The Research Of Effect Of Warming Yang To Promote Diuresis And Chemotherapy In The Treatment Of Malignant Ascites With Spleen-kidney Yang Deficiency Caused By Digestive Tract Carcinomas

Objective:Observe the clinical effect of Warming Yang to promote diuresis and abdominal cavity perfusion chemotherapy in the treatment of malignant ascites with spleen-kidney yang deficiency caused by digestive tract carcinomas.To make a preliminary discussion by combining TCM with western medicine in the treatment of malignant ascites with terminal-stage,and to provide the objective research for the clinical study.Methods:In the clinical research,60 cases of clinical cases in line with the inclusion Criteria,were randomly and averagely divided into two groups,including treatment group and control group.Patients in control group only taked abdominal cavity perfusion chemotherapy with Cisplatin,and Patients in treatment group taking Zhenwu Decoction daily combined with abdominal cavity perfusion chemotherapy.The application of chemotherapy once a week,and the observation period was 2 weeks.The clinical treatment conditions includes the symptoms of malignant ascites,TCM syndrome,KPS,immune index,blood routine,liver function,kidney function.And the results were compared and analyzed.Results:(1)Efficacy of ascites:After treatment,the effective rate(ER=CR+PR)of treatment group was 66.7%,the control group was 57.1%,showing no significant differences between groups by Chi-square Test(X2=1.765,?P=0.440);the stability rate(CR+PR+NC)of treatment group was88.9%,the control group was 75.0%,also showing no significant differences between groups by Chi-square Test(X2=0.971,?P=0.295);It showed that the efficacy of ascites in treatment group is higher than the control group,but there was no statistically significant.(2)TCM syndrome:After treatment,the integral effect rate in TCM symptoms:the treatment group was 85.2%,the control group was 65.5%,showing statistical significance between groups by Chi-square Test(X2=9.115,P=0.019).After treatment,the treatment groupof TCM symptom score improved significantly better than the control group by t test(t=-4.029,P=0.000).The symptom of abdominal distention,shortness of breath,chillness,Weakness of waist and knees improved significantly after treatment.(P<0.05?P<0.01)It indicated that the effect of treatment group is obviously superior to the control group in TCM syndrome.(3)Kamofsky Performance Status:Comparing the KPS after treatment,there was rising 15cases,stabling 8 cases and reducing 4 cases in treatment group.But in control group the rising is 6 cases,the stabling was 14cases,the reducing was 8 case.It is showing that statistical significance between groups by Chi-square Test(X2=6.811,P=0.038).The mean and standard variation of treatment group and control group was(76.67±12.40)and(69.29±12.15).After treatment,the KPS score among the two groups was significantly different by t test(t=2.229,P=0.030),suggesting that the treatment group can significantly improve the quality of life of patients than the control group.(4)Immune index:After treatment,in treatment group,the CD3+cell were increased significantly(t=8.025,P=0.000),the CD4~+cell were also increased significantly(t=2.968,P=0.006),but the CD8~+cell were decreased significantly(t=-7.317,P=0.000),CD4+/CD8+were increased significantly(t=7.870,P=0.000).After treatment,in control group,the CD3~+cell were increased significantly(t=4.980,P=0.000),the CD4+cell were increased slightly(t=2.559,P=0.016),while the CD8+cell were decreased significantly(t=-2.167,P=0.035),CD4~+/CD8~+were also increased significantly.It indicated that the subset of T-cells have improved in two groups,but the result of treatment group is better than the control group.(5)The clinical and laboratory indexes:Routine blood count:Beforetreatment,the difference between two groups were not statistically significant b y t t e s t(P>0.0 5).Then after treatment,in t r e a t m e n t g r o u p,the indexes of WBC and PLT were decreased slightly,but there was no statistical significance(P>0.05),in control group,the indexes of WBC and PLT were decreased significantly(P<0.05).Liver and kidney functions:Before treatment,the difference between two groups were not statistically significant by t test(P>0.05).Then after treatment,in treatment group,the changes of the indexes of ASL?ALT?CREA and UREA has no statistical significance by t test(P>0.05),in control group,the indexes of ASL?ALT?CREA were higher(P<0.05).The indexes of UREA was also higher after treatment,while there is no statistical significance.(P>0.05)It indic a t e d t h a t t h e s a f e t y o f t h e t r e a t m e n t g r o u p i s b e t t e r t h a n t h e c o n t r o l g r o u p.(6)The toxic and side reaction:After treatment,the incidence rate of the bone marrow depression,digestive tract reaction and hepatotoxicity were lower than control group,showing significant differences by rank-sum test(P<0.05).The incidence rate of nephrotoxicity was no statistical significance between control group and treatment group by rank-sum test(P>0.05).Conclusion:In the treatment of malignant ascites with spleen-kidney yang deficiency caused by digestive tract carcinomas,in comparison with abdominal cavity perfusion chemotherapy,Warming Yang to promote diuresis combined with abdominal cavity perfusion chemotherapy had equivalent effects in alleviation of the syndrome of ascites,but it had been better in KPS score,TCM syndrome,Immune function and safety.