长期靶向治疗肺腺癌患者的中医证素特点

Characteristics of traditional Chinese medicine syndrome elements in lung adenocarcinoma patients treated with long-term targeted therapy

目的:观察比较长期靶向治疗肺腺癌患者的中医证素分布特征。方法:横断面收集2020年8月至2021年12月在中日友好医院中西医结合肿瘤内科及肺癌中心进行诊疗的长期靶向治疗时间9个月以上肺腺癌患者的病例资料,填写问卷,并进行证素提取辨证及证候分析。按用药时间分段,探讨各证素的随时间分布规律。结果:纳入长期靶向治疗的肺腺癌患者共计111例。所有样本整体核心病位证素以肺、脾、肾为主;核心虚性病性证素以阳虚、阴虚、气虚为主;核心实性病性证素以气滞和燥性为主。按不同用药时间分段,用药15~27个月病位肺为主,兼见脾;用药≥27个月病位肾为主,兼见肺和脾。虚性病性方面,病性阴虚最高点位于用药9~15个月;用药15~27个月可见气血阴阳俱虚;用药15~21个月阳虚为主,直到≥27个月差异有统计学意义(P=0.028),用药≥33个月并兼见气虚。实性病性证素方面,用药9~15个月可见热和气滞为主;用药27~33个月可见血瘀为主,兼见气滞和痰;用药≥33个月可见燥性为主,兼见气滞和血瘀。长期靶向治疗的肺腺癌患者整体中医辨证分型可见肺阴虚、肺脾气虚、脾肾阳虚、肾气虚、气滞证、阴虚内燥等。结论:长期靶向治疗肺腺癌患者,病位证素变化可见肺脾到肺脾肾;虚性病性为主,证素变化由阴虚到阴阳两虚再到阳气虚衰;实性病性兼杂,证素变化由内热到内燥再兼杂气滞血瘀痰凝的虚实夹杂状态。

Objective:To analyse the characteristics of traditional Chinese medicine(TCM)syndromes in lung adenocarcinoma patients treated with long-term targeted therapy.Methods:From August 2020 to December 2021,the crosssectional data of lung adenocarcinoma patients treated with long-term targeted therapy for more than 9 months who were treated in the Department of Oncology and Lung Cancer Center of China-Japan Friendship Hospital were collected.The questionnaire was filled in,and the syndrome elements were extracted and analyzed.According to the time of medication,the distribution and evolution of each syndrome element with time were discussed.Results:A total of 111 lung adenocarcinoma patients treated with long-term targeted therapy were included.The core elements for Zang-fu organs of all samples involved were mainly lung,spleen and kidney.The core syndromes elements manifesting excess disease nature were mainly yang deficiency,yin deficiency and qi deficiency.The core syndromes elements manifesting excess disease nature were mainly qi stagnation and dryness.According to different medication time segments,lung was the main elements for Zang-fu organs in 15-27 months part with spleen.After 27 months,the elements for Zang-fu organs were mainly kidney,with lung and spleen.In the aspect of elements manifesting excess disease nature,the highest point of deficiency of pathogenic yin lied in 9-15 months part;From 15-27 months part,deficiency of both qi and blood and yin and yang could be seen;From 15-21 months part,yang deficiency predominates,and there was a significant difference between yang deficiency and other deficiency until it was greater than 27 months(P=0.028),with both qi deficiency after 33 months.In the aspect of syndrome elements manifesting excess disease nature,heat and qi stagnation were the main symptoms in 9-15 months part.In 27-33 months part,blood stasis could be seen,together with qi stagnation and phlegm.After 33 months,dryness could be seen,with qi stagnation and blood stasis.Summarizing the overall TCM syndrome differentiation and classification of lung adenocarcinoma patients treated with long-term targeted therapy,we could see the syndromes of lung yin deficiency,lung-spleen qi deficiency,spleen-kidney yang deficiency,kidney qi deficiency,qi stagnation syndrome,yin deficiency and internal dryness,etc..Conclusion:For patients with lung adenocarcinoma treated with long-term targeted therapy,the evolution of syndrome elements for Zang-fu organs is from lung and spleen to lung,spleen and kidney.The elements manifesting deficiency disease nature are the main factor,and the syndrome elements evolve from yin deficiency to yin and yang deficiency,and then to yang deficiency.The elements manifesting excess disease nature are mixed,and the syndrome elements evolve from internal heat to internal dryness,and then mixed with qi stagnation,blood stasis and phlegm coagulation.