乳腺癌术后内分泌治疗后类更年期综合征中医证型列线图预测模型的建立和评估  

Establishment and evaluation of a nomogram for predicting traditional Chinese medicine syndromes of menopause⁃like syndrome after endocrine therapy for postoperative breast cancer

作　　者：王宗玉 何晞辰 陈一贞 郑景辉[2] 谢雪焜 陈蔚[1] 李锦源 林栋毅 龙的乐 陈闯[1] WANG Zongyu;HE Xichen;CHEN Yizhen;ZHENG Jinghui;XIE Xuekun;CHEN Wei;LI Jinyuan;LIN Dongyi;LONG Dile;CHEN Chuang(Guangxi Medical University Cancer Hospital,Nanning,Guangxi 530021,China;Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi 530200,China;Jiangxi Ganzhou Nankang District Hospital of Traditional Chinese Medicine,Ganzhou,Jiangxi 341400,China)

机构地区：[1]广西医科大学附属肿瘤医院,广西南宁530021 [2]广西中医药大学,广西南宁530200 [3]江西省赣州市南康区中医院,江西赣州341400

出　　处：《上海中医药杂志》2023年第4期29-35,共7页Shanghai Journal of Traditional Chinese Medicine

基　　金：广西壮族自治区科技厅中央引导地方科技发展专项资金项目(ZY1949017);广西壮族自治区中医药管理局广西中医药重点学科建设项目(GZXK-Z-20-18);广西壮族自治区中医药管理局自筹经费科研课题(GZZC2019135)。

摘　　要：目的建立和评估乳腺癌术后内分泌治疗后类更年期综合征中医证型列线图预测模型。方法根据中医辨证标准,将乳腺癌术后内分泌治疗后类更年期综合征患者辨为冲任失调证、肝气郁结证、毒热蕴结证、气血两虚证,分析比较各中医证型患者肿瘤TNM分期、性激素受体类型、内分泌治疗时间等一般资料,相关实验室指标,以及Karnofsky评分、Kupperman改良症状评分,在此基础上建立中医证型列线图预测模型,并制作模型校准曲线图和受试者工作特征(ROC)曲线进行评估。结果(1)共纳入180例乳腺癌术后内分泌治疗后类更年期综合征患者,其中冲任失调证54例、肝气郁结证34例、毒热蕴结证44例、气血两虚证48例。(2)各中医证型患者肿瘤TNM分期、性激素受体类型、内分泌治疗时间、血清雌二醇(E2)水平,Kupperman改良症状总评分及泌尿系感染、性生活状况分项评分比较,差异有统计学意义(P<0.05)。(3)冲任失调证的预测变量为三酰甘油(TG)、肿瘤分期,肝气郁结证的预测变量为E2、肿瘤分期,毒热蕴结证的预测变量为内分泌治疗时间,气血两虚证的预测变量为骨关节痛、肿瘤分期、性激素受体,采用以上预测变量建立各中医证型的列线图预测模型;经ROC曲线和预测模型校准曲线综合评估,上述各中医证型预测模型的预测能力、校准能力较好,诊断价值较高。结论乳腺癌术后内分泌治疗后类更年期综合征中医证型列线图预测模型可对相关的预测变量实现可视化,根据预测变量建立中医证型列线图预测模型可预测各中医证型的发生率,对中医证型的诊断具有参考价值。Objective To establish and evaluate a nomogram prediction model for traditional Chinese medicine(TCM)syndromes of menopause-like syndrome in patients who have undergone endocrine therapy after breast cancer surgery.Methods According to the standard of TCM syndrome differentiation,patients with menopause-like syndrome after endocrine therapy for postoperative breast cancer were divided into Chongren imbalance syndrome,liver-qi stagnation syndrome,toxic heat accumulation syndrome and qi and blood deficiency syndrome.The general data such as tumor TNM stage,sex hormone receptor types,endocrine therapy duration,related laboratory indicators,Karnofsky scores and Kupperman improved symptom scores were analyzed and compared.On this basis,a nomogram prediction model of TCM syndromes was established,and a model calibration curve and a receiver operating characteristic(ROC)curve were made to evaluate the model.Results①A total of 180 patients with menopause-like syndrome after endocrine therapy for postoperative breast cancer surgery were included,including 54 cases of Chongren imbalance syndrome,34 cases of liver-qi stagnation syndrome,44 cases of toxic heat accumulation syndrome,and 48 cases of qi and blood deficiency syndrome.②There were significant differences in tumor TNM stage,sex hormone receptor types,endocrine therapy duration,serum estrogen(E2)level,Kupperman improved symptom total score,and each sub-score including urinary tract infection and sexual life status among patients with different TCM syndromes(P<0.05).③The predictive variables of Chongren imbalance syndrome were TG and tumor stage.The predictive variables of liver-qi stagnation syndrome were E2 level and tumor stage.The predictive variable of toxic heat accumulation syndrome was endocrine therapy duration.The predictive variables of qi and blood deficiency syndrome were bone and joint pain,tumor stage and sex hormone receptor.The nomogram prediction model of each TCM syndrome was established by using the above predictive variables.According to th

关 键 词：乳腺癌 内分泌治疗 类更年期综合征 中医证型 列线图 预测模型 

分 类 号：R273[医药卫生—中西医结合]