化疗对大肠癌中医证候影响的研究

Study on the Influence of Chemotherapy in the TCM Syndrome of Colorectal Cancer with Analysis of 780 cases

目的:研究大肠癌中医证候分类特征,明确化疗对其中医证候演变规律的影响。方法:收集780例1998年1月—2008年1月浙江省中医院肿瘤科住院大肠癌患者,将复杂证型分拆为单一证型进行统计,凡出现相应证型者即予归类。患者初次、末次入院及化疗前、后分别进行1次证型分类,比较初次末次入院及化疗前、后证型分布,观察化疗前后证型变化。统计接受化疗且存在证型变化患者,剔除化疗前即出现证型变化患者,分析化疗次数与中医证型变化相关性。结果:患者初、末次入院整体证型分布大致相仿,中医证候频数从多到少依次为气虚证、脾虚证、阴虚证、血虚证、痰湿证、热毒证、气滞证、阳虚证和血瘀证;末次与初次入院证型出现频率比较气虚证减少,脾虚证和阴虚证增加,差异均有统计学意义(P<0.05)。化疗后大肠癌脾虚证及阴虚证病例明显增加(P<0.05),气虚证及血虚证例数减少(P>0.05),其他证型基本相仿;化疗2次发生证型变化例数最多,占53.2%;从证型的纵向比较来看,接受化疗的病例与未接受化疗的病例,其发生中医证型变化的概率相比较有统计学意义(P<0.05)。结论:中医药介入大肠癌治疗需要考虑化疗对证型的影响,化疗后应着重对脾虚证和阴虚证的干预。

Objective：To clear the influence of chemotherapy in the evolution rule of colorectal cancer by researching the characteristics of Chinese medical syndromes.Methods：The enrolled 780 colorectal cancer patients being hospitalized in the Department of Oncology in Zhejiang Hospital of Traditional Chinese Medicine,were researched through the retrospective study method to analyze the characteristics of the TCM syndromes and the influence of chemotherapy on the evolution rule of colorectal cancer.Results：At the beginning and the end time,the TCM syndrome distributions were roughly similar,which were qi deficiency syndrome,spleen deficiency syndrome,yin deficiency syndrome,blood deficiency syndrome, phlegm damp syndrome,toxic heat syndrome,qi stagnation syndrome,yang deficiency and blood stasis syndrome in turn.Comparing with the beginning time.qi deficiency syndrome reduced,spleen syndrome and yin deficiency syndrome increased,which was statistically significant（P0.05）.After chemotherapy,yin deficiency and spleen deficiency syndromes of colorectal cancer were signnificantly increased,while qi deficiency and blood deficiency syndromes decreased（P0.05）.Among them,the patients receiving twice chemotherapy had a biggest change of syndromes（53.2%）.The differences made by chemotherapy were statistically different（P0.05）.Conclusion：The TCM interventional treatment of colorectal cancer should consider the influence on the TCM syndromes made by chemotherapy.The intervention after chemotherapy should be mainly enbodied in spleen deficiency and yin deficiency syndromes.