191例肿瘤相关性疲劳患者的中医病机研究

Clinical Research on Traditional Chinese Medicine Pathogenesis in 191 Patients with Cancer-related Fatigue

目的:通过中医辨证来观察肿瘤相关性疲劳(CRF)患者的病性虚实、脏腑定位、病理产物,以阐明其中医病机,为中医药防治肿瘤相关性疲劳提供理论依据。方法:本研究采用问卷调查法,选取2016年3月至2016年6月广州中医药大学第一附属医院手指的恶性肿瘤患者191例,进行一般信息、疲劳评分判定、中医四诊资料采集后,判定其脏腑虚损情况、脏腑辨证定位和病理产物,并分析其虚损情况与疲劳程度间的关系。结果:肿瘤相关性疲劳患者证型以脾气虚型的发生率最高(占80. 6%),其次为肾气虚型(占43. 5%)、肺气虚型(占34. 6%)、肝气郁结(占21. 5%)。而病理产物方面,53. 4%肿瘤相关性疲劳患者夹有痰浊,15. 7%夹有瘀血,30. 9%同时合并痰浊、瘀血。肿瘤相关性疲劳患者出现肾阳虚型、肾气虚型、脾阳虚型、肝气郁结型的疲劳程度较重,差异均有统计学意义(P <0. 05)。结论:肿瘤相关性疲劳患者的中医辨证总体上以虚证为主,可出现虚实夹杂。该病的病位主要在脾、肾,涉及到肝、肺二脏,病机多为脾气不足、肾精亏虚、痰瘀互结。故其中医治疗应攻补兼投,以补虚为主,治以健脾益气、补肾填精、软坚散结为法。

Objective:To observe the nature,location in zang-fu organs and pathological products of disease in patients with cancer-related fatigue(CRF)by syndrome differentiation of Traditional Chinese Medicine(TCM).It may help to further clarify the TCM pathogenesis of CRF and provide an important theoretical basis for the use of TCM in the prevention and treatment of CRF.Methods:A total of 191 patients with CRF were treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2016 to June 2016.Demographic information,score of RPFS-CV and clinical data from four diagnostic methods were collected to assess the deficiency of zang-fu organs,location and pathological products of disease,and the correlation in deficiency of zang-fu organs and level of fatigue was analyzed.Result:The most frequent syndrome of CRF was deficiency of spleen-qi,accounting for 80.6%of all patients,followed by deficiency of kidney-qi(43.5%),deficiency of lung-qi(34.6%),stagnation of liver-qi(21.5%).The analysis of pathological products indicated that 53.4%of CRF patients developed phlegm,15.7%developed static-blood and 30.9%developed both of them.CRF patients with the syndromes of kidney-yang deficiency(P<0.001),kidney-qi deficiency(P<0.001),spleen-yang deficiency(P<0.05)and stagnation of liver-qi(P<0.05)were associated with a higher level of fatigue.Conclusion:The TCM syndromes of CRF patients were dominated by deficiency syndromes and presented with the appearance of intermingled deficiency and excess.The locations of disease mainly included spleen,kidney and were also related to liver and lung.The TCM pathogenesis of CRF was related to the deficiency of spleen-qi and kidney-essence,and the intermingled phlegm,blood-stasis.The principle of treatment is reinforcing deficiency,accompanied with eliminating pathogen.The TCM methods for CRF were reinforcing qi and strengthening spleen,reinforcing kidney and replenishing essence,softening and resolving hard mass.