D期前列腺癌中医辨证分型方式及中西医结合治疗初探

发布时间：2018-12-13 08:08

【摘要】：前列腺癌是男性最常见的恶性肿瘤之一,其发病率和死亡率都很高。在美国其发病率占男性肿瘤第1位,病死率占第2位。在我国其发病率也已跃居男性泌尿、生殖系统恶性肿瘤第三位。中医古籍并无前列腺癌之病名,即使有有关记载与描述也散见于“淋证、癃闭、痛证、血证”等范畴;明确提出用中医药治疗前列腺癌,主要是近十年的事。目前中医药治疗前列腺癌的方法主要是辩证论治,但却至今没有公认的前列腺癌辨证分型模式可供临床医生参考,也没有权威的论治规范可供中医临床医生遵循,各医家对前列腺癌的证候命名繁多而不规范,离中华人民共和国国家标准《中医临床诊疗术语·证候部分》相去甚远。本课题以解决这些问题为目的,进行了创建一种较好的D期前列腺癌中医辨证分型方式的探讨。首先用循证医学的研究方法,从文献调研入手,梳理了近10年各地医家对前列腺癌的辨证分型观点,得出了肾气虚、肾阴虚、脾气虚、肾阳虚、气血两虚、气阴两虚、血瘀、热毒蕴结、下焦湿热、湿热蕴结、痰瘀互结10种证型为文献记录的前列腺癌常见证候的结论。其次用病例回顾性研究方法,对近3年广东省中医院已确诊为D期前列腺癌的103例住院病例进行回顾性研究,将这些病例的辨证证型及临床症状、体征进行频数、构成比统计。结果103名患者分属44个不同的证候名,且大多数为复合证型,以肾虚血瘀、湿热瘀阻、肝肾阴虚、肾虚不固、脾气虚、脾肾阳虚、气血两虚、血瘀、痰瘀互结9种证型出现频率较高,为我院D期前列腺癌病历记录中的常见证型;有30种证候名称分别只出现过一次,为病历记录中的少见证型。103名患者入院时共有69个不同症状体征及29种舌象、脉象。分属形神、头面、寒热、消化、呼吸与循环、泌尿与生殖、骨骼、舌象、脉象等9个维度,其中以神疲乏力、少气懒言、形体消瘦、寐差失眠、面白无华、面色萎黄、面色晦暗、两颧潮红、口唇色暗、口唇色淡、畏寒、肢冷、颜面烘热、尿线细、尿频尿急、夜尿频多、尿滴沥无力、尿短涩、尿黄、血尿、尿灼热、排尿费力、癃闭、尿失禁、尿痛、咽干口燥、恶心、腹胀、少腹坠痛、便溏不爽、大便秘结、痛骨不移、腰膝酸痛等出现频率最高,为D期前列腺癌辨证分型的常见症状、体征指标。接着在文献调研及病历回顾性研究的基础上设计D期前列腺癌辨证症、征指标调查表。使用制成的“D期前列腺癌证候调查表”对已确诊为D期前列腺癌的160例患者进行调查,采集这些患者的症状、体征信息。将这些信息审查合格后录入电子计算机,建立D期前列腺癌症状、体征信息数据库。先是把临床证候症、征指标作为变量,应用SPSS11.0统计软件包对变量进行聚类分析。然后运用专业知识对聚类结果进行比较,得出聚类分型越少复合证、兼夹证越多,证候越复杂,越不好掌握,把D期前
[Abstract]:Prostate cancer is one of the most common malignant tumors in men, with high morbidity and mortality. In the United States, the incidence of cancer is the first in men, and the mortality is the second. In China, the incidence rate has also leapt to the male urinary tract, reproductive system malignant tumors in the third place. The ancient books of Chinese medicine do not have the name of prostate cancer, even though there are relevant records and descriptions, they are scattered in the category of "Lymphoma, dysphagia, pain syndrome, blood syndrome" and so on. It is clearly proposed that the treatment of prostate cancer with traditional Chinese medicine is mainly in the past ten years. At present, Chinese medicine is mainly used to treat prostate cancer by dialectical treatment. However, there is no generally accepted pattern of differentiation and classification of prostate cancer for clinicians to refer to, and there is no authoritative standard for clinicians to follow. The names of the symptoms of prostate cancer are various and not standardized, which is far from the National Standard of the people's Republic of China, the TCM Clinical diagnosis and treatment terminology Syndrome part, which is far from the National Standard of the people's Republic of China. In order to solve these problems, this paper discusses how to establish a better way of differentiation and classification of D stage prostate cancer. Firstly, by using the research method of evidence-based medicine, starting with the literature investigation, this paper combs the views of doctors in nearly 10 years on the differentiation and classification of prostate cancer, and concludes the deficiency of kidney qi, the deficiency of kidney yin, the deficiency of spleen qi, the deficiency of kidney yang, the deficiency of both qi and blood, the deficiency of qi and yin, and the blood stasis. Ten syndromes of heat toxin accumulation, lower pyrolysis damp-heat, damp-heat accumulation and phlegm and blood stasis were the common syndromes of prostate cancer recorded in the literature. Secondly, 103 cases of stage D prostate cancer diagnosed in Guangdong traditional Chinese Medicine Hospital in recent 3 years were studied retrospectively by retrospective study. The frequency of syndrome differentiation and clinical symptoms and signs of these cases were analyzed. Results 103 patients belonged to 44 different syndromes, and most of them were complex syndromes, including kidney deficiency and blood stasis, damp-heat stasis, liver and kidney yin deficiency, kidney deficiency, spleen qi deficiency, spleen and kidney yang deficiency, qi and blood deficiency, and blood stasis. Nine syndromes of phlegm and blood stasis were common in the records of stage D prostate cancer in our hospital. There were 30 syndromes that appeared only once, which was the type of less witness in the medical record. There were 69 different symptoms and signs and 29 tongue signs and pulses at the time of admission. They belong to nine dimensions: form and spirit, head, cold and heat, digestion, respiration and circulation, urology and reproduction, bone, tongue, pulse, etc. Dark complexion, dark lips, pale lips, cold limbs, hot face, thin line of urine, frequent urination, weak urine droplets, short urine, yellow urine, hematuria, hot urine, laborious urination, dysphagia, urinary incontinence, dysphoria, dysuria, dysphagia, urinary incontinence. Urinary pain, dry pharynx, nausea, abdominal distension, less abdominal pain, loose stools, constipation, bone pain, pain of waist and knee are the most frequent symptoms and signs of D stage prostate cancer. On the basis of literature investigation and retrospective study of medical records, we designed D-stage prostate cancer syndrome differentiation and sign index questionnaire. The symptom questionnaire of stage D prostate cancer was used to investigate 160 patients who had been diagnosed with stage D prostate cancer. The information of symptoms and signs of these patients was collected. The information was checked and entered into the computer, and the D prostate cancer symptom and sign information database was established. First, the clinical syndrome, sign index as a variable, using SPSS11.0 statistical software package to cluster analysis of variables. Then using professional knowledge to compare the clustering results, it is concluded that the less the cluster classification, the more complex the syndrome, the more complex the syndromes, the more difficult to master.
【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R277.52

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