大腸癌化療后副反應(yīng)與中醫(yī)辨證分型相關(guān)性研究
發(fā)布時間：2018-07-21 13:38
【摘要】：目的:通過調(diào)查不同中醫(yī)證型患者化療后副反應(yīng)的發(fā)生情況,分析化療副反應(yīng)與證型的相關(guān)性,為中西醫(yī)結(jié)合治療結(jié)直腸癌提供客觀依據(jù)。方法:采用回顧性研究方法,收集2014年1月至2017年1月在我院腫瘤中心、外科及脾胃科住院患者的病歷資料,制作臨床信息收集表(詳見附錄1),按照納入及排除標(biāo)準(zhǔn)篩選患者,查找患者首次化療前的病歷資料,根據(jù)臨床癥狀、體征,結(jié)合患者舌苔脈象進(jìn)行辨證分型,統(tǒng)計患者首次化療后(雙周方案1-6程,三周方案1-4程)的骨髓抑制(白細(xì)胞、中性粒細(xì)胞、血紅蛋白、血小板)、胃腸道反應(yīng)(便秘、腹瀉、口腔黏膜反應(yīng)、惡心嘔吐)、肝腎功能(天門冬氨酸氨基轉(zhuǎn)移酶、丙氨酸轉(zhuǎn)氨酶、血膽紅素、血肌酐)、膽堿能綜合征、外周神經(jīng)毒性、手足綜合征、疲倦乏力及脫發(fā)情況,完成臨床信息收集表;采用統(tǒng)計學(xué)方法計算并分析。結(jié)果:共收集符合納入及排除標(biāo)準(zhǔn)的患者100例,處于40-69歲之間的患者共79例,占總數(shù)的79%,其中大腸濕熱證34例,瘀毒內(nèi)結(jié)證26例,脾腎虧虛證17例,肝腎陰虛證8例,氣血兩虛證15例,五個證型中,大腸癌患者化療后出現(xiàn)胃腸道癥狀與大腸濕熱證、瘀毒內(nèi)結(jié)證、脾腎虧虛證相關(guān)(P0.05),進(jìn)一步做兩兩分析,化療前辨證為大腸濕熱及疲毒內(nèi)結(jié)的患者化療后更容易出現(xiàn)胃腸道副反應(yīng)(P0.05),其中最常見的是惡心嘔吐癥狀;氣血兩虛證與化療導(dǎo)致的疲倦乏力以及脫發(fā)相關(guān)(P0.05);肝腎陰虛證與脫發(fā)亦存在相關(guān)性(P0.05);74%的患者在化療過程中出現(xiàn)了骨髓抑制,其中發(fā)生Ⅲ-Ⅳ度骨髓抑制的患者占13%,大腸癌五個證型在骨髓抑制的發(fā)生率及嚴(yán)重程度的頻數(shù)分布上無顯著性差異(P0.05),骨髓抑制類型方面的統(tǒng)計發(fā)現(xiàn),白細(xì)胞及血小板的減少與中醫(yī)辨證分型無顯著關(guān)聯(lián)(P0.05),而化療前辨證為氣血兩虛證及脾腎虧虛證的患者化療后則更傾向于出現(xiàn)血紅蛋白的下降(P0.05);不同化療方案的化療后副反應(yīng)發(fā)生頻數(shù)分布無顯著性差異(P0.05)。結(jié)論:大腸濕熱證、瘀毒內(nèi)結(jié)證及脾腎虧虛證的大腸癌患者在化療過程中傾向于出現(xiàn)胃腸道副反應(yīng),其中臨床最常見的是惡心嘔吐癥狀;肝腎陰虛證及氣血兩虛證的大腸癌患者與化療后脫發(fā)相關(guān),其中氣血兩虛證的患者亦與化療后出現(xiàn)的疲倦乏力相關(guān);大腸癌五個證型在骨髓抑制的發(fā)生率及嚴(yán)重程度的頻數(shù)分布上無明顯差異,氣血兩虛證及脾腎虧虛證患者在化療過程中較容易出現(xiàn)血紅蛋白降低;不同化療方案的化療后副反應(yīng)發(fā)生頻數(shù)分布無顯著性差異(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).
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34
本文編號：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).
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34
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