本文關鍵詞：基于聚類分析對晚期肺癌化療前后中醫(yī)證候分布特點的研究　出處：《南京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 肺癌 化療 中醫(yī)證候 聚類分析

【摘要】：目的:基于聚類分析的方法,對收集的晚期肺癌病人四診信息進行研究,歸納出晚期肺癌化療前后的中醫(yī)證型,探討晚期肺癌化療前后的中醫(yī)證候分布特點以及不同周期的化療對其中醫(yī)證型的影響,從而為該病化療不同階段的中醫(yī)治療,提供較客觀的辨證依據(jù),指導臨床實踐中遣方用藥,提高晚期肺癌綜合治療療效。方法:預設《晚期肺癌化療病例觀察表》,運用前瞻性的調(diào)查方法進行觀察,收集江蘇省中醫(yī)院呼吸科及腫瘤科2014年12月至2016年12月晚期肺癌住院病人(包括初次化療前81例、第3次化療前80例、第5次化療前80例)的中醫(yī)四診資料共241例。以第1、3、5次化療前為劃分點,采用Excel 2013將收集到的四診資料依據(jù)各要素的有、無(1、0)建立三組數(shù)據(jù)庫,統(tǒng)計三組患者各四診信息出現(xiàn)的頻次和百分比;應用SPSS 18.0分別對三組患者四診資料進行K-均值聚類分析。依據(jù)聚類分析的結(jié)果,結(jié)合中醫(yī)及中西醫(yī)結(jié)合專家意見,最終得出證型分類和名稱。結(jié)果:初次化療前81例晚期肺癌患者的常見四診信息有神疲乏力、舌質(zhì)紅,苔薄、脈數(shù)、脈滑、白粘痰、脈細、脈濡、氣短喘促、食欲不振、苔白膩、舌淡有齒痕或胖大舌、心煩失眠、消瘦、舌有裂紋或少津、脈弦、胸悶、盜汗、舌質(zhì)淡紅、面色少華。第3次化療前80例患者的常見四診信息有脈細、神疲乏力、苔薄、食欲不振、口燥咽干、舌質(zhì)紅、脈數(shù)、咳聲低弱、氣短喘促、心煩失眠、面色少華、惡心嘔吐、舌淡有齒痕或胖大舌、盜汗、苔少、舌質(zhì)暗紅或有瘀點、脈弦、脈澀、痰少而黏、舌有裂紋或少津。第5次化療前80例患者的常見四診信息有脈細、神疲乏力、口燥咽干、苔薄、食欲不振、咳聲低弱、面色少華、舌質(zhì)紅、舌質(zhì)紅絳或紫紅或有瘀斑、脈弱、氣短喘促、消瘦、心煩失眠、脈數(shù)、自汗、舌有裂紋或少津、盜汗、舌淡有齒痕或胖大舌、惡心嘔吐、痰少而黏。通過對初次化療前81例晚期肺癌患者的四診資料進行聚類分析,歸納出4種常見證型,它們分別是氣虛痰濕證、氣陰兩虛證(氣虛為主)和氣陰兩虛證(陰虛為主)、痰熱郁肺證。其中氣虛痰濕證居多,約占46.9%;氣陰兩虛證(氣虛為主)約占22.2%,氣陰兩虛證(陰虛為主)約占17.2%;痰熱郁肺證最少,約13.5%。第3次化療前的80例病人中,常見證型有氣虛血瘀證、氣陰兩虛證(陰虛為主)和氣陰兩虛證(氣虛為主)、氣虛痰濕證。其中氣虛血瘀證居多,約35.0%;氣陰兩虛證(陰虛為主)約占32.5%,氣陰兩虛證(氣虛為主)約占17.5%;氣虛痰濕證相對較少,約15.0%。在第5次化療前的80例病人中,常見證型為肺脾氣虛證(約占35.0%)、氣陰兩虛證(約占31.3%)和正虛瘀毒證(約占33.8%)。結(jié)論:氣虛貫穿晚期肺癌化療前后的病程始終,是本病發(fā)生、演變、惡化的基礎。初次化療前的病人以氣虛痰濕為主,隨著病程的延長及化療次數(shù)的增加,痰濕病理逐漸減少,正虛逐漸加重,而瘀毒有所增加。其中氣虛、氣陰兩虛為正虛的主要證候,實邪是痰濕、痰熱、瘀毒等。不同周期的化療可能是影響晚期肺癌中醫(yī)證型的因素之一。
[Abstract]:Objective: Based on clustering analysis and a method of advanced lung cancer patients to collect diagnostic information, summed up the TCM syndrome type of lung cancer before and after chemotherapy, to explore the characteristics of TCM syndrome distribution before and after chemotherapy in advanced lung cancer and chemotherapy in different periods of the TCM syndrome type of influence, so as to Chinese medicine treatment of the disease in different stages of chemotherapy the syndrome differentiation objective bases, guide clinical practice prescription medication, improve the curative effect of comprehensive treatment of advanced lung cancer. Methods: the default "chemotherapy in advanced lung cancer case observation table", using the prospective investigation method to observe, collect the Department of respiration of Jiangsu Province Traditional Chinese Medicine Hospital and Oncology from December 2014 to late December 2016 of lung cancer patients (including 81 cases before the first chemotherapy, third time before chemotherapy in 80 cases, fifth times before chemotherapy in 80 cases). TCM four diagnostic data of 241 cases. The first, third, fifth time before chemotherapy as the dividing point, the Excel 2013 will be collected according to the diagnostic data elements, (1, 0) to establish three databases, the frequency and percentage statistics of each of the three groups of patients appeared four diagnostic information; the application of SPSS 18 respectively in three groups of patients with four diagnostic data analysis K- clustering. According to the results of cluster analysis, combining the expert opinions of traditional Chinese medicine and traditional Chinese and Western medicine, the classification and name of the syndrome type are finally obtained. Results: before the first chemotherapy in 81 cases of lung cancer patients with common diagnostic information were lassitude, red tongue, thin tongue fur, pulse, slippery pulse, white phlegm, fine pulse, pulse moisten, shortness of breath, loss of appetite, greasy, pale tongue with teeth marks or big fat tongue, insomnia, emaciation, tongue crack or Shaojin, taut pulse, chest tightness, sweating, pale red tongue, pale shaohua. The third time before chemotherapy in 80 patients with common diagnostic information has fine pulse, lassitude, loss of appetite, moss thin, dry mouth and throat, red tongue, pulse, cough, shortness of breath, weakness, insomnia, nausea and vomiting, a small pale tongue with scalloped tongue, night sweats, or fat little moss, dark red tongue or petechiae, pulse string, pulse astringent, little sputum and sticky, tongue cracks or less tianjin. The fifth time before chemotherapy in 80 patients with common diagnostic information has fine pulse, lassitude, kouzaoyangan, moss thin, poor appetite, cough, weakness of a small, red tongue, dark red tongue or purple or ecchymosis, weak pulse, shortness of breath, weight loss, insomnia, sweating, pulse there is a crack or, tongue Shaojin, sweating, pale tongue with teeth marks or big fat tongue, nausea and vomiting, sputum less sticky. Based on the cluster analysis of initial chemotherapy before 81 cases of patients with advanced lung cancer diagnostic data, summed up the 4 common syndromes are phlegm, Qi and yin deficiency syndrome (Qi deficiency) two and two Qi and yin deficiency syndrome (yin deficiency), phlegm heat obstructing lung syndrome. Among them, Qi deficiency and phlegm dampness syndrome account for 46.9%, while Qi Yin two deficiency syndrome (mainly Qi deficiency) accounts for 22.2%, Qi Yin two deficiency syndrome (yin deficiency predominating) accounts for 17.2%, and phlegm heat is the least in lung syndrome, which is about 13.5%. Of the 80 patients before the third chemotherapy, the common syndrome types were Qi deficiency and blood stasis syndrome, Qi Yin two deficiency syndrome (yin deficiency mainly) and Qi Yin two deficiency syndrome (Qi deficiency mainly) and Qi deficiency phlegm damp syndrome. Among them, Qi deficiency and blood stasis were mostly 35%, Qi Yin two deficiency syndrome (yin deficiency) accounted for 32.5%, Qi Yin two deficiency syndrome (mainly Qi deficiency) accounted for 17.5%, deficiency of Qi and phlegm dampness syndrome were relatively less, about 15%. Among the 80 patients before fifth times chemotherapy, the common syndrome types were lung qi deficiency syndrome (about 35%), Qi Yin two deficiency syndrome (about 31.3%) and Zheng deficiency syndrome (about 33.8%). Conclusion: the course of chemotherapy before and after chemotherapy of qi deficiency through advanced lung cancer is the basis of the occurrence, evolution and deterioration of this disease. Before the initial chemotherapy, the patients were mainly Qi deficiency, phlegm dampness. With the prolongation of the course of disease and the increase of the number of chemotherapy, the phlegm dampness pathology gradually reduced, and the deficiency increased gradually, while the stasis and toxin increased. Qi deficiency, Qi and yin deficiency are the main syndromes of positive deficiency, and the real evil is phlegm dampness, phlegm heat and blood stasis and so on. Different cycles of chemotherapy may be one of the factors that affect the TCM syndrome type of advanced lung cancer.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R273

