基于证候分层诊断模式的223例胰腺癌患者中医证型分布特点回顾性分析  

Characteristics of Traditional Chinese Medicine Syndromes in 223 Pancreatic Cancer Cases based on Syndrome Hierarchical Diagnosis Mode

作　　者：黄蓉 张培彤[1] 缪锐 HUANG Rong;ZHANG Peitong;MIAO Rui(Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing,100053)

机构地区：[1]中国中医科学院广安门医院,北京市100053

出　　处：《中医杂志》2022年第6期551-556,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81673797)。

摘　　要：目的基于证候分层诊断模式探讨胰腺癌中医证候的特点。方法回顾性收集223例胰腺癌患者初诊时的一般情况、既往治疗情况、临床分期、肿瘤原发部位、有无远处转移、中医刻下症、既往史、舌象、脉象信息。采用中医证候分层诊断模式,包括一层级诊断:实证、虚证。二层级诊断:里实证、里虚证(本研究不涉及表实证、表虚证)。里实证的三层级诊断有气实证、血实证、津液实证、实寒证、实热证;里虚证的三层级诊断有气虚证、血虚证、阴虚证、阳虚证、津亏证、精亏证、虚热证。四层级诊断及五层级诊断均在符合上一层级诊断基础上进一步辨证。对证型进行例数和百分比进行统计,并分析胰腺癌患者远处转移与无远处转移、肝转移与仅无肝转移、不同临床分期、不同肿瘤原发部位的患者其证型分布特征。结果223例胰腺癌患者中里实证者214例(96.0%),里虚证者198例(88.8%)。里实证以血实证-血瘀证-脾血瘀证(84.3%)最多见,其次为气实证-气滞证-胃气滞证(61.9%)、血实证-血瘀证-肝血瘀证(37.2%);里虚证以气虚证-脾气虚证(58.7%)最多见,其次为气虚证-胃气虚证(34.1%)、阴虚证-脾阴虚证(21.5%)。远处转移患者中气实证、胃气虚证、肝血瘀证、胃气上逆证、大肠气滞证、肺血瘀证均较无远处转移患者多见(P<0.05)。不同临床分期的气实证、血实证、血瘀证、脾气虚证、胃气虚证、胆气虚证、脾血瘀证、肝血瘀证、大肠气滞证的分布差异具有统计学意义(P<0.05)。胰腺癌肝转移患者中胃气虚证、胆气虚证、大肠气滞证、胃气上逆证、肝血瘀证较无肝转移患者多见,血实证、实热证较无肝转移患者少见(P<0.05)。胰头癌患者血瘀证、脾血瘀证较胰体尾癌患者多见,津亏证、脾阴虚证、胃气上逆证较胰体尾癌患者少见(P<0.05)。结论胰腺癌患者中医证型多虚实夹杂,气滞证�Objective To explore the characteristics of traditional Chinese medicine(TCM)syndromes in pancreatic cancer patients based on syndrome hierarchical diagnosis mode.Methods The general condition,previous treatment,clinical stage,primary location of tumor,with or without distant metastasis,instant TCM symptoms,past history,tongue and pulse manifestations on first admission were retrospectively collected from 223 patients with pancreatic cancer. The hierarchical diagnosis mode of TCM syndromes was adopted. The first level diagnosis differentiated excess from deficiency syndrome. The second level diagnosis included interior excess and interior deficiency syndromes(exterior excess and exterior deficiency syndromes were not involved in this study). The third level diagnosis under interior excess syndrome includes qi excess,blood excess,fluid excess,excess cold,and excess heat patterns,while interior deficiency syndrome was classified into qi deficiency,blood deficiency,yin deficiency,yang deficiency,fluid depletion,essence depletion,and deficiency heat patterns. The fourth level and fifth level diagnosis differentiation were further performed after meeting previous diagnosis levels. The number of cases and percentages of different syndromes were statistically analyzed. The distribution of TCM syndromes in different patients groups were analyzed in terms of with or without distant metastasis,with or without liver metastasis,different clinical stages,and different primary locations of tumor.Results (96. 0%)with interior excess syndrome,and 198 cases(88. 8%)with interior deficiency syndrome. For interior excess syndrome,blood excess/blood stasis/liver blood stasis pattern was mostly common seen(84. 3%),followed by qi excess/qi stagnation/stomach qi stagnation pattern(61. 9%)and blood excess/blood stasis/liver blood stasis pattern(37. 2%). The most common pattern of interior deficiency syndrome was qi deficiency/spleen qi deficiency pattern(58. 7%),followed by qi deficiency/stomach qi deficiency pattern(34. 1%)and yin defic

关 键 词：胰腺癌 分层诊断 证型分布 

分 类 号：R273[医药卫生—中西医结合]