非小细胞肺癌术后化疗后不同阶段中医证候变化规律的研究

发布时间：2018-01-10 05:14

本文关键词：非小细胞肺癌术后化疗后不同阶段中医证候变化规律的研究　出处：《暨南大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:非小细胞肺癌发病率高,手术及化疗是临床治疗非小细胞肺癌主要手段之一,但手术为有创操作,化疗药物对机体的毒副作用严重。为进一步探索和提高中医药对非小细胞肺癌术后化疗的疗效,减轻手术并发症和化疗毒副反应,本研究选取I-III期非小细胞肺癌术后并化疗的患者,探索总结术后及化疗后不同阶段中医证候变化规律,以期作为临床辨证论治的客观根据,进一步提高中西医结合治疗肺癌的临床疗效。方法:采用前瞻性和回顾性研究方法,系统收集I-III期非小细胞肺癌术后并化疗的患者60例。记录一般资料、所选用的化疗方案、实验室检查结果。按非小细胞肺癌术后4-6个化疗周期,每2个化疗周期合为一个化疗阶段。然后原则上先进行单一证候的辨别,并以此为基础,将单证整合作为复证的诊断标准,通过拟定的诊断标准进行辨证,收集记录数据。最后采用spss17.0进行统计。结果:(1)术后气虚痰湿证构成下降至25.0%,气滞血瘀证升高至51.7%。(2)肺脾两虚证在第一阶段化疗后占60.0%,第二阶段后下降至41.7%,全程化疗后为8.3%。气滞血瘀证在第一阶段化疗后占8.3%,随后逐渐下降至3.3%,1.7%。气阴两虚证候比例由8.3%,最终上升至20.0%。气虚痰湿证从20.0%最终降至15.0%。化疗后统计患者中医证型发现脾肾阳虚证候呈明显的增多趋势,由第一阶段化疗后的3.3%快速上升至最后的55.0%。(3)不同治疗阶段肿瘤标志物浓度均呈现一定的统计学差异,(P0.05)。并且随着治疗继续,各中医证型四种肿瘤标志物(CEA、SCC、CA125、CA153)均有降低趋势,患者症状也明显改善。(4)化疗不同阶段血常规中的白细胞计数均呈现降低趋势(P0.05)。结论:(1)非小细胞肺癌手术后可使气滞血瘀证明显增加,气虚痰湿证明显减少。(2)非小细胞肺癌病变部位在肺,主要表现为肺气虚损,化疗初期对脾胃损伤大,易引起肺脾两虚,后期主要损害肾脏,引起肾阳亏虚,痰湿内停。(3)随着化疗的进展,肿瘤标志物呈现降低趋势,通过监测CEA、SCC、CA125、CA153值的变化有助于非小细胞肺癌术后及化疗后疗效的判断。(4)化疗治疗对骨髓抑制作用较为显著,可使白细胞计数降低,甚至明显低于正常水平,而手术对骨髓抑制作用较小。
[Abstract]:Objective: the incidence of non-small cell lung cancer is high, surgery and chemotherapy is one of the main clinical treatment of non-small cell lung cancer, but surgery is invasive. In order to further explore and improve the curative effect of traditional Chinese medicine on non-small cell lung cancer, reduce the complications and side effects of chemotherapy. This study selected I-III stage non-small cell lung cancer postoperative patients with chemotherapy to explore the postoperative and different stages after chemotherapy TCM syndromes changes in order to serve as the objective basis of clinical syndrome differentiation. To further improve the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of lung cancer. Methods: prospective and retrospective study methods. A total of 60 patients with stage I-III non-small cell lung cancer (NSCLC) treated with chemotherapy were collected. The general data, chemotherapy regimen and laboratory results were recorded according to 4-6 chemotherapeutic cycles of NSCLC. Each of the two chemotherapy cycles is a chemotherapy stage. Then, in principle, the single syndrome is identified, and based on this, the document integration as the diagnostic criteria, through the proposed diagnostic criteria for syndrome differentiation. Finally, spss17.0 was used to collect the recorded data. Results the composition of qi deficiency and phlegm dampness syndrome decreased to 25.0% after operation. Qi stagnation and blood stasis syndrome increased to 51.7%. 2) Lung and spleen deficiency syndrome accounted for 60.0% after the first stage of chemotherapy, and then decreased to 41.7% after the second stage. Qi stagnation and blood stasis syndrome accounted for 8.3 after the first stage of chemotherapy, then gradually decreased to 3.3 and 1.7.The Qi and Yin deficiency syndrome ratio from 8.3%. Qi deficiency and phlegm dampness syndrome decreased from 20.0% to 15.0. After chemotherapy statistics of TCM syndrome type found spleen and kidney yang deficiency syndrome showed an obvious increase trend. From 3.3% after the first stage of chemotherapy to the final 55.0. 3) there were statistical differences in tumor markers in different stages of treatment. As the treatment continued, the four tumor markers of all TCM syndromes, CEACA125CA153, had a tendency to decrease. The leukocyte count in different stages of chemotherapy all showed a decreasing trend (P 0.05). Conclusion: 1). Non-small cell lung cancer can significantly increase the syndrome of Qi stagnation and blood stasis after operation. Qi deficiency and phlegm dampness syndrome decreased significantly. (2) Non-small cell lung cancer lesions in the lung, mainly manifested as lung qi deficiency, the initial stage of chemotherapy to the spleen and stomach damage, easy to cause deficiency of the lung and spleen, the main damage to the kidney at the later stage. With the progress of chemotherapy, tumor markers showed a decreasing trend. The change of CA153 value is helpful to judge the curative effect of non-small cell lung cancer (NSCLC) after operation and chemotherapy.) chemotherapy therapy has a significant effect on bone marrow suppression, which can make leukocyte count lower, even lower than normal level. The effect of surgery on bone marrow suppression was less.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2

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