蒽环类药物急性心脏毒性的中医证候、证素特点探析

A Preliminary Study on TCM Syndromes and Syndrome Elements of Anthracyclines Acute Cardiotoxicity

目的探讨蒽环类药物急性心脏毒性患者的中医证候、证素特点。方法回顾性调查100例患者的四诊信息,运用因子分析和热图聚类方法提取本病的中医证候、证素。结果病位证素涉及五脏,以脾、心为主;病性证素涉及气虚、湿、血瘀、阴虚、阳虚、气滞、热、血虚、痰,以气虚为主,其次为湿、血瘀、阴虚等。证候可分为5大类,分别为类气阴两虚证、类湿热阻滞证、类脾虚湿困证、类气虚血瘀证、类脾肾阳虚证,其中类气阴两虚证最常见。结论蒽环类药物急性心脏毒性证候特点为多虚实夹杂,病机为虚、湿、瘀、热、气滞5个方面。“虚”是其病变根本,“补虚”为其基本治疗大法,临证以益气养阴、健脾化湿、活血化瘀、温阳益气、调气疏肝、清心化痰等为治法。

Objective:To explore the TCM syndromes and syndrome elements of anthracyclines cardiotoxicity.Methods:Four consultations of TCM of 100 patients were collected through retrospective clinical observation and research,and TCM syndromes and syndrome elements of anthracyclines cardiotoxicity were explored by factor anal⁃ysis and heatmap.Results:The syndrome elements of disease location involved the five internal organs and spleen and heart were the most common ones.The nature of syndrome elements included qi deficiency,wetness,blood stasis,yin deficiency,yang deficiency,qi stagnation,heat,blood deficiency,and sputum.qi deficiency were the main disease syndrome element,followed by dampness,blood stasis,yin deficiency,etc.Syndrome types could be divided into 5 categories,which were similar qi-yin deficiency syndrome,similar damp-heat block syndrome,similar spleen deficiency and dampness syndrome,similar syndrome of deficiency of QI and blood stasis,similar syndrome of yang deficiency of spleen and kidney.Similar qi-yin deficiency syndrome was the most common.Con⁃clusion:Anthracyclines cardiotoxicity are mainly intermingled with deficiency and excess,and the pathogenesis in⁃cludes deficiency,dampness,stasis,heat,and qi stagnation.“Deficiency”is the root cause of the disease.There⁃fore,“supplementing deficiency”is a basic treatment method.According to the specific symdromes of patients,the treatment methods include“benefiting qi and nourishing yin”“invigorating spleen for eliminating dampness”“pro⁃moting blood circulation for removing blood stasis”“warming yang and benefiting qi”“relieving liver-qi”“clearing heart fire and dissipating phlegm”,etc.