陆明学术思想与临床经验总结及经验方治疗绝经前乳腺癌临床疗效观察

发布时间：2018-01-16 19:05

本文关键词：陆明学术思想与临床经验总结及经验方治疗绝经前乳腺癌临床疗效观察　出处：《北京中医药大学》2017年博士论文　论文类型：学位论文

更多相关文章： 临床经验 经验方 乳腺癌 学术思想

【摘要】：1研究目的1.1总结陆明教授的学术思想、临证经验及遣方用药方法、规律,并追溯其理论渊源。1.2对陆明教授应用扶正祛邪理论治疗绝经前乳腺癌的临床疗效进行总结,用以指导临床实践。2研究方法2.1通过临床跟师、临证抄方、随堂听课及教学查房,并结合深度访谈的定性研究方法,对陆明教授的中医学术论文、医案、论著、经典回顾性病例等原始资料收集、整理、分析,总结其学术思想、渊源及临证经验。2.2采取前瞻性临床研究方法,将120例绝经前激素受体阳性乳腺癌患者随机分为治疗与对照两组,以陆明教授临证经验,运用扶正祛邪经验方治疗6个月,总结临床疗效。3研究结果3.1陆明教授学术思想研究结果3.1.1学习学术渊源:注重经典,灵活实践,兼容并蓄,融汇诸家,师承前贤。3.1.2陆明教授顾护胃气论,主张辨证用药以顾护胃气为先,对中晚期肿瘤患者重护胃气,对肝癌患者中医治疗从脾胃论治。3.1.3总结陆明教授恶性肿瘤的中医治疗理论,主张肿瘤微观辨证论,肿瘤的中医治疗采取部位、阴阳、经络辨证方法,中医治疗将化疗及靶向治疗药物进行寒热燥湿分类,采取多方法治疗、多途径给药,恶性积液从寒论治的相关新论。3.2陆明教授临证经验研究结果3.2.1陆明教授的临证用药特色鲜明,擅用虫类药、参类药,多采取复方大剂以全面地兼顾病情。3.2.2陆明教授的肿瘤食疗义理经验行之有效,适宜的饮食有益于肿瘤患者的康复并减轻术后、放化疗后的毒副反应。3.2.3陆明教授将病因辨证与脏腑辨证相结合治疗肺癌,临证经验效果甚佳。3.2.4对陆明教授治疗体表肿瘤、乳腺癌、食管癌、恶性淋巴瘤、慢性萎缩性胃炎、慢性非特异性溃疡性结肠炎、脂肪肝的临证经验进行系统梳理总结,为中医临床的发展提供新思路。3.3以扶正祛邪经验方治疗绝经前激素受体阳性乳腺癌患者巩固期的研究结果3.3.1观察指标3.3.1.1相关肿瘤标记物:①治疗后两组患者血清中的CA125与CA153抗原含量比较,对照组显著高于治疗组(p0.05),有统计学意义。②治疗后两组患者血清中的CEA抗原含量比较,p0.05,无统计学意义。结果表明陆明教授经验方可降低机体血清中肿瘤抗原CA125与CA153的水平。3.3.1.2各项激素水平:①两组患者治疗后各项激素水平比较,p0.05,无统计学意义。②两组患者治疗前后各项激素水平比较,经统计学检验分析,p0.05,有统计学意义。总体分析,他莫昔芬、陆明教授经验方+他莫昔芬治疗均不升高乳腺癌患者的激素水平,具有调节作用,经验方在调节激素水平方面具有优势。3.3.1.3骨密度:对两组患者治疗前后的骨密度值进行比较,治疗前两组患者的骨密度对比差异不明显(p0.05),无统计学意义。两组患者治疗前后骨密度值的组内对比差异明显(p0.05),但对照组患者的骨密度较治疗前减低,治疗组则升高,两组治疗后的骨密度值组间对比差异同样显著(p0.05),表明经验方对绝经前乳腺癌患者的骨密度有显著提升效果。3.3.1.4子宫内膜厚度:①治疗前两组患者的子宫内膜厚度比较,p0.05,差异不具统计学意义,具有可比性;②对照组治疗前后子宫内膜厚度比较,p0.05,治疗前后差异具有统计学意义;③治疗组治疗前后子宫内膜厚度比较,p0.05,差异不具统计学意义。上述结果说明:单纯运用他莫昔芬治疗绝经前乳腺癌确实会引起患者子宫内膜增厚,而联合中药经验方治疗后,患者子宫内膜非但没有增厚,还略有减少,可有效改善他莫昔芬不良反应。3.3.1.5生存质量变化:对乳腺癌患者采取经验方治疗,对比其治疗前后的生理状况、情感状况、社会/家庭状况、机体功能状况、附加关注等方面情况。两组患者治疗后生存质量总积分比较,经统计学检验分析,p0.05,有统计学意义。①对照组:治疗前后的生理状况比较,经统计学检验分析(t=3.109,P=0.008),p0.05,有统计学意义;治疗前后情感状况比较,经统计学检验分析(t=2.239,P=0.017),p0.05,有统计学意义;治疗前后社会/家庭状况比较,经统计学检验分析(t=0.266,P=0.785),p0.05,无统计学意义;治疗前后机体功能状况比较,经统计学检验分析(t=-0.448,P=0.665),p0.05,无统计学意义;治疗前后附加关注比较,经统计学检验分析(t=-0.776,P=0.507),p0.05,无统计学意义;治疗前后量表总分比较,经统计学检验分析(t=-0.915,P=0.374),p0.05,无统计学意义。②治疗组:治疗前后生理状况、情感状况、社会/家庭状况、机体功能状况、附加关注、量表总分比较,p0.05,有统计学意义。总体分析:对绝经前乳腺癌患者应用经验方治疗可提高其生存质量评分,有效改善其生存质量。3.3.1.6中医证候总分变化:两组患者治疗后中医证候总分比较,p0.05,有统计学意义。总体分析表明:经验方的运用,能明显改善患者的潮热汗出、烦躁、抑郁、疲倦乏力、食少纳差、手足麻木、腰膝酸软、夜寐差等临床症状和体征。3.3.1.7KPS评分变化:两组患者治疗前后KPS评分比较,经统计学检验分析,p0.05,有统计学意义,总体分析表明:经验方的运用,能提高患者的生活质量。3.3.2临床疗效判定:两组患者治疗前后,中医证候改善情况有统计学差异,p0.05。结果表明:经验方能显著提高证候疗效,较单纯他莫昔芬组具有明显优势。两组患者治疗前后KPS评分改善情况比较,有统计学意义,p0.05。结果表明:经验方能明显改善绝经前乳腺癌患者生活质量。4结论4.1陆明教授在三十余载的中医临床工作中,主张以中医经典理论为根,辨证论治观点为本,强调中西医互相学习,讲究融会贯通,力倡运用现代方法以确定疾病的病位和性质,从而提高中医治疗水平,与此同时敏锐洞悉国内外医学的发展动态,注重学习新知识新思维,倡导与时俱进的医学思维观念及科学合理的临床治疗方法,值得继承与发扬。4.2在临床中应用扶正祛邪经验方治疗绝经前激素受体阳性乳腺癌患者巩固期可减轻他莫昔芬不良反应,明显提高其临床疗效及预后生存质量,从而改善其复发及转移情况,因此具有较好的临床应用价值及推广意义。
[Abstract]:1 Objective: 1.1 summary of Professor Lu Ming's academic thoughts and clinical experience of prescription method, and traces the theoretical origin of.1.2 clinical curative effect on Application of Fuzhengquxie theory of Professor Lu Ming treating premenopausal breast cancer were summarized, in order to guide the clinical practice of.2 2.1 through clinical research method with the teacher, certificate copy party, attending lectures and teaching rounds, and qualitative research, in-depth interviews, academic papers, Chinese medicine on Professor Lu Ming's medical records, books, classic case review of original data collection, collation, analysis, summarized the academic thought and clinical experience of.2.2 origin, take prospective clinical research methods, 120 premenopausal hormone receptor positive breast cancer patients were randomly divided into treatment group and control group in two, Lu Ming Professor clinical experience, using Fuzhengquxie experience for 6 months, 3.1 Lu Ming Professor summarize the clinical efficacy of.3 results The results of 3.1.1 learning academic origin: focus on the classic, flexible practice, integrate various teachers, fully inclusive and equitable, former.3.1.2 Professor Lu Ming protecting stomach qi theory, advocated by TCM drugs protecting stomach qi first, in patients with advanced tumors support stomach, liver cancer patients in the