Objectives: To investigate the clinical efficacy of heat-sensitive moxibustion combined with intrapleural perfusion of cisplatin in comparison with simple intrapleural perfusion of cisplatin on malignant pleural effusion (MPE).
Methods: Forty patients with MPE, in compliance with the inclusion criteria, were randomly divided into an observation group (20 cases) and a control group (20 cases). In the control group, cisplatin solution (60 mg/m2) was injected into the thoracic cavity after pleural drainage under B-ultrasound positioning, once a week for 4 weeks. In the observation group, based on the intervention as the control group, the heat-sensitive moxibustion was delivered at the back and lumbar region (where Feishu ［BL13］, Pishu ［BL20］ and Shenshu ［BL23］ are located) and the chest-abdomen region (where Danzhong ［CV17］, Guanyuan ［CV4］ and Shuidao ［ST28］ are located), for 30 min to 90 min, once daily (the treatment was discontinued on Saturday and Sunday) and for 4 weeks. Before and after treatment, in the two groups, the pleural effusion volume was detected using B ultrasound, the activity of daily living was evaluated with Karnofsky performance statue (KPS) scale and TCM symptoms with TCM syndrome grading scale. The clinical therapeutic effect was evaluated in the two groups. According to the classification criteria table for acute and subacute toxicity of anticancer drugs made by WHO, the toxic and side reaction was judged.
Results: After treatment, the pleural effusion volume was reduced in comparison with that before treatment in the two groups (P<0.01, P<0.001), and the volume in the observation group was lower than that of the control group (P<0.05). KPS score was increased in the two groups after treatment compared with that before treatment (P<0.001), and the score in the observation group was higher than that of the control group (P<0.05). After treatment, the total score of TCM syndromes and the scores for dyspnea, cough and chest pain were lower than those before treatment in the two groups (P<0.001), and the scores in the observation group were lower than those of the control group (P<0.001, P<0.05). The scores for anorexia and lassitude were reduced in comparison with those before treatment in the observation group (P<0.001)；and the scores in the observation group were lower than those in the control group after treatment (P<0.001, P<0.01). After treatment, the effective rate of the observation group was 65.0%(13/20), which was higher than that of the control group (30.0%, 6/20, P<0.05). The incidence of bone marrow suppression in the observation group was 15.0%(3/20), lower than that in the control group (55.0%, 11/20, P<0.05). The incidence of gastrointestinal reactions in the observation group was 30.0%, lower than that in the control group (65.0%, 13/20, P<0.05).
Conclusions: Heat-sensitive moxibustion combined with intrapleural infusion of cisplatin is superior to intrapleural infusion of cisplatin in the aspects of the amelioration of pleural effusion, daily-living activity and TCM syndromes in patients with MPE. This combined therapy presents the synergism by cooperating with chemotherapeutics and reduces the incidence of toxic and side effects implicated in chemotherapy so as to attenuate the toxicity of chemotherapeutics.
目的: 比较热敏灸联合胸腔灌注顺铂与单纯胸腔灌注顺铂治疗恶性胸腔积液（MPE）的临床疗效。方法: 纳入40例符合纳排标准的MPE患者随机分为观察组（20例）和对照组（20例）。对照组在B超定位下行胸腔置管引流术后向胸腔内注射顺铂溶液（60 mg/m2），每周1次，共治疗4周。观察组在对照组基础上加用热敏灸背腰部（肺俞、脾俞、肾俞穴区）及胸腹部（膻中、关元、水道穴区）治疗约30~90 min，每天1次（周六、周日休息），共治疗4周。治疗前后采用B超检测两组患者胸腔积液量，采用卡氏功能状态（KPS）量表评分评价日常生活能力，采用中医证候积分量表评价中医证候，评价两组患者临床治疗有效率，评定化疗药物毒性和不良反应。结果: 两组患者治疗后胸腔积液量均较治疗前降低（P<0.01，P<0.001），且观察组低于对照组（P<0.05）。两组患者治疗后KPS评分均较治疗前升高（P<0.001），且观察组高于对照组（P<0.05）。两组患者治疗后中医证候总积分、呼吸困难评分、咳嗽评分、胸痛评分均较治疗前降低（P<0.001），且观察组低于对照组（P<0.001，P<0.05）。观察组治疗后食欲不振评分、乏力评分均较治疗前降低（P<0.001），且观察组低于对照组（P<0.001，P<0.01）。治疗后观察组有效率（65.0%，13/20）高于对照组（30.0%，6/20，P<0.05）。观察组骨髓抑制的发生率（15.0%，3/20）低于对照组（55.0%，11/20，P<0.05）。观察组胃肠道反应的发生率（30.0%，6/20）低于对照组发生率（65.0%，13/20，P<0.05）。结论: 热敏灸联合胸腔灌注顺铂对MPE患者胸腔积液量、日常生活能力、中医证候改善优于单纯胸腔灌注顺铂，可达到对化疗药物减毒增效。.
Keywords: Heat-sensitive moxibustion; Intrapleural infusion of cisplatin; Malignant pleural effusion; Randomized controlled trial.