Clinical observation of bloodletting therapy for peripheral neurotoxicity caused by paclitaxel
刺络放血治疗紫杉醇所致周围神经毒性的临床观察

摘要

目的 探讨刺络放血疗法对比中药外用疗法及西药口服疗法治疗紫杉醇类化疗药物导致的外周神经毒性（CIPN）的疗效差异。方法 本研究纳入于2023年11月至2025年3月期间，于宝鸡市中医医院肿瘤血液科和宝鸡市中心医院肿瘤内科住院使用紫杉醇类药物（紫杉醇注射液、白蛋白结合型紫杉醇、脂质体紫杉醇、多西他赛）化疗引起的≥I级外周神经毒性（CIPN）的患者。所有患者根据电脑随机数字分组分为对照组（口服甲钴胺片治疗）和研究组（A组：刺络放血治疗，B组：中药外洗治疗）。治疗周期为4周。神经毒性分级使用NCI-CTCAE V5.0评估，疼痛缓解率(RR)采用WHO疼痛疗效标准结合NRS数字分级法双重判定，生活质量评估使用美国癌症治疗功能评价系统（FACT）的神经毒性生活质量评价量表（FACT／GOG－Ntx量表）进行评分。结果 治疗结束后，研究组A（刺络放血组）在神经毒性总有效率98.3%和疼痛缓解率96.7%上均显著优于B组（中药外用组，88.3 % 和86.7%）及对照组（西药口服组，85.0% 和 72.1%）。研究组A在神经毒性分级改善、疼痛减轻及生活质量提升方面均取得明显优势。安全性方面，各组均未出现严重不良事件。结论 刺络放血疗法能够有效缓解紫杉醇类药物化疗后导致的外周神经毒性，减轻疼痛并改善患者的生活质量，值得在临床上推广应用。

Abstract

Objective To investigate the therapeutic difference of peripheral neurotoxicity (CIPN) in this treatment.
Methods This study was included in patients with grade I peripheral neurotoxicity (CIPN) caused by chemotherapy with paclitaxel (paclitaxel injection, albumin-bound paclitaxel, liposomal paclitaxel, docetaxel), hospitalized in the hematology oncology department of Baoji TCM Hospital and Baoji Central Hospital between November 2023 and March 2025. All patients were divided into control group (oral study group) and study group (group A: collateral therapy, group B: herbal treatment). The treatment cycle was performed for 4 weeks. Neurotoxicity grading was assessed using NCI-CTCAE V5.0, pain relief rate (RR) was double assessed using the WHO pain efficacy criteria combined with NRS digital grading, and quality of life was assessed using the Neurotoxic Quality of Life Evaluation Scale (FACT / GOG-Ntx scale) of the American Cancer Treatment Functional Evaluation System (FACT).
Results After treatment, study group A (exiting group) was significantly better than group B (88.3% and 86.7%) and control group (85.0%, 85.0% and 72.1%). Study group A has achieved significant advantages in improving neurotoxicity grade, pain reduction and improving quality of life. In terms of safety, no serious adverse events occurred in each group.
Conclusion   The bloodletting therapy can effectively alleviate the peripheral neurotoxicity caused by paclitaxel chemotherapy, reduce pain and improve the quality of life of patients, which is worth clinical application.