中晚期非小细胞肺癌化疗前后中医证型变化规律研究

Study on the changing rules of TCM syndromes of non-small cell lung cancer at the middle and late stage before and after chemotherapy

目的观察中晚期原发性非小细胞肺癌(NSCLC)患者化疗前后的中医证候。方法采用前瞻性和回顾性相结合的流行病学研究方法,对确诊NSCLC的化疗患者进行化疗前后证候变化的对照研究。结果化疗前患者以气虚痰热、气虚血瘀证为多;化疗后气虚痰热型、气阴两虚型减少,气虚血瘀型、气滞血瘀型增多,差异有统计学意义(P<0.05);气虚、痰湿、血瘀型,气虚痰湿型变化不明显。鳞癌以气虚痰热型为主,腺癌以气虚血瘀型为主;Ⅲ期气虚血瘀型较多(14%),Ⅳ期气虚痰热型较多(14%),但差异无统计学意义(P>0.05)。结论中晚期非小细胞肺癌患者在化疗用药后,证候出现的变化及每个时点的证候分布特点可为化疗期间的中医药干预提供依据,且在一定程度上可间接反映出化疗药物药性。

Objective To observe the TCM syndromes of the patients with advanced primary non-small cell lung cancer （ NSCLC ） before and after chemotherapy. Methods Prospective and retrospective epidemiological study method were used to compare TCM syndromes of the patients confirmed with NSCLC before and after chemotherapy. Results Before chemotherapy, syndrome of Qi deficiency with phlegm heat and syndrome of Qi deficiency with blood stasis were more seen in patients; after chemotherapy, syndrome of Qi deficiency with phlegm heat, syndrome of Qi and yin deficiency, syndrome of Qi deficiency and blood stasis, syndrome of qi stagnation and blood stasis were increased, the difference was statistically significant （ P 〈 0. 05 ） ; the change of Qi deficiency, phlegm damp, blood stasis, Qi deficiency and phlegm dampness type was not obvious. Qi deficiency and phlegm heat were more commonly seen in squamous cell carcinoma, and qi deficiency and blood stasis in adenocarcinoma, and qi deficiency and blood stasis were more found in stage In （ 14% ）, Qi deficiency with phlegm heat more in stage IV （ 14% ）, but the difference had no statistical significance （ P 〉 0. 05 ）. Conclusion The changes of the syndrome and the distribution characteristics of syndromes at every time point in patients with advanced non-small cell lung cancer can provide evidence for the intervention of Chinese medicine during chemotherapy, and may reflect indirectly the property of chemotherapy drug to a certain extent.