原发性肝癌患者经导管动脉化疗栓塞术治疗前后中医证候特点分析

Analysis of Chinese Medical Syndrome Features of Patients with Primary Liver Cancer before and after Transcatheter Arterial Chemoembolization

目的观察原发性肝癌患者经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TA-CE)治疗前后中医证候变化特点。方法选取106例2009年5—11月广西医科大学第一附属医院肝胆外科行TACE治疗原发性肝癌患者,采用自身前后对照的方法,比较肝癌患者治疗前后气滞证、血瘀证、实热证、水湿证、气虚证、血虚证、阴虚证、阳虚证8种证型分布,分别对各证型患者治疗前后进行证候量化评分。结果治疗前106例患者共出现8种单证,共计412例次,证型比例由高至低依次为:血瘀证(92例,86.8%)、实热证(73例,68.9%),气滞证(62例,58.5%)、气虚证(62例,58.5%)、阴虚证(60例,56.6%)、血虚证(30例,28.3%)、阳虚证(18例,17.0%)、水湿证(15例,14.2%)。治疗后共出现456例次,其中证型比例由高至低为:血瘀证(89例,84.0%)、气虚证(87例,82.1%)、实热证(85例,80.2%)、气滞证(52例,49.1%)、阴虚证(49例,46.2%)、血虚证(42例,39.6%)、阳虚证(32例,30.2%)、水湿证(20例,18.9%)。治疗后气虚证、阳虚证比例升高,差异有统计学意义(P<0.01,P<0.05);治疗前后其他证型变化比较,差异无统计学意义(P>0.05)。治疗前量化积分最高的两个证型是血瘀证、气滞证;治疗后量化积分最高的两个证型是血瘀证、气虚证。治疗后气滞证积分降低,实热证、气虚证、血虚证、阳虚证积分升高,差异有统计学意义(P<0.05)。结论肝癌患者治疗需重视理气清热、益气化瘀;TACE治疗后辨证论治应同时重视清热益气补血,兼顾温阳。

Objective To observe the Chinese medical syndrome features of patients with primary liver cancer before and after transcatheter arterial chemoembolization （TACE）. Methods Recruited were 106 primary liver cancer （PLC） patients treated with TACE at the Department of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University from May to November 2009. Using self-control study, the distributions of 8 syndrome types were compared, such as qi stagnation syndrome, blood stasis syndrome, excess-heat syndrome, fluid and damp syndrome, qi deficiency syndrome, blood deficiency syndrome, yin deficiency syndrome, and yang deficien- cy syndrome. The scoring for each syndrome quantization was performed to all patients before and after TACE. Results Eight syndromes occurred in the 106 patients before treatment, amounting to 412 cases. The proportions of syndrome types in PLC patients before TACE were ranked from high to low as blood stasis syndrome [ （92 ca- ses, 86. 8%） 1, excess-heat syndrome E （73 cases, 68. 9%） ], qi stagnation syndrome [ （62 cases, 58. 5%） 1, qi deficiency syndrome [ （62 cases, 58. 5% ） 1, yin deficiency syndrome E （60 cases, 56. 6% ） ], blood deficiency syn- drome [ （30 cases, 28. 3%） ], yang deficiency syndrome E （18 cases, 17. 0%） ], fluid and damp syndrome E （15 cases, 14. 2%） ]. The 8 syndromes occurred in 456 cases after TACE. The proportions of syndrome types in PLC patients after TACE were ranked from high to low as blood stasis syndrome [ （89 cases, 84. 0%）], qi deficiencysyndrome [ （87 cases, 82. 1%） ], excess-heat syndrome [ （85 cases, 80. 2% ） ], qi stagnation syndrome [ （52 ca- ses, 49. 1%） ], yin deficiency syndrome [ （49 cases, 46. 2%） ], blood deficiency syndrome [ （42 cases, 39.6%） ], yang deficiency syndrome [（32 cases, 30. 2%）], fluid and damp syndrome [ （20 cases, 18. 9%）]. After TACE the proportions of qi deficiency syndrome and yang deficiency syndrome increased with statistical differ- ence （P 〈 0. 01, P 〈 0. 05）. There were no statistical difference in terms of other syndromes between before and af- ter TACE （P 〉0. 05）. Blood stasis syndrome and qi stagnation syndrome got the highest quantization scores before TACE. After TACE blood stasis syndrome and qi deficiency syndrome got the highest quantization scores. After TACE the score of qi stagnation syndrome decreased, while that of excess-heat syndrome, qi deficiency syndrome, blood deficiency syndrome, yang deficiency syndrome increased （all P 〈0. 05）. Conclusions It＇s necessary to pay attention to regulating qi, clearing heat, replenishing qi, and removing stasis for treating liver cancer patients. Clearing heat, replenishing qi, enriching blood, and warming yang after TACE should also be paid equal attention to while using syndrome typing methods.