medical treatment of treatment of traditional Chinese medicine theory to treat.3.1.3 summary of land the professor of malignant tumors from the stomach, advocate the tumor micro differentiation theory, Chinese medicine treatment of cancer to take part, yin and yang meridians method, Chinese medicine treatment of chemotherapy and target of cold dampness classification to drug treatment, taking treatment, many ways of delivery, from the cold treatment of malignant effusion associated.3.2 of Professor Lu Ming the clinical experience of the results of clinical medicine Professor Lu Ming's distinctive feature of 3.2.1, using insect class medicine, ginseng medicine, take a more comprehensive consideration of large compound agents in the condition of.3.2.2 tumor therapy Professor Lu Ming Yi Li The experience of effective, suitable diet is beneficial to the recovery of the patients with tumor and reduce the postoperative adverse reaction after chemotherapy.3.2.3 Lu Ming, will cause the combination of syndrome differentiation and syndrome differentiation in treatment of lung cancer, the effect is very good.3.2.4 clinical experience of Professor Lu Ming in treating superficial tumor, breast cancer, esophageal cancer, malignant lymphoma, chronic atrophic gastritis, chronic nonspecific ulcerative colitis, systematically summarize the fatty liver clinical experience, for the development of clinical medicine to provide a new way to experience.3.3 Fuzhengquxie Decoction in the treatment of premenopausal patients with hormone receptor positive breast cancer consolidation results 3.3.1 observed 3.3.1.1 related tumor markers: comparison of two groups of patients in serum CA125 and CA153 antigen content after treatment, the control group was significantly higher than the treatment group (P0.05), there was statistical significance. After the treatment of CEA antigen in two groups of patients in serum than A, P0.05, no statistical significance. The results show that the experience of Professor Lu Ming Fang can reduce the tumor antigen CA125 and CA153 in serum.3.3.1.2 levels of the hormone levels: the two groups were compared after treatment, the hormone level of P0.05 was not statistically significant. The hormone levels in the two groups before and after treatment, the statistical test analysis of P0.05 was statistically significant. The overall analysis, tamoxifen, Professor Lu Ming's experience of tamoxifen therapy were not elevated Decoction + hormone levels in patients with breast cancer and its role in regulating hormone level experience has the advantage of.3.3.1.3 mask bone density: compare bone density values before and after treatment in two groups of patients before treatment, bone density contrast differences between the two groups were not significant (P0.05), no statistically significant difference. The bone density in two groups before and after treatment within the group of contrast (P0.05), but the control group of patients with bone Lower density than before treatment, the treatment group increased bone density after treatment of the two groups of values of the differences between the two groups were also significantly (P0.05), showed that the experience of bone density in premenopausal breast cancer patients had significantly improved.3.3.1.4 endometrial thickness: before treatment, the endometrial thickness of two groups of patients with P0.05. The difference was not statistically significant, comparable; in the control group after treatment, the endometrial thickness P0.05, with statistically significant differences before and after the treatment; the treatment group before and after treatment, the endometrial thickness of P0.05, the difference was not statistically significant. The results showed: the simple use of tamoxifen in premenopausal breast cancer patients does cause endometrial thickening, and combined with traditional Chinese medicine experience after treatment, patients with endometrial thickening instead, also slightly reduced, can effectively improve the quality of life and adverse effects of.3.3.1.5 tamoxifen