肝癌和大肠癌“异病同证”的证候分布及其与临床实验室指标的关联研究  

TCM Syndromes Distribution of Liver Cancer and Colorectal Cancer with "Different Diseases with Same Syndrome" and its Association with Clinical Laboratory Indicators

作　　者：杨梦蝶 陈晓乐 谢小峥 周汶君 呼雪庆 季青 李琦[2] 王文海[3] 王鹏 孟志强 苏式兵 Yang Mengdie;Chen Xiaole;Xie Xiaozheng;Zhou Wenjun;Hu Xueqing;Ji Qing;Li Qi;Wang Wenhai;Wang Peng;Meng Zhiqiang;Su Shibing(Research Center for Traditional Chinese Medicine Complexity System,Institute of Interdisciplinary Integrative Medicine Research,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Oncology,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai 201900,China;Department of Integrated traditional Chinese and Western medicine,Tumour Hospital,Shanghai Fudan University,Shanghai 200032,China)

机构地区：[1]上海中医药大学交叉科学研究院中医复杂系统研究中心,上海201203 [2]上海中医药大学附属曙光医院肿瘤科,上海201203 [3]上海市宝山区中西医结合医院,上海201900 [4]上海复旦大学附属肿瘤医院中西医结合科,上海200032

出　　处：《世界科学技术-中医药现代化》2019年第11期2461-2468,共8页Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology

基　　金：国家自然科学基金委员会重点项目(81330084):基于系统生物学的原发性肝癌和大肠癌“异病同证”和“异病同治”的研究,负责人:苏式兵;上海市宝山区中西医结合医院项目(GZRPYJJ-201707):从网络药理学探讨肝癌和大肠癌术后肝肾阴虚兼脾气虚证“异病同证”实质,负责人:王文海。

摘　　要：目的调查原发性肝癌(肝癌)与大肠癌患者的中医证候分布,探讨血常规、肝肾功能、免疫功能和肿瘤指标等临床实验室指标与中医证候的关联。方法运用《中医肝癌与大肠癌病例汇报表(CRF表)》采集中医四诊信息、客观指标等,分析肝癌与大肠癌的证型分布及各证型在临床客观指标上的表现特点及"异病同证"的规律。结果 460例肝癌和759例大肠癌患者具有肝肾阴虚、脾虚、瘀血、湿热、实热、气虚、阴虚、隐证8种单证及各种兼证,其中脾虚证(27%)、肝肾阴虚证(12%)、隐证(11%)、湿热证(9%)、肝肾阴虚兼脾虚证(8%)为肝癌和大肠癌临床较为常见的五种中医证型。血常规HB、肝肾功能TBIL、ALB和GGT在五种证型间整体分布有显著差异(P <0.05),AFP在肝癌证型间差异无统计学意义(P> 0.05),在大肠癌证型间差异显著(P <0.001)。但免疫功能和细胞因子在上述五种证型间整体分布差异无统计学意义(P> 0.05)。结论脾虚证、肝肾阴虚证、肝肾阴虚兼脾虚证、隐证、湿热证是肝癌与大肠癌证候分布的前五位,其证候分布与HB、TBIL、ALB、GGT和AFP存在关联,提示这些临床实验室指标可能作为肝癌和大肠癌"异病同证"辩证的参考依据。Objective To investigate the traditional Chinese medicine(TCM) syndrome distribution in liver cancer(LC)and colorectal cancer(CRC), and explore their correlation with clinical laboratory indicators including blood routine examination, liver and kidney function, immune function and tumor biomarkers. Methods Using the CRC cases report form(CRF) of TCM, collecting LC and CRC patients with TCM four diagnosis information and clinical laboratory indicators, analyzing TCM syndromes distribution in LC and CRC, and the performance characteristics on clinical laboratory indicators of each syndrome and the discipline of "Different Diseases with Same Syndrome". Results In 460 cases of LC and 759 cases of CRC, there were 8 single syndromes including liver and kidney yin deficiency syndrome(LKYDS), spleen deficiency syndrome(SDS), damp-heat syndrome(DHS), hidden syndrome(HS), blood stasis syndrome, real heat syndrome, qi deficiency syndrome, yin deficiency syndrome and various composite syndromes.Among SDS(27%), LKYDS,(12%), HS(11%), DHS(9%) and LKYDS-SDS(8%) were more common TCM syndrome types. There were statistically significant difference in overall distribution of above 5 TCM syndrome of blood routine such as HB, liver and kidney function such as TBIL, ALB and GGT(P < 0.05). There was no significant difference in AFP between LC above 5 TCM syndrome(P > 0.05), and there were significant differences among CRC(P < 0.001).There was no statistically significant difference in the distribution of immune function and cytokine among the five TCM syndromes(P > 0.05). Conclusion SDS, LKYDS, HS, DHS and LKYDS-SDS were the first 5 TCM syndromes in LC and CRC. There were the significant correlations between the distribution of TCM syndrome, and the clinical laboratory indicators such as HB, TBIL、ALB、GGT and AFP, suggesting that these clinical laboratory indicators may serve as a dialectical reference basis for distinguishing the "Different Diseases with Same Syndrome" of LC and CRC.

关 键 词：肝癌 大肠癌 证候分布 临床实验室指标 

分 类 号：R259[医药卫生—中西医结合]