原发性肝癌中医证型与ECOG评分相关性研究

Research on Relationship between TCM Syndrome Type and ECOG Scores in Patients with Primary Liver Cancer

目的:探讨175例原发性肝癌患者的中医证型与体力状态(ECOG)评分的相关性。方法:以2013年3月—2013年12月广西医科大学附属肿瘤医院住院收治原发性肝癌(PLC)初治患者175例为研究对象。对PLC患者进行ECOG评分,并将其分为肝气郁结型、气滞血瘀型、湿热聚毒型、肝肾阴虚型4组,分析中医证型与ECOG评分的相关性。结果:(1)4种证型PLC患者的ECOG评分不一致(P<0.05)。肝气郁结型患者评分明显低于肝肾阴虚型(P多重比较<0.01),且低于湿热聚毒型的可能性大。气滞血瘀型患者评分明显低于湿热聚毒型、肝肾阴虚型(P多重比较<0.01)。湿热聚毒型患者评分明显低于肝肾阴虚型(P多重比较<0.01)。(2)4个证型ECOG评分为0、1、3、4分所占比率均不一致(P<0.05)。肝气郁结型评分为0分的比率明显高于肝肾阴虚型(P多重比较<0.01),且肝气郁结型高于湿热聚毒型、气滞血瘀型高于肝肾阴虚型的可能性大。肝肾阴虚型评分为1分的比率明显低于气滞血瘀型、湿热聚毒型(P多重比较<0.01),且低于肝气郁结型的可能性大。肝肾阴虚型评分为3分的比率明显高于肝气郁结型(P多重比较<0.01),且高于气滞血瘀型的可能性大。肝肾阴虚型评分为4分的比率明显高于其它证型(P多重比较<0.01)。结论:(1)肝气郁结型、气滞血瘀型患者一般健康状况较好,湿热聚毒型较差,肝肾阴虚型最差。(2)ECOG评分为0分可以被认为是肝气郁结型与肝肾阴虚型相互鉴别的临床参考,且对于前者与湿热聚毒型,后者与气滞血瘀型相互鉴别仍有一定的指导意义。评分为1分可以被认为是肝肾阴虚型与气滞血瘀型、湿热聚毒型相互鉴别的临床参考,且对于前者与肝气郁结型相互鉴别仍有一定的指导意义。评分为3分可以认为是肝肾阴虚型与肝气郁结型相互鉴别的临床参考,且对于前者与气滞血瘀型相互鉴别仍有一定的指导意义。评分为4分是肝肾阴虚型与其它证型相互鉴别的临床参考。(3)PLC患者中医证型与ECOG评分存在一定的相关性。ECOG评分对于中医辨证分型有一定的指导意义。

Objective：To investigate the relationship between TCM syndrome type and Eastern Cooperative Oncology Group（ECOG）scores from the information of 175 primary liver carcinoma（PLC）patients. Methods：175 PLC patients in initial treatment who hospitalized in affiliated tumor hospital of Guangxi medical university from March to December in 2013 were divided into four groups such as depression of liver-Qi,stagnation of vital energy and blood stasis,moist heat and poly poison and hepatic and renal Yin deficiency,and then were graded by ECOG. To analysis the relationship between PLC patients TCM pattern of syndrome and ECOG scores. Results：（1）Four TCM syndrome type PLC patients were not coincident in ECOG scores（P〈0.05）. Depression of liver-Qi is obvious lower than hepatic and renal Yin deficiency（P〈0.01）in the scores. The possibility of depression of liver-Qi was lower than moist heat and poly poison is large. Stagnation of vital energy and blood stasis was obvious lower than moist heat and poly poison and hepatic and renal Yin deficiency（P〈0.01）in the scores. Moist heat and poly poison was obvious lower than hepatic and renal Yin deficiency（P〈0.01）in the scores.（2）Four TCM pattern of syndrome in 0,1,3 and 4 score were not coincident in occupation ratio（P〈0.05）. The occupation ratio of the 0 score in depression of liver-Qi was obviously higher than hepatic and renal Yin deficiency（P〈0.01）. The possibilities of occupation ratio of the 0 score in depression of liver-Qi higher than moist heat and poly poison,stagnation of vital energy and blood stasis higher than hepatic and renal Yin deficiency were large. The occupation ratio of the 1 score in hepatic and renal Yin deficiency was obviously lower than stagnation of vital energy and blood stasis and moist heat and poly poison（P〈0.01）. The possibility of occupation ratio of the 1 score in hepatic and renal Yin deficiency lower than depression of liver-Qi was large. The occupation ratio of the 3 score in hepatic and renal Yin deficiency was obviously higher than depression of liver-Qi（P〈0.01）. The possibility of occupation ratio of 3 score in hepatic and renal Yin deficiency higher than stagnation of vital energy and blood stasis was larege. The occupation ratio of the 4 score in hepatic and renal Yin deficiency was obviously higher than the others（P〈0.01）. Conclusion：（1）Depression of liver-Qi and stagnation of vital energy and blood stasis are good,moist heat and poly poison gets worse,hepatic and renal Yin deficiency was worst of all in general health status.（2）The 0 score in ECOG can be considered as clinic reference to distinguish depression of liver-Qi and hepatic and renal Yin deficiency,to discriminate depression of liver-Qi and moist heat and poly poison,hepatic and renal Yin deficiency and stagnation of vital energy and blood stasis to some extent. The 1 score in ECOG can be considered as clinic reference to distinguish hepatic and renal Yin deficiency and stagnation of vital energy and blood stasis,moist heat and poly poison,to discriminate hepatic and renal Yin deficiency and depression of liver-Qi to some extent. The 3 score in ECOG can be considered as clinic reference to distinguish hepatic and renal Yin deficiency and depression of liver-Qi,to discriminate hepatic and renal Yin deficiency and stagnation of vital energy and blood stasis to some extent. The 4 score in ECOG can be considered as clinic reference to distinguish hepatic and renal Yin deficiency and the others.（3）There are some relationships between PLC patients TCM syndrome type and ECOG scores. And the latter has the value of guidance to confirm the former.