differentiation, individualized treatment is it’s prominent advantage, Has a unique advantage in improving the quality of life. Excavating and arranging the contents of Chinese medicine for the treatment of CRF has important significance.ObjectiveTheoretical study objective:by searching and sorting in ancient and modern literature about CRF, then sum up the corresponding traditional Chinese medical(TCM) diagnosis, etiology and pathogenesis, diagnosis, treatment and cultivate, etc. And explore the significance and value of invigorating spleen and kidney in the treatment of CRF theoretically.Clinical study objective:To observe the subject’s relationship among QOL, T lymphocyte subsets, NK cell, testosterone, thyroid hormone, cortisol of peripheral blood and the CRF. To observe the effect of invigorating spleen and kidney on CRF, syndrome, KPS, T lymphocyte subsets, NK cells, testosterone, thyroid function and cortisol. To explore the effect and mechanisms of improving the cancer-related fatigue though invigorating spleen and kidney in patients with advanced colorectal cancer after chemotherapy.MethodTheory research methods:taking "cancer-related fatigue" as the key words, search contemporary TCM disease name about in the Chinese journal full-text database, then take the keywords of the related disease, search the TCM argument about CRF in zhonghuayidian, summary TCM etiology, pathogenesis, treatment, cultivate of CRF, etc.Clinical research methods:76 patients were randomly divided into two groups using random number table, treatment group (38 cases) and control group (38 cases), two groups of patients were treated with FOLFOX6 chemotherapy, 14 days as a course,3 course totally, The treatment group give Chinese medicine to invigorate spleen and kidney throughout.Statistical methods:establish database with SPSS21.0 software, and input the data. All the measurement data sign with the mean and standard deviation (x±s), between the two groups were compared with independent sample mean value t/t’test, self control means comparison before and after the intervention use the paired t test; all count data are showed with frequency (f) and proportion or percentage, no sequence classification data use Pearson chi-square test (x2), four tables from data use Fisher exact probability method, small sample level data to said with average rank (R), use U test and Mann-Whitney rank correlation analysis between two independent samples; Use Pearson correlation coefficient (r) to express the two measurement variables correlation analysis, T test was performed on the correlation coefficient. Multiple correspondence (optimal scale) analysis used to determine appropriate crowd of invigorating spleen and kidney. α=0.05.ResultsThe theoretical research results:according to the CRF features and different focus of patients, the TCM name of the disease are corresponds with "xulao", "baihe bing", "zangzao", "yuzheng", "jianwang" etc. search from "zhonghua yidian" with the name of disease, the results show congenitally deficient, eating disorders, and disorders, emotions and internal injuries, diseases after the disorder, six exogenous pathogenic factors and many other factors are all the cause of CRF, in general, Congenital or acquired factors. The pathogenesis is deficiency ben and excessive biao, Deficiency of Qi and blood deficiency of yin and Yang. The treatment principles and methods include helping the healthy atmosphere, Quxie, long course of treatment, combined treatment.Clinical study results:Before the intervention, The total score of CRF and physical function, role function, cognitive function, emotional function, social function, general health status showed a negative correlation (P<0.05), but There was a positive correlation with pain, fatigue, insomnia, loss of appetite (P<0.05), had no significant correlation with shortness of breath, nausea, vomiting, constipation, diarrhea, economic difficulties (P>0.05). Behavior, emotion, sensation, cognition dimensions have the same regularity with The total score of CRF. The total score of CRF was negatively correlated with male testosterone, cortisol, CD4+, CD4+/CD8+(P<0.05). has positive correlation with CD8+, TSH, score of syndrome, KPS (P<0.05). has no correlation with female testosterone, CD3+,NK,FT3, FT4 (P>0.05).Evaluation of CRF:Compared with the control group, the total score of fatigue, behavior, sensory and cognitive dimensions were significantly lower (P<0.05), and there was no significant difference in the emotion aspect (P>0.05); The difference of total score, behavior, cognitive were significantly lower than that of the control group(P<0.05), the difference of sensory, emotion was not significant (P>0.05). Compared with pre-intervention, the total score of fatigue, behavior, sensory and cognitive dimensions of the treatment group were significantly decreased (P<0.01), no obvious effect on the emotion aspect (P>0.05); the total score of fatigue, behavior, sensory and emotion dimensions had no significant difference(P>0.05), Cognitive dimensions were significantly elevated (P<0.05). In the treatment group, among 35 cases,0 cases were cured,2 cases were markedly effective,20 cases were effective,13 cases were ineffective, the effective rate was 62.86%. In the control group among 34 cases 0 cases were cured,1 cases was markedly effective, 6 cases were effective,27 cases were ineffective, the effective rate was 20.59%. The efficacy in the treatment group was significantly better than that in the control group (P<0.05). Before intervention, there were 6 cases of mild fatigue,23 cases of moderate fatigue,6 cases of severe fatigue In the treatment group; 5 cases of mild fatigue in control group,22 cases of moderate fatigue,7 cases of severe fatigue in the control group. After intervention, there were 14 cases of mild fatigue,18 cases of moderate fatigue,3 cases of severe fatigue In the treatment group;2 cases of mild fatigue in control