180例晚期非小细胞肺癌患者中医证候分布与组合规律

Study on the distribution and combination law of TCM syndromes on 180 cases patients with advanced non-small cell lung cancer

目的:探讨晚期非小细胞肺癌(NSCLC)初治、非初治患者的中医证候要素及应证组合规律。方法:制定NSCLC临床病例调查表,采用多中心、前瞻性研究方法对纳入的180例合格患者进行资料采集,将数据输入数据库进行统计学分析。结果:1180例晚期NSCLC患者中,初治者97例(占53.9%),非初治者83例(占46.1%)。初治患者病性要素出现的频率从高到低依次是气虚证(19.7%)、痰湿证(18.4%)、邪毒证(14.9%)、气滞证(13.2%)、阴虚证(12.7%)、血瘀证(12.3%)、热毒证(7.0%)、阳虚证(1.8%)。非初治患者证候要素出现的频率从高到低依次是气虚证(21.0%)、邪毒证(18.4%)、痰湿证(14.8%)、阴虚证(14.4%)、气滞证(13.5%)、血瘀证(11.4%)、热毒证(5.2%)、阳虚证(1.3%)。其中,邪毒证在非初治患者较初治患者多见,差异具有统计学义(P<0.05)。2初治患者病性证候要素有40种组合,以2因素、3因素为主,分别占33.0%、28.9%。非初治患者病性证候要素有63种组合,以3因素、2因素、4因素为主,分别占26.5%、25.3%、25.3%。3在病位与虚性证素组合中,两者均以肺气虚、脾气虚及肺阴虚为多见,且脾气虚证在非初治患者中更多见,差异具有统计学意义(P<0.05)。结论:晚期NSCLC证候要素实证以痰湿、邪毒为主,虚证以气虚、阴虚为主。初治及非初治NSCLC证候要素组合均复杂。其中邪毒证及脾气虚证在非初治患者中更为常见。

Objective： To explore the distribution and combination law of TCM Syndromes on patients with advanced non-small cell lung cancer who had accepted the initial treatment or not. Methods： The NSCLC clinical cases questionnaire was made. The data of included 180 cases patients with advanced non-small cell lung cancer were collected with multicentric and prospective investigation method. Then, the data were entered into a database for statistical analysis. Results： （1）In 180 cases, there were 97 cases that had accepted the initial treatment accounting for 53.9%, while 83 cases that had not accepted accounting for 46.1%. The occurrence frequency of TCM syndromes on cases accepted the initial treatment in sequence from high to low was： qi deficiency （19.7%）, phlegm-damp （18.4%）, pathogenic toxin （14.9%）, qi stagnation （13.2%）, yin deficiency （12.7%）, hlood-stasis （12.3%）, heat toxin （7.0%） and yang deficiency （1.8%）, while cases not accepted the initial treatment was： qi deficiency （21.0%）, pathogenic toxin （18.4%）, phlegm-damp （14.8%）, yin deficiency （14.4%）, qi stagnation （13.5%）, blood-stasis （11.4%）, heat toxin （5.2%） and yang deficiency （1.3%）. The factor of pathogenic toxin in cases not accepted the initial treatment was more than that in cases accepted the initial treatment, with having statistical differences. （2）There were 40 types of syndrome combination incases accepted the initial treatment, most of them including 2 factors and 3 factors, accounting for 33.0% and 28.9% respectively. While there were 63 types of syndrome combination in cases not accepted the initial treatment, most of them including 3 factors, 2 factors and 4 factors, accounting for 26.5%, 25.3% and 25.3% respectively. （3）In the combination of disease location and the deficiency syndromes, the lung qi deficiency, the spleen qi deficiency and lung yin deficiency were both in cases, and the spleen qi deficiency in cases not accepted the initial treatment was more than that in cases accepted the initial treatment, with having statistical differences （P〈0.05）. Conclusion： The sthenic syndrome factors of advanced NSCLC patients are phlegm-damp and pathogenic toxin, while deficient syndrome factors of advanced NSCLC patients are qi and yin deficiency. Syndrome combination is complicated in total advanced NSCLC patients. But the syndromes of pathogenic toxin and spleen qi deficiency are more common in treated patients than that in untreated patients.