结直肠癌肝转移中医证型与凝血指标的预后分析  

Correlation Between Prognosis and Coagulation Indicators in Colorectal Cancer Liver Metastases Patients with Various Traditional Chinese Medicine Syndrome Types

作　　者：陈楚瑶 方崇锴 聂多锐 黄学武[3] CHEN Chu-yao;FANG Chong-kai;NIE Duo-rui;HUANG Xue-wu(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Hunan University of Chinese Medicine,Changsha 410208 Hunan,China;The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]湖南中医药大学研究生院,湖南长沙410208 [3]广州中医药大学第一附属医院,广东广州510405

出　　处：《中医肿瘤学杂志》2022年第5期9-16,共8页Journal of Oncology in Chinese Medicine

摘　　要：目的分析结直肠癌肝转移(colorectal cancer liver metastases,CRLM)各中医证型的凝血指标差异及凝血指标水平与预后的关系。方法回顾性分析2015年1月1日至2021年9月31日期间收住广州中医药大学第一附属医院肿瘤中心的232例CRLM患者病历资料,将患者辨证分为大肠湿热型、瘀毒蕴结型、气血两虚型、脾肾亏虚型和肝肾阴虚型5个证型,采用单因素ANOVA分析比较各证型的凝血指标差异,log-rank法和Cox回归模型分析各证型的血小板计数(blood platelet,PLT)、血浆凝血酶原时间(plasma prothrombin time,PT)、国际标准化比率(international normalized ratio,INR)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、血浆纤维蛋白原(plasma fibrinogen,FIB)与预后的关系。结果肝肾阴虚型的PT、INR、APTT均高于大肠湿热型(P<0.05);瘀毒蕴结型与气血两虚型的INR均低于肝肾阴虚型(P<0.05)。PLT水平是大肠湿热型(P=0.003)、气血两虚型(P<0.001)CRLM患者预后的影响因素,PT、INR水平均与大肠湿热型(P<0.05)、脾肾亏虚型(P<0.05)患者预后关系密切,FIB水平与肝肾阴虚型(P=0.007)患者预后相关。PLT水平(P=0.001)、FIB水平(P=0.018)分别为气血两虚型、肝肾阴虚型CRLM的独立预后因素,PT(P=0.015)和INR(P=0.015)水平是脾肾亏虚型CRLM预后的独立影响因素。结论PLT、PT、INR、FIB水平可联合中医证型作为预测指标,判断CRLM的预后,指导临床治疗决策。Objective To analyze the differences in coagulation indicators of colorectal cancer liver metastases(CRLM)patients with various traditional Chinese medicine(TCM)syndrome types and to explore the correlation between the levels of coagulation indicators and the prognosis of CRLM with various TCM syndrome types.Methods The medical records of 232 patients with CRLM admitted to the Oncology Center of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 1,2015 to September 31,2021 were retrospectively analyzed.The patients were classified into five syndromes,i.e.,large intestine damp-heat syndrome,stasis and toxin accumulation syndrome,qi-blood deficiency syndrome,spleen-kidney insufficiency syndrome,and liver-kidney yin deficiency syndrome.Differences in coagulation indicators between the syndrome types were compared using one-way ANOVA analysis.The correlation of platelet count(PLT),plasma prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(APTT),and plasma fibrinogen(FIB)with the prognosis were analyzed using the log-rank test.Results The PT,INR,and APTT of CRLM patients with the liver-kidney yin deficiency syndrome were higher than those of the large intestine damp-heat syndrome(P<0.05).The INR of stasis and toxin accumulation syndrome and the qi-blood deficiency syndrome were lower than that of the liver-kidney yin deficiency syndrome(P<0.05).PLT level was an influential factor for the prognosis of CRLM patients with large intestine damp-heat syndrome(P=0.003)and qi-blood deficiency syndrome(P<0.001).PT and INR levels were correlated with the prognosis of patients with the large intestine damp-heat syndrome(P<0.05)and spleen-kidney insufficiency syndrome(P<0.05).Furthermore,FIB level was significantly correlated with the prognosis of patients with liver-kidney yin deficiency syndrome(P=0.007).Conclusion PLT,PT,INR,and FIB levels combined with TCM syndrome types can be used as the predictors to determine the prognosis of CRLM and to guide

关 键 词：结直肠癌 肝转移 中医证型 凝血指标 预后 

分 类 号：R735.35[医药卫生—肿瘤] R730.3[医药卫生—临床医学] R273