基于聚类分析对晚期肺癌化疗前后中医证候分布特点的研究

发布时间：2017-12-28 16:15

本文关键词：基于聚类分析对晚期肺癌化疗前后中医证候分布特点的研究　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:基于聚类分析的方法,对收集的晚期肺癌病人四诊信息进行研究,归纳出晚期肺癌化疗前后的中医证型,探讨晚期肺癌化疗前后的中医证候分布特点以及不同周期的化疗对其中医证型的影响,从而为该病化疗不同阶段的中医治疗,提供较客观的辨证依据,指导临床实践中遣方用药,提高晚期肺癌综合治疗疗效。方法:预设《晚期肺癌化疗病例观察表》,运用前瞻性的调查方法进行观察,收集江苏省中医院呼吸科及肿瘤科2014年12月至2016年12月晚期肺癌住院病人(包括初次化疗前81例、第3次化疗前80例、第5次化疗前80例)的中医四诊资料共241例。以第1、3、5次化疗前为划分点,采用Excel 2013将收集到的四诊资料依据各要素的有、无(1、0)建立三组数据库,统计三组患者各四诊信息出现的频次和百分比;应用SPSS 18.0分别对三组患者四诊资料进行K-均值聚类分析。依据聚类分析的结果,结合中医及中西医结合专家意见,最终得出证型分类和名称。结果:初次化疗前81例晚期肺癌患者的常见四诊信息有神疲乏力、舌质红,苔薄、脉数、脉滑、白粘痰、脉细、脉濡、气短喘促、食欲不振、苔白腻、舌淡有齿痕或胖大舌、心烦失眠、消瘦、舌有裂纹或少津、脉弦、胸闷、盗汗、舌质淡红、面色少华。第3次化疗前80例患者的常见四诊信息有脉细、神疲乏力、苔薄、食欲不振、口燥咽干、舌质红、脉数、咳声低弱、气短喘促、心烦失眠、面色少华、恶心呕吐、舌淡有齿痕或胖大舌、盗汗、苔少、舌质暗红或有瘀点、脉弦、脉涩、痰少而黏、舌有裂纹或少津。第5次化疗前80例患者的常见四诊信息有脉细、神疲乏力、口燥咽干、苔薄、食欲不振、咳声低弱、面色少华、舌质红、舌质红绛或紫红或有瘀斑、脉弱、气短喘促、消瘦、心烦失眠、脉数、自汗、舌有裂纹或少津、盗汗、舌淡有齿痕或胖大舌、恶心呕吐、痰少而黏。通过对初次化疗前81例晚期肺癌患者的四诊资料进行聚类分析,归纳出4种常见证型,它们分别是气虚痰湿证、气阴两虚证(气虚为主)和气阴两虚证(阴虚为主)、痰热郁肺证。其中气虚痰湿证居多,约占46.9%;气阴两虚证(气虚为主)约占22.2%,气阴两虚证(阴虚为主)约占17.2%;痰热郁肺证最少,约13.5%。第3次化疗前的80例病人中,常见证型有气虚血瘀证、气阴两虚证(阴虚为主)和气阴两虚证(气虚为主)、气虚痰湿证。其中气虚血瘀证居多,约35.0%;气阴两虚证(阴虚为主)约占32.5%,气阴两虚证(气虚为主)约占17.5%;气虚痰湿证相对较少,约15.0%。在第5次化疗前的80例病人中,常见证型为肺脾气虚证(约占35.0%)、气阴两虚证(约占31.3%)和正虚瘀毒证(约占33.8%)。结论:气虚贯穿晚期肺癌化疗前后的病程始终,是本病发生、演变、恶化的基础。初次化疗前的病人以气虚痰湿为主,随着病程的延长及化疗次数的增加,痰湿病理逐渐减少,正虚逐渐加重,而瘀毒有所增加。其中气虚、气阴两虚为正虚的主要证候,实邪是痰湿、痰热、瘀毒等。不同周期的化疗可能是影响晚期肺癌中医证型的因素之一。
[Abstract]:Objective: Based on clustering analysis and a method of advanced lung cancer patients to collect diagnostic information, summed up the TCM syndrome type of lung cancer before and after chemotherapy, to explore the characteristics of TCM syndrome distribution before and after chemotherapy in advanced lung cancer and chemotherapy in different periods of the TCM syndrome type of influence, so as to Chinese medicine treatment of the disease in different stages of chemotherapy the syndrome differentiation objective bases, guide clinical practice prescription medication, improve the curative effect of comprehensive treatment of advanced lung cancer. Methods: the default "chemotherapy in advanced lung cancer case observation table", using the prospective investigation method to observe, collect the Department of respiration of Jiangsu Province Traditional Chinese Medicine Hospital and Oncology from December 2014 to late December 2016 of lung cancer patients (including 81 cases before the first chemotherapy, third time before chemotherapy in 80 cases, fifth times before chemotherapy in 80 cases). TCM four diagnostic data of 241 cases. The first, third, fifth time before chemotherapy as the dividing point, the Excel 2013 will be collected according to the diagnostic data elements, (1, 0) to establish three databases, the frequency and percentage statistics of each of the three groups of patients appeared four diagnostic information; the application of SPSS 18 respectively in three groups of patients with four diagnostic data analysis K- clustering. According to the results of cluster analysis, combining the expert opinions of traditional Chinese medicine and traditional Chinese and Western medicine, the classification and name of the syndrome type are finally obtained. Results: before the first chemotherapy in 81 cases of lung cancer patients with common diagnostic information were lassitude, red tongue, thin tongue fur, pulse, slippery pulse, white phlegm, fine pulse, pulse