辨证中药治疗中晚期高龄老年肺癌患者的回顾性研究

发布时间：2018-06-09 02:38

本文选题：肺癌 + 老年　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究目的:以在广安门医院肿瘤科住院、生存时间较长的80岁及以上的高龄老年肺癌患者为研究对象,观察患者的生存期,探索单纯辨证汤药治疗与中西医结合治疗疗效的差异以及影响高龄老年肺癌的预后因素,为治疗策略的制定提供初步依据。研究方法:本研究采用临床回顾性调查方法,对2002年01月01日至2015年12月31日期间入院初治的、口服中药汤药的、生存期在6个月及以上的80岁及以上的中晚期肺癌患者病例进行研究,分为单纯中医组和中西医结合组,研究的终点指标为总生存期和1、3、5年生存率。研究结果:1、基本特征:本研究入组68例患者,平均年龄为82.19±2.645岁。分为单纯中医组47例,占69.1%;中西医结合组21例,占30.9%。其中临床Ⅲ期23例,占33.8%;临床Ⅳ期45例,占66.1%。PS评分1分40例,占58.8%;PS评分2分28例,占41.2%。病理类型明确者共37例,占54.4%,其中鳞癌11例,占16.2%;腺癌26例,占23.5%;病理不详者31例,占45.6%。辨证分型:包括脾虚痰湿证、气阴两虚证、痰热互结证、痰瘀互阻证、肺脾气虚证、肺肾两虚证、气虚血瘀证等组合而成。2、生存分析:整个研究人群的中位总生存期为:22个月。1、3、5年累积生存率分别为66.2%、44.1%、17.6%。单纯中医组与中西医结合组的1、3、5年累积生存率组间无统计学差异(P=0.098)。其中37例病理明确的患者中位生存期为19.0个月,分为单纯中医组23例(中位生存期为18.0个月)、中西医结合组14例(中位生存期为23.0个月),组间差异无统计学差异(P0.05)。生存期的单因素分析:按PS评分分组比较,差异有统计学意义(P=0.013),评分为2分的患者中位生存期为8.0个月,但无法得出PS评分为1分的患者中位生存期,考虑与截尾数据较高(60.0%)有关。31例病理不详的患者中位生存期为24.0个月,其中单纯中医组24例、中西医结合组7例。分层分析37例病理明确的患者单纯中医治疗与中西医结合治疗的中位生存期:PS评分2分(6.0个月vs 17.0个月)、临床Ⅲ期(28.0个月vs 17.0个月)、临床Ⅳ期(16.0个月vs 23.0个月)、单一证型(18.0个月vs 17.0个月)、合并症轻度(28.0个月vs 19.0个月)、合并症中度(16.0个月vs 23.0个月)、吸烟(16.0个月vs 17.0个月)、鳞癌(10.0个月vs 17.0个月)分层,两组OS之间均未见统计学差异。中西医结合组不良反应发生率为60.0%,高于单纯中医药组不良反应发生率的8.3%,差异有统计学意义(P0.05)。3、Cox回归分析:方程中的变量为PS评分和中医证型,回归方程模型有统计学意义(P0.05)。4、中医治疗特点分析:37例病理明确的患者入院时所见最常见的中医证型为痰瘀互阻证,而后为气阴两虚证、脾虚痰湿证、肺脾气虚证、痰热互结证、肺肾两虚证、气虚血瘀证。31例病理不详的患者入院时所见最常见的中医证型为气阴两虚证,而后为痰瘀互阻证、脾虚痰湿证、肺脾气虚证、痰热互结证、肺肾两虚证、气虚血瘀证。无论病理是否明确,患者入院所用中药中补气药、化痰止咳平喘药、理气药、补阴药的使用频次均为最高。对病理明确的患者治疗以补气扶正、理气化痰为主,辅以清热解毒、养阴、消食、活血、止血等法;对病理不详的患者治疗以补气养阴、理气化痰为主,辅以清热解毒、利水渗湿、消食、活血、收涩等法。结论:1、治疗80岁及以上的高龄老年中晚期肺癌患者,单纯中医治疗与中西医结合治疗对生存期的疗效无明显差异,单纯中医治疗的安全性更好。2、PS评分是80岁及以上中晚期高龄老年肺癌患者预后的可能影响因素。PS评分、单一中医证型是影响患者死亡的独立危险因素。3、高龄老年中晚期肺癌患者,由于体质偏弱,难以耐受手术及放化疗等治疗手段,多愿接受中医药(包括中西医结合)治疗。其中医辨证属本虚标实、虚实夹杂、以虚为主;中医治疗以扶正(益气、养阴)为主,辅以祛邪(清热解毒、活血化瘀、化痰祛湿)之法。
[Abstract]:Objective: To study the survival time of the elderly patients with lung cancer in the hospital of the oncology department of the hospital of Guanganmen for a longer survival time of 80 years and above, to explore the difference in the curative effect of the treatment of simple Decoction and the combination of Chinese and Western medicine as well as the prognostic factors of the elderly patients with lung cancer, and to provide the treatment strategy. Preliminary basis. Research methods: This study used a clinical retrospective survey method to study the cases of middle and late lung cancer patients who were taken orally with Chinese herbal medicine in the first period of 01 months from 01 to December 31, 2015 2002 to the middle and advanced lung cancer patients with the survival period of 6 months or more. The study was divided into the end of the study and the end of the study. The index was the total life and 1,3,5 year survival rate. The results were as follows: 1, the basic features: 68 patients in the study group, with the average age of 82.19 + 2.645 years, were divided into only 47 cases of traditional Chinese medicine, 69.1%, 21 cases in the combination group of Chinese and Western medicine, which accounted for 23 of the clinical stage III, accounting for 33.8%, and 45 cases in the clinical stage IV, accounting for 1 scores of 58.8% in the 66.1%.PS score, and PS score 2 divide. A total of 37 cases, accounting for 54.4% of 41.2%. pathological types, 11 cases of squamous cell carcinoma, 16.2%, 26 cases of adenocarcinoma, 23.5%, 31 cases of unknown pathology, accounting for 45.6%. syndrome differentiation, including spleen deficiency phlegm damp syndrome, Qi Yin two deficiency syndrome, phlegm heat mutual syndrome, phlegm stasis syndrome, lung kidney two deficiency syndrome, Qi deficiency syndrome, Qi deficiency and blood stasis syndrome and so on into.2, survival analysis: the whole survival analysis: the whole survival analysis: the whole survival analysis: the whole survival analysis: the whole analysis: the whole survival analysis: the whole analysis: the whole analysis: the whole Analysis: the whole analysis: the whole analysis: the whole analysis: the whole The median total survival time of the study group was: the cumulative survival rate of 22 months.1,3,5 years was 66.2%, 44.1%. There was no statistical difference between the group of traditional Chinese medicine and the combination of traditional Chinese and Western medicine in the cumulative survival rate (P=0.098). Among them, the median survival time of 37 patients with clear pathology was 19 months, which was divided into 23 cases in the simple Chinese medicine group (median survival time was 1). 