海南地区晚期非小细胞肺癌中医证候分布规律研究

TCM syndrome classification in late-stage non-small-cell lung cancer in Hainan

目的探索海南地区晚期非小细胞肺癌中医证候分型,为晚期非小细胞肺癌的中医临床治疗的辨证分型提供参考。方法选取2010年1月至2014年12月在海南省中医院门诊或肿瘤科病房治疗的240例晚期非小细胞肺癌患者,均海南地区常住人口,统计所有患者单一证候要素出现的频率及频数,并应用聚类分析及主成分分析的方法对数据进行归类分析处理,归纳出晚期非小细胞肺癌的证候类型。结果气虚、痰湿、阴虚出现频率分别为60.0%、42.5%、31.7%。两证组合和三证组合分别占到40.8%和37.5%,晚期非小细胞肺癌可被归为三大类证候组合,分别为脾虚痰湿、气阴两虚、痰热内蕴伴血瘀。咳嗽痰多、食后腹胀、苔黄腻舌胖边有齿痕、泄泻便溏是诊断晚期非小细胞肺癌脾虚痰湿证的主要症状体征,贡献度分别为19.258%、16.445%、10.200%、8.534%;咳喘无力舌红苔少、口干咽燥、脉细数是诊断气阴两虚的主要症状体征,贡献度分别为24.980%、16.257%、12.645%;咳嗽喘促、面色晦暗舌紫暗或有瘀斑瘀点、发热口渴、脉沉迟脉细数是诊断痰热内蕴伴血瘀的主要症状体征,贡献度分别为22.560%、19.271%、9.440%、7.980%。结论气虚、痰湿、阴虚是晚期非小细胞肺癌最常见的证候,两证组合和三证组合最常见,脾虚痰湿、气阴两虚、痰热内蕴伴血瘀是海南地区晚期非小细胞肺癌的常见证候分型。

Objective To explore the TCM syndrome classification of late-stage non-small-cell lung cancer(NSCLC) in Hainan province so as to provide reference for clinical treatment. Methods Two hundred and forty patients with late-stage NSCLC treated in our hospital from Jan. 2010 to Dec. 2014 were enrolled in this study. The frequency of single Chinese medicine syndrome was collected. Cluster analysis and principal component analysis were applied to summarize the common syndromes of late-stage NSCLC in Hainan Province. Results The frequency of Qi deficiency, phlegm, Yin deficiency was 60.0%, 42.5%, 31.7%, respectively. And 40.8% patients displayed two syndromes in combination, and 37.5% patients displayed three syndromes in combination. Late-stage NSCLC could be classified as three syndrome groups: spleen-deficiency with phlegm-stasis, Qi and Yin deficiency, phlegm-heat brewing in the lung combining blood stasis. Cough and sputum, abdominal distention after eating, yellow greasy fat tongue with scalloped edges, diarrhea and loose stools were the main symptoms and signs for the diagnosis of spleen phlegm of late-stage NSCLC, with the contribution of 19.258%, 16.445%, 10.200%, 8.534%, respectively. Inability to cough and less red tongue, dry mouth and throat, rapid pulse were the main symptoms and signs for the diagnosis of Qi and Yin deficiency,with the contribution of 24.980%, 16.257%, 12.645%, respectively. Cough and breathlessness, dull dark purple tongue or ecchymosed petechiae, fever and thirst, delayed pulse were the main symptoms and signs for the diagnosis of phlegm-heat brewing in the lung combining blood stasis, with the contribution of 22.560%, 19.271%, 9.440%, 7.980%,respectively. Conclusion Qi deficiency, phlegm and Yin deficiency are the most common syndromes of the late-stage NSCLC in Hainan province. Most patients appeared two or three syndromes in combination. Spleen-deficiency with phlegm-stasis, Qi and Yin deficiency, phlegm-heat brewing in the lung combining blood stasis are the common syndrome classification of late-stage NSCLC.