鲫鱼利水方联合顺铂灌注对恶性腹水脾虚湿盛证患者营养状态及免疫功能的影响*

作者：张金玲1，刘 宇2，张会平2，郭小培2，高 睿2

单位：1.山东中医药大学，山东 济南 250000； 2.中国中医科学院广安门医院济南医院/济南市中医医院，山东 济南 250000

引用：引用：张金玲，刘宇，张会平，郭小培，高睿.鲫鱼利水方联合顺铂灌注对恶性腹水脾虚湿盛证患者营养状态及免疫功能的影响[J].中医药导报,2025,31(5):98-102,134.

DOI：10.13862/j.cn43-1446/r.2025.05.017

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摘要：

目的：研究鲫鱼利水方联合顺铂灌注治疗恶性腹水脾虚湿盛证的临床疗效及其对患者营养状况及免疫功能的影响。方法：纳入62例恶性腹水脾虚湿盛证患者，按随机数字表法分为对照组和治疗组，每组31例。对照组患者采用顺铂腹腔灌注，每周1次；治疗组患者在对照组的基础上每日口服鲫鱼利水方。2周后比较两组患者腹水控制率、卡氏（KPS）评分、中医证候评分、营养状态评分和血清白蛋白、前白蛋白及CD3+、CD4+、CD8+、CD4+/CD8+水平的变化，并进行安全性评价。结果：治疗后两组比较，治疗组患者腹水控制率、KPS评分、中医证候和营养状态改善情况、血清白蛋白、前白蛋白以及CD3+、CD4+水平均高于对照组（P＜0.05），CD8+、CD4+/CD8+水平与对照组比较，差异无统计学意义（P＞0.05）。治疗后，治疗组患者血清前白蛋白水平高于治疗前（P＜0.05），血清白蛋白与治疗前比较，差异无统计学意义（P＞0.05）；对照组患者治疗后血清白蛋白、前白蛋白水平均较治疗前降低（P＜0.05）；两组患者治疗后CD3+、CD4+、CD4+/CD8+水平均高于治疗前（P＜0.05），对照组患者治疗后CD8+水平较治疗前升高（P＜0.05），而治疗组患者CD8+水平则降低（P＜0.05）；对照组患者治疗后营养状态评分高于治疗前（P＜0.05），而治疗组患者治疗后营养状态评分降低（P＜0.05）。治疗组消化道反应发生率低于对照组（P＜0.05）；两组患者白细胞减少发生率比较，差异无统计学意义（P＞0.05）。结论：鲫鱼利水方联合顺铂灌注治疗恶性腹水脾虚湿盛证疗效显著，有利于控制腹水，改善患者营养状况、免疫功能及生活质量，且安全性高。

关键词：恶性腹水；脾虚湿盛证；鲫鱼利水方；顺铂；营养状态；免疫功能；腹腔灌注

Abstract：

Objective: To evaluate the clinical efficacy of Jiyu Lishui Formula combined with intraperitoneal cisplatin perfusion in treating malignant ascites with spleen deficiency and dampness excess syndrome, and to analyze its effects on nutritional status and immune function. Methods: Sixty-two patients were randomized into a control group (intraperitoneal cisplatin perfusion, once weekly) and a treatment group (control regimen + daily oral Jiyu Lishui Formula). After two weeks, outcomes including ascites control rate, Karnofsky Performance Scale (KPS) score, TCM syndrome score, nutritional status, serum albumin/prealbumin levels, CD3+, CD4+, CD8+, CD4+/CD8+ ratios, and safety were assessed. Results: The treatment group showed significantly higher ascites control rate, KPS score, TCM syndrome improvement, nutritional status, serum albumin, prealbumin, CD3+, and CD4+ levels compared to the control group (P<0.05). No significant differences were observed in CD8+ and CD4+/CD8+ ratios (P>0.05). Post-treatment, the treatment group exhibited increased prealbumin (P<0.05) but unchanged albumin (P>0.05), whereas the control group showed decreased albumin and prealbumin (P<0.05). Both groups demonstrated elevated CD3+, CD4+, and CD4+/CD8+ levels post-treatment (P<0.05). The control group had increased CD8+ levels (P<0.05), while the treatment group showed reduced CD8+ levels (P<0.05). Nutritional scores improved in the control group (P<0.05) but decreased in the treatment group (P<0.05). The treatment group had lower gastrointestinal adverse events (P<0.05) and comparable leukopenia incidence (P>0.05). Conclusion: The combined therapy effectively controls ascites, improves nutritional status, enhances immune function, and elevates quality of life with favorable safety in patients with malignant ascites of spleen deficiency and dampness excess syndrome.

Key words：malignant ascites; spleen deficiency with dampness excess syndrome; Jiyu Lishui Formula; cisplatin; nutritional status; immune function; intraperitoneal perfusion

发布时间：2025-12-31

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