650例康复期乳腺癌患者中医证候分布规律的横断面研究

Cross-sectional Study on the Distribution of Traditional Chinese Medicine Syndromes in 650 Patients with Convalescent Breast Cancer

目的探讨康复期乳腺癌患者的中医证候分布规律。方法采用横断面研究方法对650例康复期乳腺癌患者进行问卷调查,调查表内容包括一般人口学信息、肿瘤相关病史以及中医症状体征量表。使用SPSS 22.0软件,将126个四诊信息条目中出现频率<2%的证候信息条目删除,将得到的条目进行K-means聚类,由系统自动选择5个(聚类的类数)初始聚类中心,直到聚类中心无更改时,迭代完成。再采用Logistic回归分析对各证候与各相关因素进行相关性分析。结果将得到的91个症状体征进行K-means聚类,频率>30%的症状体征有急躁易怒、健忘、神疲乏力、入睡困难、眠浅易醒、多梦、口干、焦虑不安等。最终确定5个中医证型依次为有病无证型(190例,29.23%)、脾肾亏虚型(129例,19.85%)、肝郁脾虚型(128例,19.69%)、肝肾亏虚型(104例,16%)、心肾不交型(99例,15.23%)。Logistic回归分析结果显示,体重指数(BMI)与肝肾亏虚呈正相关,与心肾不交呈负相关;孕激素受体(PR)表达与肝肾亏虚呈负相关;人类表皮生长因子受体2(Her2)表达与肝肾亏虚、脾肾两虚均呈正相关;内分泌治疗与肝肾亏虚证呈正相关;雌激素受体(ER)表达与心肾不交呈正相关;年龄与肝郁脾虚、有病无证均呈负相关,与脾肾亏虚呈正相关;病程与有病无证呈正相关(P<0.05)。结论康复期乳腺癌中医证候主要为有病无证型、脾肾亏虚型、肝郁脾虚型、肝肾亏虚型、心肾不交型,BMI、年龄、病程、内分泌治疗及Her2、ER、PR表达对证候的形成有一定影响。

Objective To investigate the distribution of traditional Chinese medicine（ TCM） syndromes in patients with convalescent breast cancer. Methods A cross-sectional study was conducted on 650 patients with convalescent breast cancer who underwent a questionnaire survey. The questionnaire included general demographic information,history of tumor-related disease,and TCM symptoms and signs. SPSS 22. 0 software was used to delete 126 syndrome information items with frequencies less than 2%. K-means clustering was performed on the obtained items,and the system automatically selected 5 clusters（ the number of clusters） to be initialized. The iteration was completed until the cluster center has not changed. Logistic regression analysis was used to analyze the correlation between each syndrome and related factors. Results The 91 symptoms and signs obtained were clustered by K-means.Symptoms and signs with frequency 30% were impatience and irritability,forgetful,fatigued,difficulty falling asleep,easily awakened,dreaminess,dry mouth,and anxiety. Finally,5 TCM syndromes were identified as disease and syndrome-free（ 190 cases,29. 23%）,spleen and kidney deficiency（ 129 cases,19. 85%）,liver depression and spleen deficiency（ 128 cases,19. 69%）,and liver and kidney deficiency（ 104 cases,16%）,and heart and kidney imbalance（ 99 cases,15. 23%）. Logistic regression analysis showed that body mass index（ BMI） was positively correlated with liver and kidney deficiency and negatively correlated with heart and kidney imbalance. Progesterone receptor（ PR） expression was negatively correlated with liver and kidney deficiency. Human epidermal growth receptor 2（ Her2） was positively correlated with deficiency of liver and kidney,deficiency of spleen and kidney.Endocrine treatment was positively correlated with deficiency of liver and kidney. Expression of estrogen receptor（ ER） was positively correlated with heart and kidney imbalance. Age was negatively correlated with liver depression and spleen deficiency,disease and syndrome free,and positively correlated with deficiency of spleen and kidney. The course of disease was positively correlated with disease and syndrome free（ P〈0. 05）. Conclusions The TCM syndromes of convalescent breast cancer are mainly disease and syndrome free,spleen-kidney deficiency,liver depression and spleen deficiency,liver kidney deficiency,heart kidney imbalance. BMI,age,disease course,endocrine treatment and expression of Her2,ER and PR has a certain influence on the formation of syndromes.