Change: take the experience of treatment for breast cancer patients, before and after the treatment of affective physiological condition, contrast condition, social / family status, functional status, additional concerns. Compare the total score of quality of life of two groups of patients after treatment, after statistical analysis and inspection, P0.05, was statistically significant. The control group: the physiological condition before and after treatment, analysis of the statistical test (t=3.109, P=0.008, P0.05), there was statistical significance; comparison of emotional status before and after treatment, analysis of the statistical test (t=2.239, P=0.017), P0.05, have statistical significance; social / family status before and after treatment, analysis of the statistical test (t=0.266, P=0.785). P0.05, no statistical significance; comparison of the status of the body function before and after treatment, analysis of the statistical test (t=-0.448, P=0.665), P0.05, no statistical significance; comparison of additional attention before and after treatment, analysis of the statistical test (t=-0.776 , P=0.507, P0.05), no statistical significance before and after treatment; the total scores of comparison, analysis of the statistical test (t=-0.915, P=0.374), P0.05, was not statistically significant. The treatment group: emotional physiological status, before and after the treatment, social / family status, functional status, additional attention score comparison, P0.05 there was statistical significance. The overall analysis of premenopausal breast cancer patients experience treatment can improve the quality of life score, effectively improve the life quality of.3.3.1.6 TCM syndrome score changes: the two groups were compared after treatment, TCM syndrome score of P0.05 was statistically significant. The overall analysis showed that using the experience, obviously to improve the patient's hot flashes sweating, irritability, depression, fatigue, eat less anorexia, numbness, Yaoxisuanruan, insomnia and poor clinical symptoms and signs of change:.3.3.1.7KPS scores KPS scores between the two groups before and after treatment by the system In terms of analysis and inspection, P0.05, have statistical significance, the overall analysis showed that using the experience, can improve the quality of life of.3.3.2 patients with clinical efficacy assessment: two groups of patients before and after treatment, TCM symptoms had significant difference, p0.05. results show that the empirical formula can significantly improve the therapeutic effect of syndrome, compared with tamoxifen group obvious advantages. Two groups of patients before and after treatment KPS score improvement compared with statistical significance, p0.05. results show that the experience can significantly improve premenopausal breast cancer patients life quality.4 conclusion 4.1 Lu Ming professor in clinical medicine for three years, advocated by the classical theory of TCM syndrome differentiation is the root view for this emphasis on traditional Chinese and Western medicine, learn from each other, pay attention to mastery, advocating the use of modern methods to determine the disease location and nature of the disease, so as to improve the level of Chinese medicine treatment at the same time, a keen insight into the domestic and foreign medicine The development of dynamic learning, learning new knowledge, thinking of the times and promote medical scientific and reasonable methods of clinical treatment, worthy of inheriting and developing the.4.2 application experience Fuzhengquxie Decoction in the treatment of premenopausal women with hormone receptor positive breast cancer patients with a period of consolidation can reduce the side effects of tamoxifen in the clinic, improve the clinical curative effect and survival quality thus, to improve its recurrence and metastasis, so it has better clinical application value and popularization significance.

【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R249;R273

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