晚期非小细胞肺癌TP方案化疗前后中医证候特征临床研究

发布时间：2017-12-28 16:30

本文关键词：晚期非小细胞肺癌TP方案化疗前后中医证候特征临床研究　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:本课题采用前瞻性的研究方法,观察晚期非小细胞肺癌患者TP方案化疗前后中医证候特征,探讨肺癌发病机制,TP方案化疗前后中医证候的演变规律,以及中医药配合化疗的最佳切入点,为晚期非小细胞肺癌的临床诊疗提供重要理论依据。方法:选取2016年4月至2016年12月,在江苏省中医院、江苏省肿瘤医院病房及门诊确诊为晚期非小细胞肺癌患者50例。通过调查问卷方式记录TP方案化疗前d7、化疗后d8、化疗后dl5三个时间点的症状、体征、舌苔、脉象等,并根据相关中医诊断标准进行辨证分型。用SPSS20.0建立数据库,分析化疗前后中医证候的变化规律,计数资料选用x2检验,计量资料选用方差分析,P0.05为有统计学差异。结果:(1)男女人群发病率未见明显统计学差异;61-70岁为高发人群,50岁较50岁人群发病率高。(2)IIIB与IV期非小细胞肺癌患者在年龄、性别、中医证型构成未见明显差异。(3)化疗前d7咳嗽、痰多质粘、痰中带血、倦怠乏力、胸闷气喘等症状多见,淡红舌、白腻苔最多,分别占50%、48%,其次是红舌、薄白苔、少苔分别占28%、22%、20%。脉象以滑脉38%居多,细弱脉24%继之。证型分布以痰湿证、气虚证、阴虚内热证为多,分别占38%、22%、20%。(4)化疗后d8咳嗽咳痰、痰中带血、胸痛、胸闷气喘等肺系相关症状缓解,纳差、恶心呕吐、脱发、关节酸痛、手足麻木、目涩、便干等症状明显增加。淡红舌、白腻苔减少至26%,20%,少苔、红舌和齿痕舌分别增至42%、38%、24%,黄腻苔和紫暗舌也稍有增加。滑脉显著减少至12%,细数脉和细弱脉呈上升趋势,达30%及40%。相对应的痰湿证、气虚证明显减少至20%、10%,气阴两虚证、阴虚内热证较前增长,占32%和26%。(5)化疗后dl5同样表现为痰湿证、气虚证减少,阴虚内热证、气阴两虚证较前增多,瘀阻肺络证达10%。但是化疗后dl5与化疗后d8天相比,舌象、脉象、证型变化未见统计学差异,而在症状上有差异,主要表现为恶心呕吐、纳差等消化道症状缓解显著。结论:晚期非小细胞肺癌患者TP方案化疗前后中医证候演变有一定的规律可循。化疗前以痰湿证为主,气虚证及阴虚内热证也占有一定的比例,化疗后痰湿证、气虚证明显减少,气阴两虚证、阴虚内热证较前增加,表明TP方案即紫杉醇加顺铂为热毒之品,耗气伤阴,损伤肝肾,提示采取TP方案化疗的患者可提前予以益气、养阴、清热,调补肝肾,并辅以活血化瘀。
[Abstract]:Objective: this topic using prospective research method, observation of advanced non small cell lung cancer patients before and after TP regimen chemotherapy the characteristics of TCM syndromes and investigate the pathogenesis of lung cancer, the evolution regularity of TCM syndromes before and after TP chemotherapy, and the traditional Chinese medicine with the best starting point for chemotherapy, provides an important theoretical basis for clinical diagnosis and treatment for advanced non-small cell lung cancer. Methods: from April 2016 to December 2016, 50 patients with advanced non-small cell lung cancer were diagnosed in Jiangsu Province Traditional Chinese Medicine Hospital, Jiangsu tumor hospital ward and outpatient clinic. The symptoms, signs, tongue fur and pulse condition of three time points before TP chemotherapy, D7, D8 after chemotherapy and DL5 after chemotherapy were recorded by questionnaires. Database was established by SPSS20.0, and the change rule of TCM syndromes before and after chemotherapy was analyzed. X2 test was used to count data, and variance analysis was used to measure data. P0.05 was statistically significant. Results: (1) there was no significant difference in the incidence of the male and female population; 61-70 years old was a high incidence population, and the incidence of the 50 year old population was higher at the age of 50. (2) there was no significant difference in age, sex and TCM syndrome type between IIIB and IV patients with non-small cell lung cancer. (3) before chemotherapy D7 cough, phlegm, sputum with blood viscosity, fatigue, chest tightness, shortness of breath and other symptoms more common, pale red tongue, white and greasy fur, accounted for 50%, 48%, followed by Bo Baitai, red tongue, little coating accounted for 28%, 22%, 20%. 38% pulse to pulse are fine and quick after 24%. The distribution of syndrome type was more than that of phlegm damp syndrome, Qi deficiency syndrome and yin deficiency internal heat syndrome, which accounted for 38%, 22% and 20% respectively. (4) after chemotherapy of d8 cough and expectoration, bloody sputum, chest pain, chest tightness, asthma and other lung related symptoms, anorexia, nausea and vomiting, hair loss, joint pain, numbness, dry eyes, dry stool and other symptoms significantly increased. Pale red tongue, white and greasy fur is reduced to 26%, 20%, less moss, red tongue and tooth marked tongue were increased to 42%, 38%, 24%, and Huang Nitai, dark purple tongue is also slightly increased. Pulse was reduced to 12%, and the fine and quick pulse count increased up to 30% and 40%. The corresponding phlegm dampness syndrome and Qi deficiency proved to be reduced to 20%, 10%, Qi Yin two deficiency syndrome and yin deficiency internal heat syndrome, accounting for 32% and 26%. (5) after chemotherapy, DL5 also showed that the syndrome of phlegm dampness and Qi deficiency decreased, the syndrome of yin deficiency and internal heat, deficiency of Qi and Yin were increased, and the syndrome of stagnation of lung and collaterals was 10%. But DL5 after chemotherapy and chemotherapy after D8 days compared, tongue and pulse, different syndromes of no significant difference, but there are differences in symptoms, mainly for nausea and vomiting, anorexia and other gastrointestinal symptoms significantly. Conclusion: there is a certain regularity in the evolution of TCM syndrome before and after TP chemotherapy in patients with advanced non-small cell lung cancer (non-small cell lung cancer). Before chemotherapy with phlegm, Qi deficiency and yin deficiency syndrome also occupy a certain proportion, after chemotherapy, phlegm, Qi deficiency obviously reduced, two Qi and yin deficiency syndrome, yin deficiency syndrome was increased than before, which shows that the TP of paclitaxel plus cisplatin for heat, Yin consumption, liver kidney injury take the TP chemotherapy, patients can advance to Qi, nourishing Yin, clearing heat, nourishing the liver and the kidney, and supplemented with blood stasis.
【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】：R734.2

【参考文献】