不同分期乳腺癌证候分布规律研究

Study on the syndrome distribution of different stages of breast cancer

目的:研究不同分期乳腺癌的证候分布规律,为中医治疗乳腺癌奠定基础。方法:通过临床问卷调查收集709例乳腺癌患者的四诊信息,由2名中医肿瘤专业主任医师根据事先制定的证候诊断标准,采用传统辨证方法进行辨证。然后对不同分期乳腺癌的证候进行频次分析及χ2分析,阐明不同分期乳腺癌的证候分布规律。结果:乳腺癌的总体证候分布规律如下(从高频到低频):肝气郁滞、肾阴虚、肝热、肝阴虚、湿邪困脾、脾气虚、痰证、瘀血内停、阳虚、心阴虚、气虚、肾阳虚、胃热、湿热困脾。其中随临床分期变化的证候有肝阴虚、脾气虚、湿邪困脾、心阴虚、痰证;不随临床分期变化的证候有肝气郁滞、肝热、瘀血停滞、肾阴虚、肾阳虚、阳虚、气虚、胃热、湿热困脾。具体分析不同分期的证候变化规律:Ⅳ期及复发患者中,肝阴虚证、脾气虚证、痰证、湿邪困脾证频率最高,心阴虚证出现频率最低,并且与其他期别比较有统计学意义。结论:不同分期对中医辨证有一定程度的影响,但有一定的限度。而且即使受分期影响的证候也只是出现频率的不同,而没有有和无的差异。也就是说上述证候贯穿乳腺癌发病的始终,是乳腺癌病因病机的体现。

Objective： To lay the foundation for the treatment of breast cancer with traditional Chinese medicine（TCM） by studying the distribution regularity of the syndromes of breast cancer of different stages. Methods： Informations of the four methods of diagnosis in 709 breast cancer patients were collected through clinical questionnaire. Two chief physicians of TCM oncology conducted syndrome differentiation with traditional differentiating method based on the pre-established criteria. Then frequency analysis and chi-square analysis were conducted on the syndromes of breast cancer of different stages to clarify the distribution regularity of the syndromes of breast cancer of different stages. Results： The overall distribution regularity of breast cancer syndromes is as follows（from high frequency to low frequency）： stasis of liver qi, deficiency of kidney yin, liver heat, deficiency of liver yin, pathogenic dampness retaining in spleen, deficiency of spleen qi, phlegm syndrome, internal blockade of static blood, yang deficiency, deficiency of heart yin, qi deficiency, deficiency of kidney yang, stomach heat, dampnessheat stagnating in spleen. The syndromes changing with clinical stages included deficiency of liver yin, deficiency of spleen qi, pathogenic dampness retaining in spleen and deficiency of heart yin and phlegm syndrome; the syndromes not changing with clinical stages included stasis of liver qi, liver heat, internal blockade of static blood, deficiency of kidney yin, deficiency of kidney yang, yang deficiency, qi deficiency, stomach heat and dampness-heat stagnating in spleen. The result of analyzing the change rule of the syndromes of different stages was as follows： in stage Ⅳ and the relapsing patients, syndrome of deficiency of liver yin, syndrome of deficiency of spleen qi, phlegm syndrome and pathogenic dampness retaining in spleen presented the highest frequency while the syndrome of deficiency of heart yin presented the lowest frequency. The differences from stages indicated statistical significance. Conclusion： Staging has influence of a certain degree on the TCM differentiation, but the influence is limited to a certain extent. In addition, even if the syndromes affect by staging, the differences are restricted to the frequency ofoccurrence but not whether the differences exist. In other words, the syndromes above developped throughout the incidence of breast cancer and they are the manifestations of the etiology and pathogenesis of breast cancer.