group, 22 cases of moderate fatigue,10 cases of severe fatigue in the control group. The fatigue level of the treatment group was significantly better than that of the control group (P<0.05).Evaluation of Syndromes:compared with the control group, the treatment group symptom score, lassitude, dizziness, tinnitus and hearing loss, emaciation, insomnia, eat less poor appetite, abdominal distension, loose stool, constipation, backache, tongue and pulse rates significantly decreased (P<0.05), nausea, vomiting, abdominal pain, knee soft no significant difference (P>0.05); the difference between before and after the intervention of the syndrome scores, lassitude, dizziness, tinnitus and hearing loss, emaciation, insomnia, eat less poor appetite, abdominal distension, loose stool, backache, tongue and pulse integration significantly decreased(P<0.05), nausea, vomiting, abdominal pain, constipation, knees soft no significant difference (P>0.05). Compared with the pre-intervention, treatment group syndromes score, lassitude, dizziness, emaciation, insomnia, eat less poor appetite, bloating, abdominal pain, loose stool, constipation integration significantly lower (P<0.05), tinnitus deafness, nausea, vomiting, backache, knee soft, tongue and pulse was no significant difference (P>0.05); the control group, lassitude, tinnitus and hearing loss, abdominal pain, constipation, tongue and pulse integration increased significantly (P>0.05). syndromes score, dizziness, emaciation, insomnia, eat less poor appetite, nausea, vomiting, abdominal distension, loose stool, backache, knee soft integral no significant difference (P>0.05).Evaluation of the status of survival:the control group compared the treatment group KPS scores were significantly increased (P<0.01), KPS score difference was no significant change before and after the intervention (P> 0.05); and compared to the previous intervention, the treatment group had no significant difference (P>0.05), KPS score in the control group was significantly lower (P<0.01).Evaluation of weight:The control group compared the treatment group weight was no significant difference(P>0.05), the weight difference was significant difference before and after the intervention (P<0.01), treatment group weight less decreased; compared with the pre-intervention, treatment group weight gain (P<0.01), no significant changes in body weight in the control group (P>0.05).Evaluation of testosterone:Compared with the control group, the treatment group testosterone levels had no significant difference(P>0.05). compared with the pre-intervention, the treatment group had no significant difference (P>0.05);significantly lower in the control group of male testosterone concentrations (P<0.05), women in the control group had no significant difference(P>0.05).Evaluation of immune function:Compared with the control group, the treatment group CD3+, CD4+, NK significantly increased (P<0.05), CD8+, CD4+ /CD8+were no significant difference; the difference before and after the intervention CD4+and NK statistically significant difference (P<0.05); CD3+, CD8+, CD4+/CD8+had no significant difference (P>0.05). Compared with the pre-intervention, CD3+, CD4+had no significant difference (P>0.05);CD8+ decreased significantly, CD4+/CD8+and NK significantly increased (P<0.05) in the treatment group; in control group, CD3+, CD8+, CD4+/CD8+, NK were no significant difference (P>0.05), CD4+decreased significantly (P<0.05). Evaluation of Cortisol:Compare with the control group, the treatment group cortisol concentrations and the difference had no significant difference (P>0.05). Compare with pre-intervention, Cortisol concentrations was no significant difference in treatment group (P>0.05) VS. significantly decreased in the control group(P<0.05).ConclusionCRF affected the quality of life in patients with advanced colorectal cancer, pain, fatigue, insomnia, loss of appetite and other symptoms not only reduce the quality of life, but also make patients appear CRF. And shortness of breath, nausea, vomiting, constipation, diarrhea, economic difficulties and other symptoms, or because of the low frequency, or because of treatment effect were good, thad little effect on CRF. In patients with high score of syndrome, have lower physical state and more severe fatigue. CRF was associated with lower levels of cortisol secretion, immune dysfunction and low thyroid function. in male patients, CRF was associated with lower serum testosterone.The method of invigorating spleen and kidney can improve the cancer-related fatigue of patients with advanced colorectal cancer during chemotherapy, mainly for the behavior dimension, feeling dimension and cognitive dimension. Invigorating spleen and kidney can alleviate the overall symptoms of chemotherapy patients, mainly for lassitude, dizziness, tinnitus and hearing loss, emaciation, insomnia, eat less poor appetite, abdominal distension, loose stool, constipation, backache, tongue and pulse rates, no obvious curative effect on the symptoms of nausea, vomiting, abdominal pain, knee soft. Improve the physical condition of patients with chemotherapy. Increase body weight of patients with chemotherapy. Protective effect on male patients cortisol, thyroid and immune function injury caused by chemotherapy.Spleen and kidney deficiency is common in patients with advanced colorectal cancer. The method of invigorating spleen and kidney can improve the cancer-related fatigue, syndrome score and the survival status of the patients with advanced colorectal cancer after FOLFOX6 chemotherapy. it’s possible mechanism is related to the regulation of serum cortisol, testosterone, thyroid function and immune function. The method of invigorating spleen and kidney has the dominant position in the treatment of cancer-related fatigue in patients with advanced colorectal cancer, but we still advocates the comprehensive treatment mode. |
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