癌症相关性疲乏患者疲劳特征与中医辨证的临床研究

Clinical manifestations of cancer-related fatigne and their relationship with traditional Chinese medicine syndromes

目的运用测评量表对癌症患者的癌症相关性疲乏(CRF)症状进行研究,探索其中医证型特点。方法以疲劳自评量表、MDASI-TCM症状评估量表等进行问卷调查;中医证型诊断标准参照《中医证候的临床研究指导原则》。运用网络自评系统、Excel及SPSS13.0软件对数据进行统计分析。结果 CRF患者常伴随困倦、睡眠不安、健忘、烦躁、疼痛、出汗、口干、食欲差、气短、麻木感、心慌等症状;健康人躯体疲劳分值11.88±12.89,CRF患者51.38±28.13(P<0.05),健康人疲劳后果16.92±14.76,CRF患者39.00±25.64(P<0.05);CRF患者辨证常出现两证(如肺肾两虚证)或三证(如肾阴虚气血两虚证)相兼的情况,在证型频次中,气虚证及脾、肺气虚证占43.43%,血虚及阴虚证占36.36%,阳虚证占8.08%,实证(湿热蕴脾、寒湿困脾证)占12.12%。结论 CRF患者的疲劳类型以躯体疲劳为主,程度重,通常不能通过睡眠或休息缓解。中医辨证常见多证相兼情况,分型以虚证多,实证少,尤以气虚为主,血虚次之,实证均为脾受湿邪之累而致。不同证型间的疲劳特征无显著性差异。

Objective To summarize the clinical manifestations of cancer-related fatigue （CRF） and explore their relationship with traditional Chinese medicine （TCM） syndromes. Methods Using the MDASI-TCM and FSAS, we conducted a survey in both patients with CRF and healthy subjects. On the basis of Clinical Guidelines on TCM Syndromes, we summarized the types of TCM syndromes related with CRF. Statistical analyses were performed with web system, SPSS （v13.0） software and Excel software. Results Patients with CRF suffered multiple symptoms, such as drowsy, disturbed sleeping, forgetfulness, dysphoria, pain, sweating, dry mouth, anorexia, shortness of breath, numbness, and palpitation. The scores of physical fatigue between healthy subjects and patients with CRF were 16. 92 ±14. 76 and 51.38 ±28. 13 （P 〈 0. 05）, and for the consequences of fatigue, they were 16. 92 ±14. 76 and 39.00 ± 25.64 （ P 〈 0. 05 ）. Two or there concurrent TCM syndromes existed in CRF patients. According to the frequency, the proportions of syn-dromes qi deficiency, deficiency of spleen qi and deficiency of lung qi was 43.43% , syndrome of blood deficiency and de- ficiency of kidney yin was 36. 36% , syndrome of deficiency of kidney yang was 8.08% , syndrome of dampness-heat stag- nating in spleen and cold-dampness disturbing spleen was 12. 12%. Conclusion The CRFs are mainly manifested by physical fatigue, which usually can not be relieved by sleep or rest. Deficiency syndrome is more than excess syndrome and mainly in syndrome of qi deficiency, followed by syndrome of blood deficiency. The degree of fatigue showes no remarked difference among different types of TCM syndromes.