伴癌因性疲乏肺癌患者中医证候分布规律特点及其影响因素分析

Distribution of TCM Syndromes in Patients With Lung Cancer and Cancer Related Fatigue and Its Influencing Factors

目的:分析伴癌因性疲乏(CRF)肺癌患者中医证候分布规律特点及其影响因素。方法:选取2017年1月—2018年12月期间我院肿瘤科门诊与住院的120例CRF肺癌患者为研究对象,收集患者的相关资料,采用Piper疲乏量表评估CRF程度,并采用单证及单证组合方式,总结肺癌CRF的中医证型。结果:120例患者中,CRF程度包括轻度18例(15.00%)、中度76例(63.33%)、重度26例(21.67%),CRF严重程度与患者TNM分期、卡氏评分(KPS)、治疗方法密切相关(P<0.05)。CRF肺癌患者的一般症状主要包括乏力(70.83%)、肢体困重或浮肿(55.00%)、口苦口干(52.50%)、久咳不愈(48.33%)、形体消瘦(46.67%)等;胸腹部症状以腹部隐痛(53.33%)、腹胀(48.33%)、胸脘痞闷(48.33%)为主,多可见两便异常;舌象以舌淡、白苔、腻苔、舌黯紫居多。单证统计中,CRF肺癌患者单证出现构成比超过50%发热证型包括肺气虚证、脾气虚证、痰湿证、血瘀证、肾虚证;组合证型共55例,未见单证组合,其中以4证相兼最常见,4证相兼32例(58.18%),其次分别为3证相兼15例(27.27%)、2证相兼6例(10.91%)、5证相兼2例(3.64%)。结论:肺癌患者CRF程度受TNM分期、KPS评分及治疗方法影响,中医证型分布广,多为2个以上证型合并,且以虚实夹杂证为主。

Objective:To analyze the distribution and influencing factors of TCM syndromes in patients with lung cancer and cancer related fatigue(CRF). Methods:A total of 120 patients with lung cancer and CRF who were admitted to the oncology department of the hospital from January 2017 to December2018 were selected as the study subjects. Their relevant data were collected and the Piper fatigue scale was used to assess the degree of CRF. The TCM syndrome of lung cancer with CRF were summarized by single syndrome and combination of single syndrome. Results:Among the 120 patients,CRF was mild in 18 cases(15.00%),moderate in 76 cases(63.33%)and severe in 26 cases(21.67%). The severity of CRF was closely related to the TNM stage,Kamofsky performance status(KPS)and treatment method(P<0.05).The general symptoms of patients with lung cancer and CRF mainly included fatigue(70.83%),limb fatigue or edema(55.00%),dry mouth(52.50%),chronic cough(48.33%)and emaciation(46.67%),etc.. Abdominal symptoms included abdominal pain(53.33%),abdominal distension(48.33%)and chest stuffiness(48.33%),with abnormal urination and defecation. Pale tongue,white fur,greasy fur and dark tongue were common signs of the tongue. In the statistical analysis of single syndrome,the constituent ratio of single syndrome in patients with lung cancer and CRF was higher than 50% and fever syndromes included lung Qi deficiency syndrome,spleen Qi deficiency syndrome,phlegm-damp syndrome,blood stasis syndrome and kidney deficiency syndrome. The combined syndrome type occurred in 55 cases,without combination of single syndrome. Combination of 4 syndromes was the most common[32 cases(58.18%)],followed by combination of 3 syndromes [15 cases(27.27%)],combination of2 syndromes(10.91%)and combination of 5 syndromes(3.64%). Conclusion:The degree of CRF in patients with lung cancer is affected by TNM stage,KPS scores and treatment methods. TCM syndromes are widely distributed,and combination of more than two types of syndromes is common. Simultaneous insufficiency and excessive syndrome is primary.