非肌层浸润性膀胱癌术后卡介苗灌注不良反应病机及小蓟饮子加减应用

Pathogenesis of Adverse Reactions Induced by Bacillus Calmette‑Guérin Perfusion after Transurethral Resection for Non‑Muscle Invasive Bladder Cancer and Application of Modified Xiaoji Yinzi

摘要: 目的：探讨非肌层浸润性膀胱癌(Non‑Muscle Invasive Bladder Cancer, NMIBC)经尿道膀胱肿瘤电切术(Transurethral Resection of Bladder Tumor, TURBT)后卡介苗(Bacillus Calmette-Guérin, BCG)膀胱灌注所致不良反应的中医病机特点，阐释小蓟饮子加减的组方内涵，为该类医源性损伤的中医辨治干预提供理论参考。方法：梳理古今中医文献，结合现代中医病因认识，剖析BCG灌注后“尿血”“血淋”本虚标实的复合病机；以小蓟饮子原方为基础，解析加减方配伍逻辑，对现有药理证据进行评述。结果：TURBT术后BCG灌注不良反应病机以金刃损伤下焦血络为发病始因，灌注药毒郁而化热，兼癌毒伏留、正气耗伤，病机属虚实夹杂；小蓟饮子加减方实现凉血散瘀止血、清热通淋与益气扶正兼顾，适用于热结下焦证患者；现有药理证据多来源于单味药、动物及体外实验，可作为配伍的间接佐证。结论：小蓟饮子加减契合NMIBC术后BCG灌注后湿热下注、络损正伤的复合病机，可作为灌注不良反应的中医辅助辨治思路；但本研究属于理论探析，尚未开展临床研究，其临床疗效仍有待前瞻性临床观察加以验证。

Abstract: Objective: To explore the characteristics of traditional Chinese medicine (TCM) pathogenesis of adverse reactions induced by Bacillus Calmette‑Guérin (BCG) intravesical perfusion after transurethral resection of bladder tumor (TURBT) in patients with non‑muscle invasive bladder cancer (NMIBC), and interpret the prescription connotation of modified Xiaoji Yinzi, so as to provide theoretical reference for TCM syndrome‑differentiated intervention on this kind of iatrogenic injury. Methods: Ancient and modern TCM literatures were reviewed. Combined with the etiology understanding of modern TCM, this paper analyzed the complex pathogenesis of deficiency‑excess intermingled hematuria and blood‑stranguria after BCG perfusion. Based on the original prescription of Xiaoji Yinzi, the compatibility logic of its modified formula was analyzed, and the available pharmacological evidence was reviewed. Results: The starting cause of adverse reactions after TURBT combined with BCG perfusion was injury of collateral vessels in lower‑jiao by metal‑blade operation. The perfusate‑derived medicinal toxin stagnated and transformed into heat, accompanied by latent cancer toxin and consumption of healthy qi, forming a pathogenesis pattern of intermingled deficiency and excess. Modified Xiaoji Yinzi could cool blood, dissipate stasis to stop bleeding, clear heat and relieve stranguria, as well as replenish qi and strengthen healthy qi, which was suitable for patients with heat accumulation in lower‑jiao syndrome. Current pharmacological evidence was mostly obtained from single‑herb, animal and in‑vitro experiments, which could only serve as indirect supporting evidence for prescription compatibility. Conclusion: Modified Xiaoji Yinzi is consistent with the complex pathogenesis of damp‑heat pouring downward, collateral injury and healthy‑qi impairment after BCG perfusion for NMIBC, and can be adopted as an auxiliary TCM syndrome‑differentiated treatment strategy for perfusion‑related adverse reactions. As a theoretical analysis without clinical verification, its clinical efficacy remains to be confirmed by prospective clinical observations.