鼻咽癌放化疗期间中医证候分布规律及辨证要素探讨

Discussion on the Distribution of Traditional Chinese Medicine Patterns and Identification Elements of Nasopharyngeal Carcinoma During Radiotherapy and Chemotherapy

目的探讨鼻咽癌放化疗期间的中医证候及辨证要素,为确立、指导中医辨证论治提供思路。方法设计中医证候问卷,采集200例鼻咽癌放化疗患者的四诊资料并进行聚类分析及Logistic回归分析。结果初步得出鼻咽癌放化疗患者中医证型,可归类为痰瘀互结证、热毒阴伤证、脾虚湿阻证、气阴两虚证、气血两虚证5类,各证型有统计意义的主要症状如下。痰瘀互结证:头重、舌暗或舌绛、舌下脉络迂曲、苔白;热毒阴伤证:溃疡疼痛、痰涕黄稠、口臭、脉细数、舌红、苔黄、少津;气阴两虚证:口干口渴、少气懒言、潮热盗汗、五心烦热、腰膝酸软、饥不欲食、脉弦、少津、苔少;脾虚湿阻证:耳鸣、食后腹胀、脘腹胀闷、恶心呕吐、苔黄腻或白腻、舌胖;气血两虚证:自汗、面色苍白或萎黄、舌淡或舌暗、脉细。结论根据聚类分析及Logistic分析结果,结合临床,将鼻咽癌放化疗期间证候归纳为5个证候群并得出对诊断有意义的主要症状,但其科学性及实用性有待进一步临床研究。

Objective To explore the traditional Chinese medicine patterns and identification elements during radiotherapy for nasopharyngeal carcinoma,and to provide ideas for establishing guidance on the identification and treatment of traditional Chinese medicine.Methods A traditional Chinese medicine pattern questionnaire was designed,and the four diagnostic methods data of 200 patients with nasopharyngeal carcinoma treated with radiotherapy and chemotherapy were collected and analyzed by cluster analysis and logistic regression.Results Based on the results of cluster analysis,the patterns of nasopharyngeal carcinoma were grouped into five clusters.The main symptoms with statistical significance of each syndrome type are as follows:syndrome of phlegm and blood stasis pattern:heavy head,dark or crimson tongue,tortuous hypoglossal vein and white fur,syndrome of heat toxin damaging yin pattern:ulcer pain,yellow and thick sputum,bad breath,thready pulse,red tongue,yellow coating and scanty body fluid,syndrome of deficiency of qi and yin pattern,dry mouth and thirst,lack of qi and laziness in speaking,hot flashes and night sweats,five vexations and fever,soreness of waist and knees,hungry but with no appetite,thready pulse,scanty body fluid and scanty fur,syndrome of spleen deficiency and dampness obstruction pattern,tinnitus,abdominal distension after eating,abdominal distension and tightness,nausea and vomiting,yellow or white greasy fur,and fat tongue,syndrome of deficiency of qi and blood pattern,spontaneous sweating,pale or sallow complexion,pale or dark tongue and thready pulse.Conclusion According to the results of cluster analysis and Logistic analysis,combined with clinical practice,the syndromes of nasopharyngeal carcinoma during radiotherapy and chemotherapy were summarized into five pattern groups and the main symptoms that were meaningful for diagnosis were obtained,but its scientific and practical nature needs further clinical study.