阿片类药物所致便秘中医证型与相关量化指标的临床研究  

Clinical study on TCM syndromes and related quantitative indicators of opioid-induced constipation

作　　者：雎岩 袁媛 袁彬 吴文安 庞宏涛 JU Yan;YUAN yuan;YUAN Bin;WU Wen'an;PANG Hongtao(Shaanxi Provincial Cancer Hospital,Xi'an 710061,China)

机构地区：[1]陕西省肿瘤医院,陕西西安710061

出　　处：《临床医学研究与实践》2023年第36期103-107,共5页Clinical Research and Practice

基　　金：陕西省中医管理局中医药科研课题(No.LCMS044)。

摘　　要：目的探讨阿片类药物所致便秘(OIC)不同中医证型之间相关量化指标的差异性,从而为OIC中医证型的辨证分型寻求客观诊断指标。方法选择2018年9月至2020年12月本院收治的120例癌症患者为研究对象。观察各证型分布情况,比较各证型患者的性别、年龄、体力状态(ECOG)评分、便秘评分,以及阿片类药物使用情况是否具有差异性。结果120例患者中,脾肾阳虚证38例、肺脾气虚证28例、津亏肠燥证35例、肠道实热证19例。各证型患者的性别、年龄比较,差异无统计学意义(P>0.05)。津亏肠燥证ECOG评分>3分的患者占比多于其他三种证型(P<0.05);津亏肠燥证的便秘评分高于肺脾气虚证(P<0.05)。脾肾阳虚证的阿片类药物使用时间显著长于其他三种证型(P<0.05);津亏肠燥证的当前使用剂量高于肠道实热证、肺脾气虚证(P<0.05);脾肾阳虚证、津亏肠燥证的累计使用剂量均多于肺脾气虚证、肠道实热证(P<0.05)。脾肾阳虚证的胃动素(MTL)水平低于肺脾气虚证、肠道实热证(P<0.05),津亏肠燥证的MTL水平低于肠道实热证(P<0.05);各证型的血管活性肠肽(VIP)水平无显著差异(P>0.05)。结论OIC患者的ECOG评分、便秘评分、阿片类药物使用情况及MTL水平在不同中医证型之间有统计学差异,作为OIC中医辨证分型客观量化指标有一定的参考价值。Objective To explore the differences of quantitative indicators between different TCM syndromes of opioid-induced constipation(OIC),so as to seek objective diagnostic indicators for TCM syndrome differentiation of OIC.Methods A total of 120 cancer patients admitted in our hospital from September 2018 to December 2020 were selected as the study subjects.The distribution of each syndromes were observed,and the gender,age,Eastern Cooperative Oncology Group(ECOG)score,constipation score,and opioid drugs use of each syndromes were compared.Results Among 120 patients,there were 38 cases of spleen and kidney Yang deficiency syndrome,28 cases of lung and spleen Qi deficiency syndrome,35 cases of Jin deficiency and intestinal dryness syndrome,and 19 cases of intestinal excess heat syndrome.There were no significant difference in gender and age of patients with different syndromes(P>0.05).The proportion of patients with ECOG score>3 points in Jin deficiency and intestinal dryness syndrome were more than the others three syndromes(P<0.05);the constipation score of Jin deficiency and intestinal dryness syndrome was higher than that of lung and spleen Qi deficiency syndrome(P<0.05).The use time of opioid drugs in spleen and kidney Yang deficiency syndrome were significantly longer than those of the others three syndromes(P<0.05);the current dosage of Jin deficiency and intestinal dryness syndrome was higher than that of intestinal excess heat syndrome and lung and spleen Qi deficiency syndrome(P<0.05);the cumulative dose of spleen and kidney Yang deficiency syndrome and Jin deficiency and intestinal dryness syndrome were more than those of lung and spleen Qi deficiency syndrome and intestinal excess heat syndrome(P<0.05).The level of motilin(MTL)in spleen and kidney Yang deficiency syndrome was lower than that in lung and spleen Qi deficiency syndrome and intestinal excess heat syndrome(P<0.05),and the level of MTL in Jin deficiency and intestinal dryness syndrome was lower than that in intestinal excess heat syndrome(P<0.05)

关 键 词：癌痛 阿片类药物所致便秘 中医证型 胃动素 血管活性肠肽 

分 类 号：R256.35[医药卫生—中医内科学]