388例原发性肺癌中医证候分布状况分析

Analysis on Distribution Characteristics of TCM Syndromes in Primary Lung Cancer: a Report of 388 Cases

目的:评价肺癌患者中医证型的发病情况及分布与演变规律,为临床辨证论治及进一步构建适合当代临床的肺癌辨证标准提供依据。方法:制定原发性肺癌临床流行病学调查表,并开展肺癌中医证候的临床流行病学调查;调查表资料采用数据库系统管理,采用辨单证法进行统一辨证和统计分析。结果:共收集符合纳入标准的肺癌患者388例。从症状体征的分布情况看,肺阴虚是肺癌的主证,脾气虚、肺气虚是肺癌的常见证,瘀阻肺络是肺癌的常见病机,而痰湿亦是肺癌的常见证候;按脏腑辨证统计,其发病率较高的基本证型依次为:肺阴虚证、肺气虚证、脾气虚证、瘀阻肺络证、肺阴虚火旺证。在肺癌的不同分期中肺阴虚始终排于首位,且Ⅳ期的发病率明显低于Ⅰ期(P<0.05);而常见证型中不同病理类型的分布情况无显著性差异,但随着病情逐渐加重,Ⅲ、Ⅳ期患者兼证证型数在增加。结论:临床治疗肺癌应注重健脾补气和滋阴润肺;目前一些辨证标准笼统地命名为气阴两虚、气虚痰湿等,无法以脏腑辨证来分类,也难以客观反映病情变化,因此有待通过进一步的数据挖掘研究提出具有统计学意义的复合证型。

Objective： To investigate the distribution of TCM syndrome and its evolvement characteristics in lung cancer, and to provide basis for clinical differentiation and further construction of differentiation standards of lung cancer suited to contemporary clinical practice. Methods： An epidemiological survey of TCM syndromes in lung cancer was can＇ied out by devising the epidemiological questionnaire of primary lung cancer which was managed using a database system and was analyzed dialectically. Results： Three hundred and eighty-eight cases were collected. To the distribution of symptoms and signs, deficiency of lung yin was the main syndrome, deficiency of spleen qi syndrome and deficiency of lung qi syndrome were common ones, blood stasis blocking lung collaterals was the common pathogenesis, and phlegm-dampness was the common syndrome ; to viscera differentiation, the distribution of the basic syndromes with higher incidence of lung cancer was as follows ： deficiency of lung yin syndrome, deficiency of lung qi syndrome, deficiency of spleen qi syndrome, blood stasis blocking lung collaterals, lung dryness due to yin deficiency syndrome. Among which, deficiency of lung yin syndrome was always involved in the first place at different stages of lung cancer. Its incidence at stage VI was significantly lower than that of the stage I （ P 〈 0.05 ）. There was no obvious difference in distribution of different pathological types in common syndromes, but the types of associated symptoms at stage III and IV were increased as the disease gradually worsened. Conclusion ： Fortifying spleen and supplementing qi, nourishing yin and moistening lung should be focused in clinical treatment; now, some dialectical indexes are generally named deficiency of qi and yin, or qi deficiency and phlegm-dampness. It will be difficult to objectively reflect disease evolution since it fails to classify in accordance with viscera differentiation. So we need to propose a statistically significant composite syndrome by further study.