非小细胞肺癌铂类和非铂类方案治疗前后中医证候演变规律的研究

发布时间：2018-12-27 12:46

【摘要】：目的:本课题通过前瞻性的临床研究,观察非小细胞肺癌铂类和非铂类化疗前后中医证候演变规律,掌握其病机发展转归,为更好地指导中医在非小细胞肺癌中的治疗,优化非小细胞肺癌中医诊疗方案,进一步构建中西医结合治疗非小细胞肺癌的规范化诊治体系提供依据。方法:符合纳入标准的115例非小细胞肺癌患者,接受铂类与非铂两类化疗方案进行化疗。鳞癌采用GP(吉西他滨GEM+顺铂DDP)一线化疗方案,腺癌采用PC(培美曲塞MTA+顺铂DDP)一线化疗方案,非铂类二线化疗方案采用培美曲塞(MTA)单药化疗。收集化疗前一天和化疗结束后第七天各组症状体征、证候资料,探讨非小细胞肺癌中医证候演变规律。结果:(1)非小细胞肺癌的中医证候主要包括气虚血瘀型45例(39.1%),气虚痰热型22例(19.1%),脾虚痰湿型25例(21.7%),气阴两虚型23例(20%)。(2)非小细胞肺癌的中医证候分布差异与临床分期、病理分型及既往化疗史无统计学相关性(P0.05)。(3)化疗前以气虚血瘀型为多。铂类组(GP组和PC组)化疗后气虚痰热型和脾虚痰湿型占比最大,气虚血瘀型明显减少,差异有统计学意义(P0.05);培美曲塞组化疗后以脾虚痰湿型最多,化疗前后中医证候变化差异无统计学意义(P0.05);就单证来看,化疗后气虚证和痰湿证加重,血瘀证减轻,气阴两虚型变化不明显。结论:(1)非小细胞肺癌的临床证候复杂多变,多以复证出现,虚实夹杂为主,本课题观察的115例患者中以气虚、阴虚、痰湿、血瘀、痰热、脾虚为基本证候,其中气虚血瘀型为最多,并且气虚证贯穿了疾病的化疗前后。(2)铂类方案治疗非小细胞肺癌后血瘀证减轻,加重气虚证和痰湿证;培美曲塞组在化疗前后,均以气虚证为主,夹杂血瘀、痰湿及热痰等实邪。
[Abstract]:Objective: through prospective clinical research, we observed the changes of TCM syndromes before and after chemotherapy of non-small cell lung cancer (NSCLC), and mastered its pathogenesis and prognosis, in order to better guide the treatment of non-small cell lung cancer (NSCLC). To optimize the scheme of traditional Chinese medicine diagnosis and treatment of NSCLC and to establish a standardized diagnosis and treatment system for NSCLC. Methods: 115 patients with non-small cell lung cancer were treated with both platinum and non-platinum chemotherapy regimen. GP (gemcitabine GEM cisplatin DDP) regimen was used for squamous cell carcinoma, PC (pemetrexed MTA cisplatin DDP) for adenocarcinoma and pemetrexed (MTA) for non-platinum second line chemotherapy. The symptoms, signs and syndromes of each group were collected one day before chemotherapy and 7 days after chemotherapy, and the evolution of TCM syndromes of non-small cell lung cancer was discussed. Results: (1) TCM syndromes of non-small cell lung cancer mainly included 45 cases (39.1%) of qi deficiency and blood stasis type, 22 cases (19.1%) of qi deficiency and phlegm heat type, 25 cases (21.7%) of spleen deficiency phlegm dampness type. 23 cases (20%). (2) of non-small cell lung cancer with deficiency of qi and yin had no statistical correlation with clinical stage, pathological type and previous chemotherapy history (P0.05). (3). The proportion of qi deficiency phlegm heat type and spleen deficiency phlegm dampness type was the largest in platinum group (GP group and PC group), and the difference was statistically significant (P0.05). In Pemetrusa group, spleen deficiency and phlegm dampness type was the most after chemotherapy, and the change of TCM syndromes before and after chemotherapy had no statistical significance (P0.05); according to the documents, Qi deficiency syndrome and phlegm dampness syndrome aggravated after chemotherapy, blood stasis syndrome alleviated, and Qi and Yin deficiency syndrome did not change obviously. Conclusion: (1) the clinical syndromes of non-small cell lung cancer are complicated and changeable, with multiple syndromes appearing in multiple syndromes, with deficiency and deficiency mainly. The basic syndromes are qi deficiency, yin deficiency, phlegm dampness, blood stasis, phlegm heat and spleen deficiency in 115 patients observed in this study. Qi deficiency and blood stasis type is the most, and Qi deficiency syndrome runs through the disease before and after chemotherapy. (2) Platinum regimen after the treatment of non-small cell lung cancer blood stasis syndrome reduced, aggravated Qi deficiency syndrome and phlegm dampness syndrome; Before and after chemotherapy, Pemetrex group was characterized by Qi deficiency syndrome, blood stasis, phlegm dampness and heat phlegm.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R273

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