癌因性疲乏中医证型及证素分布规律的横断面研究

A Cross-sectional Study on Traditional Chinese Medicine Syndrome Types and Distribution of Syndrome Elements in Patients with Cancer-related Fatigue

目的:调查癌因性疲乏(CRF)的患病情况,总结CRF的中医证型及证素分布特点。方法:对2021年1月至12月就诊于中国中医科学院西苑医院肿瘤科门诊及病房的肿瘤患者进行横断面调查,采用疲乏视觉模拟评分量表(VAFS)评价患者是否存在疲乏,参考国际疾病分类修订会议制定的CRF标准进行诊断,采用Piper疲乏修订量表中文版(RPFS-CV)评估患者的疲乏程度,中医证型及证素由自拟的CRF四诊信息表收集。结果:最终共纳入306例肿瘤患者,其中CRF患者229例(占74.8%),非CRF患者77例(占25.2%);CRF患者中,轻度疲乏94例(30.7%),中度疲乏121例(39.5%),重度疲乏14例(4.6%);RPFS-CV评分为3.93(2.67,5.05),总体处于轻中度疲乏水平。中医证型分布:306例肿瘤患者中,复合证型249例,CRF占200例(80.3%),其中,纯虚证组合147例,CRF占120例(81.6%),虚实夹杂102例,CRF占80例(78.4%),本次调查未见纯实证组合;单一实证10例,CRF占5例(50.0%);单一虚证38例,CRF占21例(55.4%);有9例患者不满足任一证型的诊断标准被辨为无证,CRF占3例(33.3%)。复合证型比较:轻度、中度疲乏患者纯虚证组合>虚实夹杂(轻度:58.5%>24.5%;中度:51.2%>38.0%),重度疲乏患者虚实夹杂(78.6%)>纯虚证组合(21.4%);纯虚证组合及虚实夹杂在CRF与非CRF组间分布上差异无统计学意义(P>0.05)。虚性证素中,气虚、阳虚、血虚在CRF中发生的概率高于非CRF,其中气虚发生概率随疲乏程度加重呈现逐渐增加的趋势(P<0.05)。脏腑证素中,脾虚、肾虚、心虚、肺虚在CRF中发生的概率高于非CRF,其中脾虚、心虚随疲乏程度的加重发生概率逐渐增高(P<0.05);此外,肝虚、寒湿证素发生概率也随疲乏程度加重呈现增高趋势(P<0.05)。非CRF血瘀、阴虚证素发生概率略高于CRF,但是差异不具有统计学意义(P>0.05)。结论:CRF发病率高,以轻中度疲乏为主,总体上以虚证为主,脾虚、气虚证素在不同疲乏程度中均有较高分布,且疲乏程度越重,虚证比例越高,虚实夹杂证呈现重度疲乏更多的趋势。

Objective:To investigate the prevalence of cancer-related fatigue(CRF),and to summarize the TCM syndrome types and TCM syndrome elements distribution characteristics of CRF.Methods:A cross-sectional survey was conducted among tumor patients admitted to the outpatient department and ward of Oncology Department of Xiyuan Hospital of China Academy of Chinese Medical Science from January to December 2021.Visual Analogue Fatigue Scale(VAFS)was used to screen patients with fatigue,and CRF was diagnosed according to the revised criteria of the International Classification of Diseases.The Revised Piper's Fatigue Scale-Chinese version(RPFS-CV)was used to assess fatigue severity,while TCM syndrome types and syndrome elements were collected through a self-designed CRF four-diagnostic information form.Results:A total of 306 tumor patients were included,including 229 patients with CRF(74.8%)and 77 patients without CRF(25.2%).Among the patients with CRF,94(30.7%)cases had mild fatigue,121(39.5%)cases had moderate fatigue,and 14(4.6%)cases had severe fatigue.The score of RPFS-CV was 3.93(2.67,5.05),indicating that the overall level of fatigue was mild to moderate.Distribution of TCM syndrome types:among 306 tumor patients,249 cases were of composite syndrome types,with CRF accounting for 200 cases(80.3%).Among them,147 cases were pure deficiency syndrome combinations,with CRF accounting for 120 cases(81.6%),102 cases were mixed with deficiency and excess,and CRF accounting for 80 cases(78.4%).No pure excess combination was found in this survey.There were 10 single excess cases,with CRF accounting for 5 cases(50.0%);38 cases of single deficiency syndrome,with CRF accounting for 21 cases(55.4%);Nine patients who did not meet the diagnostic criteria for any type of syndrome were identified as asymptomatic,with CRF accounting for 3 cases(33.3%).Comparison of multiple syndrome types:combination of pure deficiency syndrome>mixed deficiency and excess(mild:58.5%>24.5%,moderate:51.2%>38.0%),and severe fatigue:the combination of deficiency and excess>the combination of pure deficiency syndrome(78.6%>21.4%).There was no statistically significant difference in the distribution of the combination of pure deficiency syndrome and mixed deficiency and excess syndrome between CRF and non CRF groups(P>0.05).In the deficiency syndrome elements,the probability of qi deficiency,yang deficiency and blood deficiency in CRF was higher than that in non-CRF,and the probability of qi deficiency increased gradually with the increase of fatigue(P<0.05).Among the Zangfu syndrome elements,the probability of spleen deficiency,kidney deficiency,heart deficiency and lung deficiency in CRF was higher than that in non CRF,and the probability of spleen deficiency and heart deficiency gradually increased with the aggravation of fatigue(P<0.05);In addition,the occurrence probability of liver deficiency and cold dampness syndrome elements also increased with the aggravation of fatigue(P<0.05).The probability of non-CRF blood stasis and yin deficiency syndrome elements was slightly higher than that of CRF,but the difference was not statistically significant(P>0.05).Conclusions:The incidence rate of CRF is high,which is mainly mild to moderate fatigue,and it is mainly deficiency syndrome.Spleen deficiency and qi deficiency syndrome elements are highly distributed in different degrees of fatigue.The heavier the degree of fatigue is,the higher the proportion of deficiency syndrome is,and the trend of mixed deficiency and excess syndrome is more.