四君子汤联合肠内营养治疗胃癌脾虚证临床研究

吴颖仪 杨洁 周卫平

摘要 目的：探究四君子湯联合肠内营养治疗脾虚证胃癌患者的临床效果。方法：选取2016年3月至2017年2月南方医科大学附属小榄医院收治的胃癌患者87例作为研究对象，随机分成为对照组（n=43）和观察组（n=44），对照组行肠内营养支持，观察组行四君子汤联合肠内营养支持。观察2组营养指标、T淋巴细胞亚群、肠道菌群以及治疗效果。结果：2组患者术后8 d较术后1 d的血清白蛋白（ALB）、前白蛋白（PA）和转铁蛋白（TRF）均显著升高（P<0.05）;与术后8 d比较，观察组ALB、PA、TFN均显著高于对照组（P<0.05）。2组患者术后8 d较术后1 d的CD3+、CD4+、CD4+/CD8+均显著升高（P<0.05）;观察组CD3+、CD4+、CD4+/CD8+均显著高于对照组（P<0.05）。治疗后，观察组拟杆菌、真杆菌、酵母菌、消化球菌、乳酸杆菌、双歧杆菌显著高于对照组（P<0.05）;小梭菌、肠球菌、肠杆菌显著低于对照组（P<0.05），观察组总有效率显著高于对照组（P<0.05）。结论：对脾虚证胃癌患者应用四君子汤联合肠内营养，能够有效提高患者营养状态和免疫功能，并对肠道菌群的平衡性形成一定的影响，效果较好。

关键词 四君子汤;脾虚证;胃癌;免疫功能;肠道菌群;营养状态;T细胞亚群;肠内营养

Abstract Objective：To explore the clinical effects of Sijunzi Decoction combined with enteral nutrition in the treatment of gastric cancer with spleen deficiency syndrome.Methods：A total of 87 patients with gastric cancer patients admitted to Xiaolan Hospital Affiliated to Southern Medical University from March 2016 to February 2017，were selected as the research objects and were randomly divided into 2 groups.The control group（43 cases）received enteral nutrition support，and the observation group（44 cases）received Sijunzi Decoction combined with enteral nutrition support.The nutrition index，T lymphocyte subgroup，intestinal flora，and therapeutic effects of the 2 groups were observed.Results：There was a significant increase of ALB，PA，and TRF in both groups 8 days after surgery compared with 1 day after surgery（P<0.05）.ALB，PA and TFN of the observation group were significantly higher than those of the control group（P<0.05）8 days after surgery.Both group of patients had a significant increase in CD3+，CD4+，CD4+/CD8+（P<0.05）8 days after surgery compared with 1 day after surgery.It was observed that CD3+，CD4+，CD4+/CD8+ of the observation group were significantly higher than those of the control group（P<0.05）.After treatment，bacteroides，eubacteria，yeast，peptococcus，lactobacillus，and bifidobacterium in the observation group were significantly higher than those in the control group（P<0.05）; clostridium parvum，enterococcus，and enterobacter were significantly lower than those in the control group（P<0.05），and the total effective rate of the observation group was significantly higher than that of the control group（P<0.05）.Conclusion：Application of Sijunzi Decoction combined with enteral nutrition in the treatment of gastric cancer patients with spleen deficiency syndrome can effectively improve the nutritional status and immune function of patients.And it has a certain effect on the balance of the intestinal flora.The treatment is superior.

Keywords Sijunzi Decoction; Spleen deficiency syndrome; Gastric cancer; Immune function; Intestinal flora; Nutritional status; T cell subsets; Enteral nutrition

中图分类号：R256.3;R735.2;R2-031文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.07.015

胃癌患者临床常表现为呕吐、返流现象，以致患者营养不良和免疫功能低下;另外，患者机体内还伴随着一定程度的肠道黏膜通透性的改变和肠道菌群改变，而这些肠道菌群容易造成患者感染，并可能引起患者多器官功能衰竭[1-2]。在治疗上，临床多以手术摘除配合其他方式，但在多种因素的影响下，患者极易出现营养状态低下。因此，采用合理的方式改善患者术后的营养不良、免疫功能低下的状态，具有一定的临床意义。目前认为，对胃癌患者应用肠内营养支持，能够改善患者的营养状态和免疫功能，进而达到改善预后的效果[3];但是，有研究表明，仅仅采用标准化的肠内营养支持，并不能很好地提高患者免疫功能[4]。而近年来越来越多的学者意识到，对胃癌患者应用一定的中医手段，能够提高治疗的效果，且已有研究表明，对胃癌患者联合益气健脾药方，在多方面具有显著作用[5]。……