Ⅲ期胃癌患者术后中医证型分布特点及与全身炎症反应标志物的相关性研究

Study on the distribution characteristics of Traditional Chinese Medicine syndrome types and their correlation with systemic inflammatory reaction markers in patients with stageⅢgastric cancer after operation

目的:探讨Ⅲ期胃癌患者术后中医证型分布特点及其与全身炎症反应标志物的相关性,为临床更全面的治疗提供依据。方法:随机选择2015年1月—2017年12月初治的182例术后Ⅲ期胃癌患者为研究对象,分析中医证型分布特点及其与临床特征的关系,患者均定期随访,采用受试者工作特征曲线(ROC)确定中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、淋巴细胞与单核细胞比值(LMR)的最佳截断值,分为高值组和低值组,分析中医证型与C-反应蛋白(CRP)、NLR、PLR、LMR的相关性。结果:(1)182例胃癌患者中医证型占比由高到低依次为胃阴亏虚证(27.5%)、脾肾阳虚证(20.8%)、肝气犯胃证(15.4%)、气血两亏证(14.3%)、痰瘀互结证(11.0%)、湿热内蕴证(11.0%);(2)不同中医证型间年龄分布差异有统计学意义(P<0.05),胃阴亏虚证和脾肾阳虚证患者>63岁(中位年龄)的占比高于其他4个证型;不同中医证型间性别差异有统计学意义(P<0.05),湿热内蕴证以男性居多,肝气犯胃证以女性为主;不同中医证型间T分期差异有统计学意义(P<0.05),T_(1-2)期患者的证型分布占比均较少,实证患者在T_(3)期占比居多,虚证患者以T_(4)期占比为主;不同中医证型间N分期差异有统计学意义(P<0.05),各证型在N_(1-2)期分布差异不大,虚证患者在N3期分布占比高于实证患者;不同中医证型间临床分期差异有统计学意义(P<0.05),虚证患者在ⅢC期的占比明显高于实证患者;不同中医证型间血红蛋白(Hb)值差异有统计学意义(P<0.05),气血亏虚证患者的Hb均值显著低于与其他5个证型患者的Hb均值;(3)不同中医证型间PLR、LMR比较差异有统计学意义,虚证患者中PLR高值所占的比例显著高于实证患者(P<0.05),虚证患者中LMR低值的比例高于实证患者(P<0.05)。结论:Ⅲ期胃癌患者术后中医证型以虚证多见;随着局部肿瘤侵犯深度扩大、淋巴结受累程度和范围的增加、肿瘤分期的进展,虚证所占比例越高;虚证的患者更易出现PLR值升高、LMR值降低,患者有存活率降低的趋势。

Objective:To investigate the distribution characteristics of postoperative Traditional Chinese Medicine(TCM)syndrome type in patients with stageⅢgastric cancer and its correlation with markers of systemic inflammatory response,so as to provide a basis for more comprehensive clinical treatment.Methods:From January 2015 to December 2017,a total of 182 patients with postoperative stageⅢgastric cancer who were initially treated were randomly selected,their clinical data were collected,the characteristics of TCM certificate type distribution and their relationship with clinical features were analyzed,and the patients were followed up regularly,and the best cut-off values of NLR,PLR and LMR were determined by using the receiver operating characteristic curve ROC.It was divided into high-value group and low-value group,and the correlation between TCM syndrome type and CRP,NLR,PLR and LMR was analyzed.Results:(1)The proportion of TCM syndrome type in 182 patients with gastric cancer from high to low was the syndrome of stomach yin deficiency(27.5%),the syndrome of spleen and kidney yang deficiency(20.8%),the syndrome of liver qi invading stomach(15.4%),the syndrome of qi and blood deficiency(14.3%),the syndrome of phlegm and blood stasis(11.0%),and the syndrome of damp heat connotation(11.0%).(2)There was a statistical difference between the TCM syndrome type and the age distribution(P<0.05),the proportion of the age distribution between the syndrome of stomach yin deficiency and the syndrome of spleen and kidney yang deficiency above 63 years old(median age)was higher than that of the other four types;there was a significant statistical difference between the TCM syndrome type and the sex(P<0.05),the syndrome of damp heat connotation was mostly male,and the syndrome of liver qi invading stomach was mainly female;there was a significant statistical difference between the TCM syndrome type and the T stage(P<0.05),the proportion of the T_(1-2)patients was relatively small,the proportion of the excessive patients in the T_(3)stage was the majority,and the proportion of the deficiency patients was mainly T_(4)stage;there was a statistical difference between the TCM syndrome type and the N stage(P<0.05)There was little difference in the distribution of each type in the N_(1-2)stage,and the proportion of deficiency patients in the N3stage was higher than that of excessive patients;there was a significant statistical difference between the TCM syndrome type and the clinical stage(P<0.05),and the proportion of the deficiency patients in theⅢC stage was significantly higher than that of the excessive patients;there was a significant statistical difference between the TCM syndrome type and the Hb value(P<0.05),and the average Hb of the patients with the syndrome of qi and blood deficiency was significantly lower than the average Hb of the patients of the other five types.(3)There are statistical differences between TCM syndrome types and PLR and LMR,and the proportion of high PLR values in the deficiency patients is significantly higher than that in the excessive patients(P<0.05),and the proportion of low LMR values in the deficiency patients is higher than that in the excessive patients(P<0.05).Conclusion:Deficiency syndrome is the most common postoperative TCM syndrome type in patients with stage Ⅲ gastric cancer;With the expansion of local tumor invasion depth,the increase of lymph node involvement,and the progression of tumor staging,the proportion of deficiency syndrome is higher;patients with deficiency syndrome are more likely to have high PLR value and low LMR value,and patients with this feature have a decreasing survival rate.