moisten, shortness of breath, loss of appetite, greasy, pale tongue with teeth marks or big fat tongue, insomnia, emaciation, tongue crack or Shaojin, taut pulse, chest tightness, sweating, pale red tongue, pale shaohua. The third time before chemotherapy in 80 patients with common diagnostic information has fine pulse, lassitude, loss of appetite, moss thin, dry mouth and throat, red tongue, pulse, cough, shortness of breath, weakness, insomnia, nausea and vomiting, a small pale tongue with scalloped tongue, night sweats, or fat little moss, dark red tongue or petechiae, pulse string, pulse astringent, little sputum and sticky, tongue cracks or less tianjin. The fifth time before chemotherapy in 80 patients with common diagnostic information has fine pulse, lassitude, kouzaoyangan, moss thin, poor appetite, cough, weakness of a small, red tongue, dark red tongue or purple or ecchymosis, weak pulse, shortness of breath, weight loss, insomnia, sweating, pulse there is a crack or, tongue Shaojin, sweating, pale tongue with teeth marks or big fat tongue, nausea and vomiting, sputum less sticky. Based on the cluster analysis of initial chemotherapy before 81 cases of patients with advanced lung cancer diagnostic data, summed up the 4 common syndromes are phlegm, Qi and yin deficiency syndrome (Qi deficiency) two and two Qi and yin deficiency syndrome (yin deficiency), phlegm heat obstructing lung syndrome. Among them, Qi deficiency and phlegm dampness syndrome account for 46.9%, while Qi Yin two deficiency syndrome (mainly Qi deficiency) accounts for 22.2%, Qi Yin two deficiency syndrome (yin deficiency predominating) accounts for 17.2%, and phlegm heat is the least in lung syndrome, which is about 13.5%. Of the 80 patients before the third chemotherapy, the common syndrome types were Qi deficiency and blood stasis syndrome, Qi Yin two deficiency syndrome (yin deficiency mainly) and Qi Yin two deficiency syndrome (Qi deficiency mainly) and Qi deficiency phlegm damp syndrome. Among them, Qi deficiency and blood stasis were mostly 35%, Qi Yin two deficiency syndrome (yin deficiency) accounted for 32.5%, Qi Yin two deficiency syndrome (mainly Qi deficiency) accounted for 17.5%, deficiency of Qi and phlegm dampness syndrome were relatively less, about 15%. Among the 80 patients before fifth times chemotherapy, the common syndrome types were lung qi deficiency syndrome (about 35%), Qi Yin two deficiency syndrome (about 31.3%) and Zheng deficiency syndrome (about 33.8%). Conclusion: the course of chemotherapy before and after chemotherapy of qi deficiency through advanced lung cancer is the basis of the occurrence, evolution and deterioration of this disease. Before the initial chemotherapy, the patients were mainly Qi deficiency, phlegm dampness. With the prolongation of the course of disease and the increase of the number of chemotherapy, the phlegm dampness pathology gradually reduced, and the deficiency increased gradually, while the stasis and toxin increased. Qi deficiency, Qi and yin deficiency are the main syndromes of positive deficiency, and the real evil is phlegm dampness, phlegm heat and blood stasis and so on. Different cycles of chemotherapy may be one of the factors that affect the TCM syndrome type of advanced lung cancer.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R273

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