结直肠癌中医证候分布及演变规律研究

Study on the Distribution and Evolution of Traditional Chinese Medicine Syndromes of Colorectal Cancer

目的基于数据挖掘,研究结直肠癌患者的证候分布,并探讨不同干预方式后结直肠癌患者证候的演变规律及肠癌核心病机在这一演变过程中的作用。方法检索中国知网、万方、维普及中国生物医学文献数据库收录的有关结直肠癌中医证候的临床研究文献,对纳入文献的中医证型、干预方式、肿瘤信息、辨证标准等进行分类统计分析。结果共纳入文献149篇,涵盖患者26756例。结直肠癌患者最常见的中医证型包括湿热内蕴(20.3%)、脾肾两虚(13.4%)、气血两虚(11.8%)、脾虚气滞(9.8%)、瘀毒内阻(9.4%)、肝肾阴虚(8.8%),南北地区的证型分布存在差异。就结直肠癌全程而言,脾肾两虚作为基础,在手术、化疗等手段干预下,证型出现变化,但湿热、瘀毒等证素胶结,难以彻底根除。结论结直肠癌证候分布虚实夹杂,且存在南北差异,脾虚是肠癌的核心证素,脾肾两虚可能是贯穿其发生发展全程的核心病机。

Objective To study the distribution of traditional Chinese medicine(TCM)syndromes in patients with colorectal cancer using data mining techniques,and to explore the evolution of syndromes in colorectal cancer patients after various interventions as well as the role of core pathogenesis of colorectal cancer in this process.Methods Relevant clinical research literature on TCM syndromes of colorectal cancer was searched from CNKI,Wanfang,VIP,and CBM.The TCM syndromes,intervention methods,tumor information,and identification criteria in the literature were classified and statistically analyzed.Results A total of 149 articles with 26756 patients were obtained.The most common TCM syndromes in patients with colorectal cancer contained syndrome of internal accumulation of dampness and heat(20.3%),syndrome of spleen and kidney deficiency(13.4%),syndrome of qi and blood deficiency(11.8%),syndrome of spleen deficiency and qi stagnation(9.8%),syndrome of stasis and toxin obstruction(9.4%),and syndrome of liver and kidney yin deficiency(8.8%).Differences on the distribution of TCM syndromes were found between the north and south regions.The syndrome of spleen and kidney deficiency served as the foundation throughout the course of colorectal cancer.Under the interventions of surgery,chemotherapy and other therapeutic means,TCM syndromes appeared to change.However,pattern elements such as damp-heat and blood stasis glued together and were difficult to be eradicated completely.Conclusion The distribution of syndromes in colorectal cancer manifests as intermingling of deficiency and excess,with regional disparity between the north and south.Spleen deficiency is the core pattern element in colorectal cancer,while spleen and kidney deficiency is the core pathogenesis throughout the occurrence and development.