大肠癌化疗后副反应与中医辨证分型相关性研究
发布时间：2018-07-21 13:38
【摘要】：目的:通过调查不同中医证型患者化疗后副反应的发生情况,分析化疗副反应与证型的相关性,为中西医结合治疗结直肠癌提供客观依据。方法:采用回顾性研究方法,收集2014年1月至2017年1月在我院肿瘤中心、外科及脾胃科住院患者的病历资料,制作临床信息收集表(详见附录1),按照纳入及排除标准筛选患者,查找患者首次化疗前的病历资料,根据临床症状、体征,结合患者舌苔脉象进行辨证分型,统计患者首次化疗后(双周方案1-6程,三周方案1-4程)的骨髓抑制(白细胞、中性粒细胞、血红蛋白、血小板)、胃肠道反应(便秘、腹泻、口腔黏膜反应、恶心呕吐)、肝肾功能(天门冬氨酸氨基转移酶、丙氨酸转氨酶、血胆红素、血肌酐)、胆碱能综合征、外周神经毒性、手足综合征、疲倦乏力及脱发情况,完成临床信息收集表;采用统计学方法计算并分析。结果:共收集符合纳入及排除标准的患者100例,处于40-69岁之间的患者共79例,占总数的79%,其中大肠湿热证34例,瘀毒内结证26例,脾肾亏虚证17例,肝肾阴虚证8例,气血两虚证15例,五个证型中,大肠癌患者化疗后出现胃肠道症状与大肠湿热证、瘀毒内结证、脾肾亏虚证相关(P0.05),进一步做两两分析,化疗前辨证为大肠湿热及疲毒内结的患者化疗后更容易出现胃肠道副反应(P0.05),其中最常见的是恶心呕吐症状;气血两虚证与化疗导致的疲倦乏力以及脱发相关(P0.05);肝肾阴虚证与脱发亦存在相关性(P0.05);74%的患者在化疗过程中出现了骨髓抑制,其中发生Ⅲ-Ⅳ度骨髓抑制的患者占13%,大肠癌五个证型在骨髓抑制的发生率及严重程度的频数分布上无显著性差异(P0.05),骨髓抑制类型方面的统计发现,白细胞及血小板的减少与中医辨证分型无显著关联(P0.05),而化疗前辨证为气血两虚证及脾肾亏虚证的患者化疗后则更倾向于出现血红蛋白的下降(P0.05);不同化疗方案的化疗后副反应发生频数分布无显著性差异(P0.05)。结论:大肠湿热证、瘀毒内结证及脾肾亏虚证的大肠癌患者在化疗过程中倾向于出现胃肠道副反应,其中临床最常见的是恶心呕吐症状;肝肾阴虚证及气血两虚证的大肠癌患者与化疗后脱发相关,其中气血两虚证的患者亦与化疗后出现的疲倦乏力相关;大肠癌五个证型在骨髓抑制的发生率及严重程度的频数分布上无明显差异,气血两虚证及脾肾亏虚证患者在化疗过程中较容易出现血红蛋白降低;不同化疗方案的化疗后副反应发生频数分布无显著性差异(P0.05)。
[Abstract]:Objective: to investigate the incidence of side effects after chemotherapy in patients with different TCM syndromes, and to analyze the correlation between the side effects of chemotherapy and syndromes in order to provide an objective basis for the treatment of colorectal cancer with integrated Chinese and western medicine. Methods: a retrospective study was conducted to collect the medical records of inpatients from January 2014 to January 2017 in the department of surgery and spleen and stomach in our hospital, and to make a clinical information collection table (see appendix 1 for details), and to screen patients according to the criteria of inclusion and exclusion. According to the clinical symptoms and signs, combined with the pulse of tongue coating, the patient's bone marrow suppression (WBC) was counted after the first chemotherapy (biweekly regimen 1-6 course, three-week regimen 1-4 course). Neutrophil, hemoglobin, platelet), gastrointestinal reaction (constipation, diarrhea, oral mucosal reaction, nausea and vomiting), liver and kidney function (aspartate aminotransferase, alanine aminotransferase, serum bilirubin), Serum creatinine), cholinergic syndrome, peripheral neurotoxicity, hand and foot syndrome, fatigue and alopecia. Results: a total of 100 patients who met the criteria of inclusion and exclusion were collected, 79 patients aged 40-69 years old, accounting for 79% of the total, including 34 cases of large intestine dampness and heat syndrome, 26 cases of blood stasis and toxin syndrome, 17 cases of deficiency of spleen and kidney syndrome, 8 cases of liver and kidney yin deficiency syndrome. Fifteen cases of qi and blood deficiency syndrome, five syndrome types, colorectal cancer patients after chemotherapy and gastrointestinal symptoms and large intestine damp-heat syndrome, blood stasis syndrome, deficiency of spleen and kidney syndrome (P0.05), further analysis, Patients with large intestine dampness and heat before chemotherapy were more likely to develop gastrointestinal side effects after chemotherapy (P0.05), and the most common symptom was nausea and vomiting. Qi-blood deficiency syndrome was associated with tiredness and alopecia caused by chemotherapy (P0.05), liver and kidney yin deficiency syndrome and alopecia were also correlated (P0.05) 74% of the patients had bone marrow suppression during chemotherapy. There was no significant difference in the frequency distribution of the incidence and severity of bone marrow depression among the five syndrome types of colorectal cancer (P0.05). There was no significant correlation between leukopenia and thrombocytopenia and syndrome differentiation of TCM (P0.05), but the patients with deficiency of qi and blood and deficiency of spleen and kidney were more inclined to appear the decrease of hemoglobin after chemotherapy (P0.05). There was no significant difference in the frequency distribution of side effects after treatment (P0.05). Conclusion: colorectal cancer patients with large intestine damp-heat syndrome, blood stasis syndrome and deficiency of spleen and kidney syndrome tend to have gastrointestinal side effects during chemotherapy, among which the most common clinical symptom is nausea and vomiting. The patients with liver and kidney yin deficiency syndrome and qi and blood deficiency syndrome were associated with alopecia after chemotherapy, and the patients with Qi and blood deficiency syndrome were also related to fatigue and fatigue after chemotherapy. There was no significant difference in the incidence and severity of bone marrow suppression among the five syndrome types of colorectal cancer. Hemoglobin decreased easily in patients with deficiency of qi and blood and deficiency of spleen and kidney during chemotherapy. There was no significant difference in the occurrence frequency of side effects between different chemotherapy regimens (P0.05).
