基于医院信息系统的真实世界胃恶性肿瘤死亡患者中医证候特征研究

Characteristics of TCM Syndromes of Death in Patients with Malignant Gastric Tumor: A Real-world Study Based on Hospital Information System

目的分析胃恶性肿瘤死亡患者的真实世界中医证候特征,为胃恶性肿瘤的临床治疗及转归提供数据参考。方法基于医院信息系统大型集成数据仓库电子医疗数据,对第一诊断为"胃恶性肿瘤"且治疗结局为"死亡"患者的一般情况、性别、年龄、中医证候分布等数据进行基于频数和频率的描述性分析。结果纳入数据涉及384例患者,以男性、体力劳动者、中老年人为主。中医证型以脾胃虚损最为多见,其余证型有瘀毒内阻、气阴两虚、肝胃不和、气血两虚、痰湿凝滞、胃热伤阴。男性以脾胃虚损为主,女性以气阴两虚为主;18~44岁患者较少,45~59岁患者以脾胃虚损为主,60~74岁患者以气阴两虚为主,75~89岁患者以瘀毒内阻为主。结论脾胃虚损可能是胃恶性肿瘤死亡患者的核心病机之一,与中医学胃气决死生的传统认知相符合。本研究可为临床针对胃恶性肿瘤危重患者可能出现的死亡终点事件进行病证结合预警及风险防控提供参考。

Objective To analyze the characteristics of TCM syndromes of death in patients with gastric cancer; To provide some references for the clinical treatment and prognosis of gastric malignant tumor. Methods Based on hospital information system large integrated data warehouse electronic medical data, the descriptive analysis based on frequency and frequency was carried out on the general situation, sex, age, distribution of TCM syndromes and other data of the first diagnosis of gastric malignancy and treatment outcome of death. Results Totally 384 cases were included in the analysis, mainly as male, physical manual workers, and the middle-aged and elderly. TCM syndromes of the spleen and stomach deficiency was the most common, and the rest of the syndromes also included： blood stasis internal resistance, qi and yin deficiency, disharmony of liver and stomach, qi and blood deficiency, phlegm stagnation, stomach heat to weak yin. Spleen and stomach deficiency was common in the male, while qi and yin deficiency was common in the female. The number of patients aged between 18 and 44 was small; patients aged between 45 and 59 were maily spleen and stomach deficiency; patients aged between 60 and 74 were mainly qi and yin deficiency; patients aged between 75 and 89 were mainly blood stasis internal resistance. Conclusion Spleen and stomach deficiency may be one of the most central pathogens in patients with gastric cancer death, consistent with the traditional cognition of TCM “Wei Qi”. In this study, the analysis of TCM syndromes in patients with death can provide a reference for real-world large data based on the early warning and risk prevention and control of death points in critically ill patients with severe gastric cancer.