真实世界直肠恶性肿瘤患者证候分布与用药特征研究

Study on syndrome distribution and medication characteristics of patients with rectal cancer in the real world

目的:了解我国直肠癌患者的一般特征、中医证候及用药情况。方法:收集全国17家大型三甲中医院医院信息系统的直肠癌住院患者的临床资料,进行数据标准化后对纳入患者的一般信息、证候分布及用药特点进行描述性分析,对药物使用情况进行关联规则分析。结果:本研究纳入了15424例直肠癌住院患者。患者男女比例为1.6∶1,平均年龄为60.87岁,主要位于50~79岁区间。12146例直肠癌患者中,中医证候前5位分别是气阴两虚(25%)、痰瘀互结(19%)、脾气亏虚(14%)、气滞血瘀(7%)和气血亏虚(6%)。排除指南推荐的抗肿瘤西药后,肾上腺皮质激素类药(43.55%)、抗生素(42.94%)和免疫调节药(42.66%)位居西药使用频率前3位。地塞米松(38.15%)、甲氧氯普胺片(20.51%)和呋塞米注射液(19.71%)是最常用的3种西药。3种西药合用中,西咪替丁、盐酸格拉司琼葡萄糖注射液+地塞米松最常见(支持度8.23%,置信度96.4%,提升度2.48%)。清热解毒剂(53.72%)、益气扶正剂(49.76%)和活血化瘀剂(15.68%)位居中药使用频率前3位。参芪扶正注射液(21.59%)、复方苦参注射液(17.52%)和艾迪注射液(11.96%)是最常用3种中成药。结论:气阴两虚、痰瘀互结和脾气亏虚等可能是直肠癌患者的主要中医证候。直肠癌患者的治疗需注重扶正固本、攻补兼施,中西医结合治疗前景值得期待。

Objective:To explore the general characteristics,traditional Chinese medicine(TCM)syndromes and medication of patients with rectal cancer in China.Methods:The clinical data of inpatients with rectal cancer from the information system of 17 tertiary A‐level traditional Chinese medicine hospitals in China were collected.After data standardization,descriptive analy‐sis was performed on the general information,syndrome distribution and medication characteristics of the included patients,and association rule analysis was performed on the drug usage.Results:A total of 15424 hospitalized patients with rectal cancer were included.The ratio of male to female patients was 1.6:1,the average age was 60.87 years old,and the age was mainly in the range of 50 to 79 years old.Among the 12146 patients with rectal cancer,the top 5 TCM syndromes were Qi and Yin deficiency syndrome(25%),phlegm and blood stasis syndrome(19%),spleen deficiency syndrome(14%),Qi stagnation and blood stasis syndrome(7%)and Qi and blood deficiency syndrome(6%).After excluding the anti‐tumor western medicine recommended by the guidelines,adrenal corticosteroids(43.55%),antibiotics(42.94%)and immunomodulatory drugs(42.66%)ranked the top three in the frequency of western medicine use.Dexamethasone(38.15%),metoclopramide tablets(20.51%)and furosemide injection(19.71%)were the three most commonly used western medicines.Among the three western medicines combined,cimetidine,granisetron hydrochloride dextrose injection+dexamethasone were the most common(support 8.23%,confidence 96.4%,and improvement 2.48%).Heat‐clearing and detoxifying agents(53.72%),Yiqi‐fuzheng agents(49.76%)and blood‐activating and stasis‐removing agents(15.68%)ranked the top 3 in the frequency of use of traditional Chinese medicine.Shenqi Fuzheng injection,Shenqi Fuzheng injection(21.59%),Compound Kushen injection(17.52%)and Aidi injection(11.96%)were the three most commonly used Chinese patent medicines.Conclusion:The main syndromes of patients with rectal cancer may be Qi and Yin deficiency syndrome,phlegm and blood stasis syndrome,and spleen deficiency syndrome,etc.The treatment needs to focus on the supplementation of vital essence,combination of dredging and tonifying method,and the integration of traditional Chinese and western medicine.