免疫治疗对晚期胃癌中医证型演变规律的影响  

The Impact of Immunotherapy on the Evolution Laws of Traditional Chinese Medicine Syndromes in Patienes with Advanced Gastric Cancer

作　　者：曾书莹 周小芳 徐鑫鑫 余志红 ZENG Shuying;ZHOU Xiaofang;XU Xinxin;YU Zhihong(Zhejiang Chinese Medical University,Hangzhou,Zhejiang,China,310053;Loudi Hospital of Traditional Chinese Medicine,Loudi,Hunan,China,417099;Tongde Hospital of Zhejiang Province,Hangzhou,Zhejiang,China,310012)

机构地区：[1]浙江中医药大学,浙江杭州310053 [2]娄底市中医院,湖南娄底417099 [3]浙江省立同德医院,浙江杭州310012

出　　处：《河南中医》2025年第2期272-277,共6页Henan Traditional Chinese Medicine

基　　金：2021年浙江省国医名师传承工作室建设项目(GZS2021001)。

摘　　要：目的:观察免疫治疗对晚期胃癌(gastric cancer, GC)患者中医证型演变规律的影响。方法:共纳入58例晚期GC患者,其中腹膜转移组38例,无腹膜转移组20例,收集患者的一般资料、临床病理学特征及治疗前后中医证型。运用χ~2检验评估各项指标间的相关性,运用Kaplan-Meier法评估各种证型无进展生存期(progression-free survival, PFS)。结果:58例GC患者治疗前中医证型以痰湿凝结证、肝胃不和证为主,两种证型PFS比较,差异无统计学意义(P>0.05);治疗后以气阴两虚证、脾胃虚寒证为主,两种证型PFS比较,差异无统计学意义(P>0.05)。腹膜转移组治疗前主要证型为肝胃不和证、痰湿凝结证、气滞血瘀证;治疗后主要证型为脾胃虚寒证、气阴两虚证、气血亏虚证。无腹膜转移组治疗前主要证型为气阴两虚证、痰湿凝结证、脾胃虚寒证;治疗后主要证型为气阴两虚证、脾胃虚寒证、气血亏虚证。腹膜转移组治疗前肝胃不和证与痰湿凝结证肿瘤原发部位、分化程度、组织学、分期比较,差异并无统计学意义(P>0.05)。58例晚期GC患者PFS为(5.19±2.95)个月,其中腹膜转移组PFS为(4.22±2.77)个月,无腹膜转移组PFS为(7.02±2.40)个月,两组PFS比较,差异具有统计学意义(P<0.05)。将58例GC患者肝胃不和证、痰湿凝结证、气滞血瘀证归为实证,气阴两虚证、脾胃虚寒证、气血亏虚证归为虚证。实证与虚证PFS比较,差异无统计学意义(P>0.05)。结论:肝胃不和证和痰湿凝结证在晚期腹膜转移患者中多见,且生存期更短,免疫治疗可改善晚期GC患者中医证型的分布规律,加强对晚期GC患者中医证型的关注,并进行及早干预,有助于提高患者的生存期。Objective:To observe the impact of immunotherapy on the evolution laws of TCM syndromes in patients with advanced gastric cancer(GC).Methods:A total of 58 advanced GC patients were enrolled,including 38 with peritoneal metastasis and 20 without peritoneal metastasis.General patient data,clinical pathological features,and pre-and post-treatment TCM syndromes were collected.Correlations between various indicators were assessed using the X test,and progression-free survival(PFS)was estimated using the Kaplan-Meier method.Results:Before treatment,TCM syndromes were predominantly phlegm-dampness obstruction and liver-stomach disharmony.No significant difference in PFS was observed between these two syndromes(P>0.05).After treatment,qi-yin deficiency and spleen-stomach cold deficiency became the dominant syndromes,with no significant difference in PFS between them(P>0.05).In the peritoneal metastasis group,pre-treatment syndromes were primarily liver-stomach disharmony,phlegm-dampness obstruction,and qi stagnation with blood stasis,while post-treatment syndromes were spleen-stomach cold deficiency,qi-yin deficiency,and qi-blood deficiency.In the non-peritoneal metastasis group,pre-treatment syndromes were primarily qi-yin deficiency,phlegm-dampness obstruction,and spleen-stomach cold deficiency,while post-treatment syndromes were qi-yin deficiency,spleen-stomach cold deficiency,and qi-blood deficiency.There were no significant differences in tumor site,differentiation degree,histology,or stage between liver-stomach disharmony syndrome and phlegm-dampness obstruction syndrome(P>0.05).The overall PFS for the 58 patients was(5.19±2.95)months:peritoneal metastasis group(4.22±2.77)months and non-peritoneal metastasis group(7.02±2.40)months,with a statistically significant difference between the two groups(P<0.05).Patients were categorized into excess syndromes(including liver-stomach disharmony,phlegm-dampness obstruction,qi stagnation with blood stasis)and deficiency syndromes(including qi-yin deficiency,spleen-stomach

关 键 词：晚期胃癌 免疫治疗 中医证型 肝胃不和证 痰湿凝结证 气阴两虚证 脾胃虚寒证 气血亏虚证 腹膜转移 

分 类 号：R273.352[医药卫生—中西医结合]