EGFR-TKI治疗后非小细胞肺癌中医证候研究

Study on Distribution of Traditional Chinese Medicine Syndromes of NSCLC after EGFR-TKI Treatment

目的观察靶向药物治疗后非小细胞肺癌(NSCLC)患者的中医证候分布。方法采用临床流行病学调查方法观察506例表皮生长因子受体酪氨酸激酶阻滞剂(EGFR-TKI)治疗后的NSCLC患者症状、体征、舌脉四诊资料,运用聚类分析方法观察靶向药物治疗后NSCLC患者的中医证候特征规律,进行因子分析,观察各个证型辨证的主次症。结果患者中医证型主要为肺阴亏虚证(281例,55.53%)、气阴两虚证(145例,28.66%)、肺脾气虚证(80例,15.81%)。肺阴亏虚证主要证素为咳嗽、痰少、痰黏、皮疹瘙痒、皮肤干燥、口干渴、舌红、裂纹舌、脉细;次症为苔薄或苔白(P=0.001)。气阴两虚证主要证素为头晕、口干不欲饮、脉弱、少寐;次症为气促、干咳无痰、咽干、心烦(P=0.001)。肺脾气虚证主要证素为神疲乏力、恶心、纳差、大便不成形、舌淡红、苔腻、胖大齿痕舌、脉滑;次症为面萎黄或胸闷(P=0.001)。结论靶向药物治疗后NSCLC患者的证型主要为肺阴亏虚证、气阴两虚证和肺脾气虚证,其核心证型是肺阴亏虚证。

Objective To observe the distribution of Chinese Medicine（ CM） syndromes in patients with non-small cell lung cancer（ NSCLC） after EGFR-TKIs treatment. Methods The clinical materials,including symptoms,signs,and manifestations of tongue and pulse,were investigated in 506 NSCLC patients by using clinical epidemiological method after EGFR-TKIs,and then the characteristics of CM syndromes in NSCLC patients after EGFR-TKIs treatment were explored by cluster analysis. On the basis of the cluster analysis the primary and secondary symptoms of each syndrome were identified preliminarily by factor analysis. Result Fei-yin deficiency syndrome（ 281 cases,55. 53%）,qi-yin deficiency syndrome（ 145 cases,28. 66%）,Fei-Pi qi deficiency syndrome（ 80 cases,15. 81%） were the main CM syndrome types of NSCLC patients after EGFR-TKIs treatment. The primary syndrome elements of Fei-yin deficiency syndrome were cough,less sputum,sticky sputum,skin rash,itching,dry skin,thirst,red tongue,fissured tongue,thin pulse. Secondary symptoms was thin lingual fur or white lingual fur（P = 0. 001）. Qi-yin deficiency syndrome differentiation basis for dizziness,dry mouth,weak pulse,little sleep.Secondary symptoms were anhelation,hoose,dry pharynx,vexation（P = 0. 001）. The primary syndrome elements of Fei-Pi qi deficiency were lassitude,nausea,anorexia,loose stool,teeth-marked tongue,slippery pulse. Secondary symptoms were sallow complexion or chest tightness（P = 0. 001）. Conclusion The main syndromes of patients with NSCLC after EGFR-TKIs treatment were Fei-yin deficiency syndrome,qi-yin deficiency syndrome,Fei-Pi qi deficiency syndrome,and the core syndrome was Fei-yin deficiency.