胃癌Ⅲ~Ⅳ期患者化疗前后中医证型变化临床观察

Clinical research on change of TCM syndrome types of pre-and post-chemotherapy of patients withⅢ-Ⅳstaging gastric cancer

目的:观察胃癌Ⅲ~Ⅳ期患者化疗前后的中医证型分布及变化规律,为中医药辅助化疗治疗胃癌提供理论依据。方法:选择胃癌Ⅲ~Ⅳ期患者62例,于化疗开始前3天及第2次化疗结束后第7天观察并比较两组患者化疗前后临床症状、舌脉及中医证型的变化规律。结果:化疗前患者中医证型以脾胃虚寒、气滞血瘀、气血亏虚为主,化疗后以胃阴亏虚、气血亏虚、痰湿凝结为主;化疗后胃阴亏虚证明显增加(P<0.05),脾胃虚寒证及气滞血瘀证明显减少(P<0.05)。结论:化疗会影响胃癌Ⅲ~Ⅳ期患者的中医证型,化疗后患者以胃阴亏虚、气血亏虚、痰湿凝结证型为主,提示中医药干预应注重养阴,酌情加用补益气血、健脾化湿、化痰散结等药物。

Objective:To approach the distribution and changing rule of TCM syndrome types of pre-and postchemotherapy of patients withⅢ-Ⅳstaging gastric cancer.Methods:62 cases of patients withⅢ-Ⅳstaging gastric cancer were selected.Within 3 days before the start of chemotherapy and 7 days after the end of the second chemotherapy,the clinical symptoms,tongue images,pulse conditions and changing rule of TCM syndrome types of preand post-chemotherapy of patients were observed and compared in two groups.Results:TCM syndrome types of prechemotherapy were mainly spleen-stomach deficiency-cold,qi-stagnation with blood-stasis and deficiency of both qi and blood,while TCM syndrome types of post-chemotherapy were mainly stomach-yin deficiency,deficiency of both qi and blood and phlegm-damp retention.After chemotherapy,the syndrome of stomach-yin deficiency was significantly increased(P﹤0.05),while the syndrome of spleen-stomach deficiency-cold and the syndrome of qi-stagnation with blood-stasis were significantly decreased(P﹤0.05).Conclusion:Chemotherapy can affect on TCM syndrome types.After chemotherapy,the syndrome of stomach-yin deficiency was significantly increased,while the syndrome of qiblood both deficiency and the syndrome of phlegm-damp retention were less increased.It should be prompted that TCM should intervene ahead of time,nourishing yin should be taken as emphasis,and Chinese herbal medicine for invigorating qi-blood,invigorating spleen for eliminating dampness and removing phlegm and resovling mass,etc.can be additionally used as appropriate.