化疗对乳腺癌患者中医体质的影响及艾灸的调节作用

Impact of chemotherapy on constitution in TCM of patients with breast cancer and the regulating effect of moxibustion

目的探讨乳腺癌患者化疗前、化疗中期和化疗后期的中医体质变化特点,并进一步评价加用艾灸对化疗过程中乳腺癌患者中医体质的调节作用。方法将符合纳入标准的乳腺癌患者随机分为艾灸组和对照组,艾灸组艾灸从化疗结束后第2天开始,连续每天艾灸直至下次化疗开始前1天为止,化疗当天不艾灸,对照组常规处理,不加用艾灸。参照《中医体质分类与判定》标准,采用问卷调查法对两组患者化疗前、化疗中期和化疗后期分别进行3次中医体质判别,分析两组患者体质的变化情况,以及艾灸对体质的调节作用。结果随机分组100例,每组50例。99例收集到基线问卷,91例收集到2次问卷,88例收集到3次问卷。99例乳腺癌患者在化疗前最常见的偏颇体质类型为:阴虚质(D型)、气郁质(H型)和气虚质(B型),两组在基线时体质类型分布情况比较差异无统计学意义(P>0.05)。91例在化疗中期,艾灸组和对照组平和质(A型)较化疗前均有显著的下降(P<0.001),艾灸组各偏颇体质未见明显差异(P>0.05),但对照组阳虚质(C型)和阴虚质(D型)在化疗中期较化疗前均明显升高(P<0.05);同时,对照组阳虚质(C型)高于艾灸组(P=0.061),但差异无统计学意义。88例在化疗后期,艾灸组正常体质和偏颇体质较化疗前均未见明显差异(P>0.05),但对照组平和质(A型)较化疗前有显著下降(P<0.001),并且在各偏颇体质中,阳虚质(C型)和阴虚质(D型)在化疗后期比化疗前明显升高(P<0.05);同时,对照组平和质(A型)显著少于艾灸组(P<0.001),并且阳虚质(C型)和痰湿质(E型)均明显高于艾灸组(P<0.05)。结论乳腺癌易感体质为阴虚质、气郁质和气虚质。化疗会影响乳腺癌患者的体质,减少平和质,增加阳虚质和阴虚质。加用艾灸对乳腺癌化疗患者的体质具有调节作用,并且随着化疗疗程的推进,稳定正常体质,减少阳虚质和痰湿质。

Objective To explore the changes of constitution in TCM of breast cancer patients before chemotherapy,at the middle stage and later stage of chemotherapy treatment period and the regulating effect of moxibustion on patients'constitution during chemotherapy.Methods Patients with breast cancer who met the inclusion criteria were randomly divided into the moxibustion group and the control group.The moxibustion group started moxibustion from the 2nd day after chemotherapy,and continued daily moxibustion until the day before the next cycle of chemotherapy.Moxibustion was not performed on the day of drug administration.The control group was given conventional treatment.According to the Classification and Determination of Constitution in TCM,questionnaire survey was conducted to both groups to determine the patients'constitutions and their changes,and the regulating effect before chemotherapy,at the middle stage and later stage of chemotherapy.Results 100 patients were randomly divided in to the two groups,with 50 patients in each group.99 caseswere collected baseline questionnaires,91 cases were collected two times of questionnaires,and 88 cases were collected three times of questionnaires.The most common abnormal constitution of 99 breast cancer patients before chemotherapy were Yin-deficiency(Type D),Qi-depression(Type H)and Qi-deficiency(Type B).There was no significant difference in the distribution of the constitution of patients between the two groups at the baseline(P>0.05).In the 91 cases at the middle stage of chemotherapy,moderate constitution(Type A)in the moxibustion group and the control group decreased significantly compared with that before chemotherapy(P<0.001).There was no significant difference in abnormal constitution of the moxibustion group(P>0.05),while Yang-deficiency(Type C)and Yin-deficiency(Type D)in the control group increased significantly at middle stage of chemotherapy compared with those at the time before chemotherapy(P<0.05).Meanwhile,the control group had higher Yang-deficiency(Type C)constitution than the moxibustion group,without statistical difference(P=0.061).In the 88 cases at the later stage of chemotherapy,there were no significant difference between the normal and abnormal constitutions in moxibustion group compared with those before chemotherapy(P>0.05).But the control group had significant reduction in the moderate constitution(Type A)than that before chemotherapy(P<0.001).Besides that,the control group had significant increases in Yang-deficiency(Type C)and Yin-deficiency(Type D)constitution among all the types than those before chemotherapy(P<0.05).Moderate constitution(Type A)in the control group was significantly lower than that in the moxibustion group(P<0.01),while Yang-deficiency(Type C)and Phlegm-dampness(Type E)were significantly higher than in the moxibustion group(P<0.05).Conclusion The susceptible constitutions of breast cancer in TCM are Yin-deficiency,Qi-depression and Qi-deficiency.Chemotherapy can affect the constitution of breast cancer patients such as reducing moderate constitution and increasing Yang-deficiency and Yin-deficiency constitutions.Moxibustion can regulate the constitution of breast cancer patients undergoing chemotherapy,stabilize normal constitution and reduce constitutions of Yang-deficiency and Phlegm-dampness.