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34
本文编号：2135700
[Abstract]:Objective: to investigate the incidence of side effects after chemotherapy in patients with different TCM syndromes, and to analyze the correlation between the side effects of chemotherapy and syndromes in order to provide an objective basis for the treatment of colorectal cancer with integrated Chinese and western medicine. Methods: a retrospective study was conducted to collect the medical records of inpatients from January 2014 to January 2017 in the department of surgery and spleen and stomach in our hospital, and to make a clinical information collection table (see appendix 1 for details), and to screen patients according to the criteria of inclusion and exclusion. According to the clinical symptoms and signs, combined with the pulse of tongue coating, the patient's bone marrow suppression (WBC) was counted after the first chemotherapy (biweekly regimen 1-6 course, three-week regimen 1-4 course). Neutrophil, hemoglobin, platelet), gastrointestinal reaction (constipation, diarrhea, oral mucosal reaction, nausea and vomiting), liver and kidney function (aspartate aminotransferase, alanine aminotransferase, serum bilirubin), Serum creatinine), cholinergic syndrome, peripheral neurotoxicity, hand and foot syndrome, fatigue and alopecia. Results: a total of 100 patients who met the criteria of inclusion and exclusion were collected, 79 patients aged 40-69 years old, accounting for 79% of the total, including 34 cases of large intestine dampness and heat syndrome, 26 cases of blood stasis and toxin syndrome, 17 cases of deficiency of spleen and kidney syndrome, 8 cases of liver and kidney yin deficiency syndrome. Fifteen cases of qi and blood deficiency syndrome, five syndrome types, colorectal cancer patients after chemotherapy and gastrointestinal symptoms and large intestine damp-heat syndrome, blood stasis syndrome, deficiency of spleen and kidney syndrome (P0.05), further analysis, Patients with large intestine dampness and heat before chemotherapy were more likely to develop gastrointestinal side effects after chemotherapy (P0.05), and the most common symptom was nausea and vomiting. Qi-blood deficiency syndrome was associated with tiredness and alopecia caused by chemotherapy (P0.05), liver and kidney yin deficiency syndrome and alopecia were also correlated (P0.05) 74% of the patients had bone marrow suppression during chemotherapy. There was no significant difference in the frequency distribution of the incidence and severity of bone marrow depression among the five syndrome types of colorectal cancer (P0.05). There was no significant correlation between leukopenia and thrombocytopenia and syndrome differentiation of TCM (P0.05), but the patients with deficiency of qi and blood and deficiency of spleen and kidney were more inclined to appear the decrease of hemoglobin after chemotherapy (P0.05). There was no significant difference in the frequency distribution of side effects after treatment (P0.05). Conclusion: colorectal cancer patients with large intestine damp-heat syndrome, blood stasis syndrome and deficiency of spleen and kidney syndrome tend to have gastrointestinal side effects during chemotherapy, among which the most common clinical symptom is nausea and vomiting. The patients with liver and kidney yin deficiency syndrome and qi and blood deficiency syndrome were associated with alopecia after chemotherapy, and the patients with Qi and blood deficiency syndrome were also related to fatigue and fatigue after chemotherapy. There was no significant difference in the incidence and severity of bone marrow suppression among the five syndrome types of colorectal cancer. Hemoglobin decreased easily in patients with deficiency of qi and blood and deficiency of spleen and kidney during chemotherapy. There was no significant difference in the occurrence frequency of side effects between different chemotherapy regimens (P0.05).
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34
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