【參考文獻】

相關期刊論文 前10條

1 李文婷;於丙寅;吳勉華;;周仲瑛從氣陰兩傷論治肺癌術(shù)后患者經(jīng)驗[J];中醫(yī)雜志;2016年08期

2 李本達;張培彤;;中晚期非小細胞肺癌化療前后中醫(yī)證型變化規(guī)律研究[J];北京中醫(yī)藥;2015年10期

3 陳丹;楊其;史麗云;杜雪丹;丁弋娜;蔡玲斐;盧哲;;慢性肺部疾病與肺癌形成的關系[J];南昌大學學報(醫(yī)學版);2015年04期

4 邱芝琳;葛信國;;益氣養(yǎng)陰解毒方聯(lián)合化療治療非小細胞肺癌臨床研究[J];中醫(yī)學報;2014年10期

5 韓睿;林洪生;;從虛勞角度探討肺癌中醫(yī)因機證治[J];天津中醫(yī)藥;2014年09期

6 盧旭全;袁穎;黃智芬;黎漢忠;譚志強;張麗娜;桂海濤;許瑞琪;;參芪瀉白散聯(lián)合化療對晚期非小細胞肺癌患者生活質(zhì)量及免疫功能的影響[J];世界中西醫(yī)結(jié)合雜志;2014年04期

7 袁東;章永紅;;通絡法治療肺癌用藥經(jīng)驗[J];吉林中醫(yī)藥;2013年06期

8 支修益;吳一龍;馬勝林;王天佑;王長利;王潔;石遠凱;盧鈾;劉倫旭;劉德若;陳東紅;楊躍;杜祥;步宏;周清華;姜格寧;韓寶惠;程剛;程穎;焦順昌;;原發(fā)性肺癌診療規(guī)范(2011年版)[J];中國肺癌雜志;2012年12期

9 鄭健;龐德湘;;龐德湘自擬肺金生方治療肺癌經(jīng)驗[J];北京中醫(yī)藥;2012年09期

10 唐雪勇;楊志波;王建湘;;白癜風聚類分析的中醫(yī)辨證分型規(guī)律研究[J];湖南中醫(yī)藥大學學報;2012年01期

，

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