观察肿瘤热疗联合益气扶正方剂治疗肺癌伴恶性胸腔积液的临床疗效。

选择2022年1月至2025年1月我院收治的118例肺癌伴恶性胸腔积液患者为对象，随机分为A组41例、B组40例、C组37例。患者接受胸腔穿刺置管引流治疗，A组行单纯肿瘤热疗治疗，B组行单纯益气扶正方剂治疗，C组行肿瘤热疗联合益气扶正方剂治疗。对比每组恶性胸腔积液缓解率、肿瘤标志物参数，血清糖类抗原125(carbohydrate antigen 125, CA125)、癌胚抗原(carcinoembryonic antigen, CEA)、细胞角蛋白19的可溶性片段(cytokeratin 19 fragment, CYFRA21-1)、神经元特异性烯醇化酶(neuron-specific enolase, NSE)、中医症候积分主症总积分、次症总积分、不良反应。

治疗后C组恶性胸腔积液缓解37例(100.00%)高于A组35例(85.37%)、B组32例(80.00%)(P<0.05)。治疗后每组CA125、CEA、CYFRA21-1、NSE较治疗前降低，C组治疗后CA125(19.97±5.13)U/ml、CEA(24.36±3.18)ng/ml、CYFRA21-1(3.21±0.43)ng/ml、NSE(21.23±3.84)ng/ml低于A组CA125(25.84±5.61)U/ml、CEA(28.12±4.39)ng/ml、CYFRA21-1(4.67±0.48)ng/ml、NSE(25.06±4.24)ng/ml和B组CA125 (30.06±7.28)U/ml、CEA(32.11±4.96)ng/ml、CYFRA21-1(5.36±0.54)ng/ml、NSE(32.13±4.72)ng/ml(P<0.05)。治疗后每组主症、次症总积分较治疗前下降，C组治疗后主症(5.27±1.02)分、次症总积分(2.01±0.76)分低于A组主症(7.95±1.09)分、次症总积分(2.97±0.82)分、B组主症(9.23±1.37)分、次症总积分(3.74±0.91)分(P<0.05)。C组出现恶心呕吐、白细胞下降、胸痛13例(35.14%)，相比于A组16例(39.02%)、B组11例(27.50%)，差异无统计学意义(P>0.05)。随访1年，A组生存14例(34.15%)，死亡27例(65.85%)；B组生存12例(30.00%)，死亡28例(70.00%)；C组存活18例(48.65%)，死亡19例(51.35%)(χ²＝3.124，P＝0.210)。

肿瘤热疗联合益气扶正方剂治疗肺癌伴恶性胸腔积液提高可有效控制积液的生成，降低肿瘤标志物CA125、CEA、CYFRA21-1、NSE，改善临床症状，具有临床意义。

To observe the clinical efficacy of tumor hyperthermia combined with Yiqi Fuzheng mixture in the treatment of lung cancer with malignant pleural effusion.

A total of 118 patients with lung cancer and malignant pleural effusion admitted to our hospital from January 2022 to January 2025 were selected and randomly divided into Group A 41 cases, Group B 40 cases, and Group C 37 cases. All patients underwent pleural puncture and catheter drainage. Group A received tumor hyperthermia alone, Group B received Yiqi Fuzheng mixture alone, and Group C received tumor hyperthermia combined with Yiqi Fuzheng mixture. The malignant pleural effusion remission rate, tumor marker parameters serum carbohydrate antigen 125 (CA125), carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1), neuron-specific enolase (NSE), total scores of primary and secondary symptoms in the traditional Chinese medicine (TCM) syndrome score, and adverse reactions were compared among the groups.

After treatment, 37 cases (100.00%) in group C had remission of malignant pleural effusion, which was higher than 35 cases (85.37%) in group A and 32 cases (80.00%) in group B (P<0.05). After treatment, CA125, CEA, CYFRA21-1, and NSE in each group decreased compared with those before treatment. The levels of CA125 (19.97±5.13) U/ml, CEA (24.36±3.18) ng/ml, CYFRA21-1 (3.21±0.43) ng/ml, and NSE (21.23±3.84) ng/ml in group C were lower than those of group A[CA125(25.84±5.61) U/ml, CEA(28.12±4.39) ng/ml, CYFRA21-1(4.67±0.48)ng/ml, NSE(25.06±4.24) ng/ml] and group B[CA125(30.06±7.28) U/ml, CEA(32.11±4.96)ng/ml, CYFRA21-1(5.36±0.54) ng/ml, NSE(32.13±4.72)ng/ml] (P<0.05). The total main symptom score and secondary symptom total score of each group decreased after treatment, and the scores of main symptoms (5.27±1.02) and secondary symptom total score (2.01±0.76) in group C were lower than those of group A main symptoms(7.95±1.09), secondary symptom total score(2.97±0.82) and group B main symptoms(9.23±1.37), secondary symptom total score(3.74±0.91) (P<0.05). There were 13 cases (35.14%) of nausea, vomiting, and chest pain in group C, which were not statistically different from 16 cases (39.02%) in group A and 11 cases (27.50%) in group B (P>0.05). After one year follow up, 14 cases (34.15%) in group A survived, 27 cases (65.85%) died; 12 cases (30.00%) in group B survived, 28 cases (70.00%) died; 18 cases (48.65%) in group C survived, 19 cases (51.35%) died(χ²=3.124, P=0.210).

Tumor hyperthermia combined with Yiqi Fuzheng mixture in the treatment of lung cancer with malignant pleural effusion can effectively control fluid accumulation, reduce the levels of tumor markers CA125, CEA, CYFRA21-1, and NSE, and improve clinical symptoms, and has clinical significance.