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| [?中药外敷联合穴位按摩治疗乳腺癌术后上肢淋巴水肿的临床研究 |
| Clinical Study on the Combination of Topical Chinese Herbal Application and Acupoint Massage for the Treatment of Upper Limb Lymphedema After Breast Cancer Surgery |
| 投稿时间：2026-09-20 修订日期：2026-10-16 |
| DOI： |
| 中文关键词: 【关键词】 乳腺癌术后上肢淋巴水肿 中药外敷 穴位按摩 生物电阻抗谱 疗效预测模型 |
| 英文关键词: Breast cancer?related upper limb lymphedema Topical Chinese herbal application Acupoint massage Bioimpedance spectroscopy Efficacy prediction model |
| 基金项目:山西省卫生健康委员会科研课题(202421011) |
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| 中文摘要: |
| 【】 目的 基于生物电阻抗谱与血清标志物构建多模态精准评估体系,评价益气活血消肿方外敷联合穴位按摩治疗乳腺癌术后上肢淋巴水肿的临床疗效,探索其分子机制并构建疗效预测模型。 方法? 纳入240例乳腺癌术后上肢淋巴水肿(breast cancer-related upper limb lymphedema,BCRL)患者,随机分为对照组〔综合消肿治疗(complex decongestive therapy,CDT),n=80〕、中药外敷组(CDT+中药外敷,n=80)和联合治疗组(CDT+中药外敷+穴位按摩,n=80),干预28 d,随访期6个月。主要结局指标为生物电阻抗谱(bioimpedance spectroscopy,BIS)L-Dex评分变化,次要结局指标包括臂围周径加权均值、上肢功能障碍量表(Disabilities of the Arm, Shoulder and Hand,DASH)评分、乳腺癌淋巴水肿症状问卷(Lymphedema Breast Cancer Questionnaire,LBCQ)评分、视觉模拟评分法(visual analogue scale,VAS)评分及血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、转化生长因子-β1(transforming growth factor-β1,TGF-β1)、血管内皮生长因子-C(vascular endothelial growth factor-C,VEGF-C)水平。 结果 234例完成全程干预,脱落率2.50%。联合治疗组L-Dex评分降幅(-15.4±4.8)显著优于中药外敷组(-10.0±4.1)和对照组(-4.6±3.3),42.5%的患者L-Dex恢复正常。联合治疗组VEGF-C升高36.1%、TGF-β1下降36.8%。6个月随访显示联合治疗组疗效维持率为90.3%。以ΔL-Dex≥10定义良好疗效,234例完成随访患者中良好疗效实际发生率为47.86%,其中联合治疗组为74.36%,中药外敷组为49.37%,对照组为19.48%。构建的疗效预测模型AUC为0.881。 结论 益气活血消肿方外敷联合穴位按摩通过“促淋巴管生成-抗炎-抗纤维化”双向调控机制显著改善BCRL,构建的疗效预测模型为个体化治疗决策提供了量化工具。 |
| 英文摘要: |
| Objective To construct a multimodal precision assessment system based on bioimpedance spectroscopy (BIS) and serum biomarkers, evaluate the clinical efficacy of topical application of Yiqi Huoxue Xiaozhong Formula combined with acupoint massage for the treatment of breast cancer-related upper limb lymphedema (BCRL), explore its molecular mechanism, and develop a treatment efficacy prediction model. Methods A total of 240 patients with BCRL were enrolled and randomly assigned to a control group (CDT, n=80), a topical Chinese herbal application group (CDT + herbal application, n=80), and a combination therapy group (CDT + herbal application + acupoint massage, n=80). The intervention lasted 28 days, with a follow?up period of 6 months. The primary outcome measure was the change in BIS L?Dex score. Secondary outcome measures included the weighted mean of arm circumference, DASH score, LBCQ score, VAS score, and serum levels of TNF?α, IL?6, TGF?β1, and VEGF?C. ROC curve and decision curve analyses were used to construct a treatment efficacy prediction model. Results A total of 234 patients completed the full intervention, with a dropout rate of 2.50%. The reduction in L?Dex score in the combination therapy group (-15.4±4.8) was significantly greater than that in the herbal application group (-10.0±4.1) and the control group (-4.6±3.3). L?Dex normalized in 42.5% of patients in the combination therapy group. VEGF?C increased by 36.1% and TGF?β1 decreased by 36.8% in the combination therapy group. At the 6?month follow?up, the efficacy maintenance rate in the combination therapy group was 90.3%. Good efficacy was defined as ΔL-Dex ≥ 10. Among the 234 patients who completed follow-up, the actual incidence of good efficacy was 47.86%, with values of 74.36% in the combination therapy group, 49.37% in the traditional Chinese medicine topical application group, and 19.48% in the control group. The AUC of the constructed efficacy prediction model was 0.881. Conclusion Topical application of Yiqi Huoxue Xiaozhong Formula combined with acupoint massage significantly improves BCRL through a bidirectional regulatory mechanism of “promoting lymphangiogenesis, anti?inflammation, and anti?fibrosis”. The developed efficacy prediction model provides a quantitative tool for individualized treatment decision?making. |
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