8 months), 14 cases (median survival period was 23 months) in the group of Chinese and Western Medicine (median survival period 23 months). There was no statistical difference between the groups (P0.05). The single factor analysis of the survival period: the difference was statistically significant (P=0.013) according to the PS score, and the median survival time of the patients with a score of 2 was 8 months, but the median survival time of the patients with a PS score was 1. The median survival time of patients with.31 cases (60%) was 24 months, including 24 cases in traditional Chinese medicine group and 7 cases of integrated traditional Chinese and Western medicine. The median survival period of 37 patients with pathological diagnosis was PS score 2 (6 months vs 17 months) and 28 clinical stage (28). Month vs 17 months), clinical IV (16 months vs 23 months), single syndrome (18 months vs 17 months), mild complication (28 months vs 19 months), amalgamative moderate (16 months vs 23 months), smoking (16 months vs 17 months), squamous cell carcinoma (10 month vs 17 months) stratification, there are no statistical differences between the OS and the traditional Chinese and Western medicine. The incidence of adverse reactions in the combined group was 60%, which was higher than 8.3% of the incidence of adverse reactions in the simple Chinese medicine group. The difference was statistically significant (P0.05).3, Cox regression analysis: the variables in the equation were PS and TCM syndrome, and the regression equation model had statistical significance (P0.05).4, and the characteristics of medical treatment in 37 cases were most seen in the hospital. The common TCM syndrome type is phlegm stasis syndrome, then Qi Yin two deficiency syndrome, spleen deficiency phlegm dampness syndrome, lung spleen qi deficiency syndrome, phlegm heat syndrome, lung kidney two deficiency syndrome, Qi deficiency and blood stasis syndrome.31 cases of the most common TCM syndrome type are Qi Yin two deficiency syndrome, and then phlegm stasis syndrome, spleen deficiency phlegm damp syndrome, lung spleen qi deficiency syndrome and phlegm heat interknot. Syndrome, two deficiency of lung and kidney, Qi deficiency and blood stasis syndrome. No matter whether the pathology is clear, the use frequency of tonifying medicine in Chinese medicine, expectorant antitussive antiasthmatic medicine, physical Qi medicine and nourishing Yin medicine are the highest. The patients were treated for nourishing qi and nourishing Yin, nourishing qi and resolving phlegm, supplementing with the methods of clearing heat and detoxifying, removing water, eliminating food, activating blood and receiving astringent, etc. conclusion: 1, the treatment of middle and advanced lung cancer patients with 80 years old and above has no significant difference in the curative effect of the survival period with the combination of traditional Chinese medicine and traditional Chinese medicine, and the safety of the simple Chinese medicine treatment is better.2, PS The score is a possible influencing factor of the prognosis of lung cancer patients aged 80 and above in the middle and advanced age. The single TCM syndrome is an independent risk factor affecting the death of the patients.3. The elderly and advanced lung cancer patients are difficult to tolerate surgery and radiotherapy and chemotherapy because of the weak constitution, and they are willing to accept Chinese medicine (including the combination of Chinese and Western Medicine). Treatment. Among them, the TCM syndrome differentiation belongs to the virtual standard, the deficiency and the real inclusion, and the deficiency mainly; the traditional Chinese medicine is based on Fuzheng (Yiqi, Yin nourishing), supplemented by the method of removing evil spirits (clearing heat and detoxifying, activating blood and removing stasis, eliminating phlegm and dispelling dampness).
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R273

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