非小细胞肺癌417例证候分布的临床研究

Syndrome Patterns Distribution of Non-small-cell Lung Cancer: An Analysis of 417 Cases

【目的】研究非小细胞肺癌(NSCLC)的证候分布特点。【方法】采用前瞻性和回顾性相结合的流行病学研究方法,对确诊NSCLC适宜化疗、手术的群体进行西医治疗前后证候改变的抽样调查,将收集病例的症状(包括体征)进行赋值量化,数据输入数据库系统,将中医临床证候(症状)按照有关诊断标准进行归纳。【结果】NSCLC中以气虚痰热、气虚痰湿、痰热气滞血瘀、气阴两虚为主,分别占32.9%、30.0%、15.1%、13.4%。Ⅰ期与Ⅲ期、Ⅳ期证候比较,差异均有显著性意义(P<0.05)。中医证候由气虚、痰热、痰湿、阴虚、气滞血瘀、阳虚6个基本因素组合而成。气虚因素最多占76.3%,痰热占52.8%,痰湿占33.8%,阴虚占18.2%,气滞血瘀占15.1%,阳虚最少仅占3.8%。舌象的相关系数值较其他症状高,表明舌象与证候相关性更明显。【结论】417例NSCLC的证候分布按比例多少排列为:气虚痰热>气虚痰湿>痰热气滞血瘀>气阴两虚>阴虚痰热>阳虚痰湿。气虚是NSCLC发生发展的内在根本原因,痰凝、气滞、血瘀为其主要病理变化。

Objective To investigate the syndrome patterns distribution of non-small-cell lung cancer（NSCLC）.Methods Prospective and retrospective study methods were used for a sampling survey of the changes of syndrome patterns of confirmed NSCLC patients before and after chemotherapy and operation.The scores of symptoms and signs of the collected cases were input into the database.Subjecting to the clinical criteria of traditional Chinese medical syndromes,the symptoms and signs of NSCLC patients were classified.Results The predominant syndrome patterns of NSCLC patients were Qi deficiency with phlegm heat,Qi deficiency with phlegm damp,phlegm heat with Qi stagnation and blood stasis,and deficiency of both Qi and yin,accounting for 32.9%,30.0%,15.1% and 13.4% respectively.The syndrome patterns of NSCLC patients at stageⅠdiffered from those at stages Ⅲ and Ⅳ（P〈0.05）.The differences between stage Ⅱ and stage Ⅳ,and those between stage Ⅲ and stage Ⅳ were significant（P〈0.05）.The syndromes of NSCLC patients were composed of six simple patterns of Qi deficiency,phlegm heat,phlegm dampness,yin deficiency,Qi stagnation and blood stasis,and yang deficiency,which accounted for 76.3%,52.8%,33.8%,18.2%,15.1% and 3.8% respectively.Conclusion The syndrome patterns in 417 NSCLC patients are Qi deficiency with phlegm heat,Qi deficiency with phlegm dampness,phlegm heat with Qi stagnation and blood stasis,deficiency of both Qi and yin,yin deficiency with phlegm heat,and yang deficiency with phlegm dampness,which are in a decreasing sequence.Qi deficiency is the basic pathogenesis of NSCLC,and phlegm coagulation,Qi stagnation and blood stasis constitute its main pathological changes.