食管癌首次化疗中医证型及证候特征系统综述

Retrospective Analysis of TCM Syndrome Types and Syndrome Characteristics of Esophageal Cancer for The First Time Chemotherapy

[主要目的]分析食管癌首次化疗中医证型及证候特征。[资料来源]选取曲阜市中医院肿瘤科2013年6月至2015年6月住院食管癌首次化疗住院患者病历。[选择文献量及依据]1研究类型:临床观察,资料完整。2研究对象:食管癌首次化疗,符合《中国常见恶性肿瘤诊治规范·第一分册·食管癌和贲门癌》《中医病证诊断疗效标准》《中药新药临床研究指导原则》。年龄≥20岁;明确病理诊断、化疗指证;无穿孔及活动性出血;无严重心肝肾及肺功能障碍。3干预措施:PF(顺铂75~80mg/m^2 d1+氟尿嘧啶750mg/m^2 d1-5,21日为1周期)、TP(紫杉醇175 mg/m^2 d1+顺铂75~80mg/m2 d2,21日为1周期)。4评价指标:中医证型(痰气阻膈、瘀血阻膈、阴虚热结、气虚阳微、脾胃虚弱)。排除中医四诊资料不全、未遵医嘱、不按规定用药、依从性差,自行退出或失访者。共107例住院病历。[数据提炼规则及应用方法]SPSS17.0软件频数描述中医症候及辨证分型构成比,χ~2检验(α=0.05)。[数据综合得出结果与结论]证型频次顺序,首次化疗前:痰气阻膈>瘀血阻膈>阴虚热结=脾胃虚弱>气虚阳微;化疗后:脾胃虚弱>瘀血阻膈>痰气阻膈>气虚阳微>阴虚热结。证候特征:化疗后恶心呕吐、神疲乏力、食欲不振脾胃虚弱表现增加,畏寒肢冷阳虚证和舌紫暗瘀血症增多;中医证型,脾胃虚弱多、瘀血阻膈、气虚阳微增多。[未来展望]扩大临床样本量,进一步深入研究调查,积极预防,有效改善患者预后。

[Primary Purpose] Analysis of TCM Syndrome Types and syndrome characteristics of first time chemotherapy for esophageal cancer. [Data source] Select the Qufu City Hospital of TCM oncology hospital of esophageal cancer from June 2013 to June 2015 for the first time with the medical records of hospitalized patients. [Selected Literature Quantity and basis]① Research Type： Clinical observation with more complete data. ②Researeh Object： Patients with esophageal cancer for the first time chemotherapy, Meet Practice of Medical Oncology, Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine, Guidance Principle of Clinical Research of New Medicine of Traditional Chinese Medicine. 20 years of age or older; There is a clear pathological diagnosis of esophageal cancer; No gastric perforation and active bleeding; No serious heart, kidney and lung dysfunction.③Intervention Measures： PF（DDP 75-80 mg/m^2 d1＋5-Fu 750 mg/m^2 d1-5, 21 days for 1 cycle）, TP （PTX175 mg/m2 dl＋ DDP 75-80mg/m^2 d2, 21 days for 1 cycle） etc. routine chemotherapy. ④Evaluating indicator： TCM Syndrome Types（Tanqi resistance diaphragm ,blood stasis obstructing the diaphragm, Yin deficiency and heat node, deficiency of Yang and Qi micro ,weak spleen and stomach ）. Remove the four diagnostic information incomplete; Patient is not in compliance with the requirements of the doctor＇s instructions; Not to affect the efficacy of medication in accordance with the provisions; Poor compliance, self withdrawal or loss of access. A total of 107 eases of hospital medical records. [Data Extraction Rules and Application Method] Recorded before and after treatment of clinical symptoms, syndrome differentiation. Processing and analysis using SPSS17.0 statistics software, The composition of TCM syndromes and syndrome differentiation and classification of TCM were statistically described before and after chemotherapy ,Use Z= test, level test a =0.05. [Result and Conclusion of Data Generalisation] Patients with esophageal cancer first before chemotherapy syndrome type frequency sort： Tanqi resistance diaphragm〉blood stasis obstructing the diaphragm〉Yin deficiency and heat node =weak spleen and stomach〉deficiency of Yang and Qi micro. After chemotherapy in the syndrome type frequency sort： The weakness of the spleen and stomach〉Blood stasis obstructing the diaphragm〉Tanqi resistance diaphragm〉deficiency of Yang and Qi micro〉Yin deficiency and heat node. After chemotherapy with nausea and vomiting, lethargy, loss of appetite and increase the performance for the weakness of spleen and stomach, On the chilly and cold limbs as the main manifestation of Yang deficiency and dark purple tongue manifestation of blood stasis increase. TCM Syndrome Types, The weakness of the spleen and stomach, Blood stasis obstructing the diaphragm, deficiency of Yang and Qi micro increase. [Future Prospect] Expand the clinical sample size, further in-depth study of the investigation, and actively prevent and effectively improve the prognosis of patients.