97例中晚期不可切除原发性肝癌的中医证型分布及预后因素分析  

Analysis of Prognostic Factors and Distribution of TCMSyndromes of 97 Cases of Intermediate and Advanced Unresectable Primary Liver Carcinoma

作　　者：袁菊花 崔宁[2] 郝腾腾[2] 吴娇 邹建华 徐晓华 李刘生 吴煜[2] YUAN Juhua;CUI Ning;HAO Tengteng;WU Jiao;ZOU Jianhua;XU Xiaohua;LI Liusheng;WU Yu(Beijing Hospital of Integrative Medicine,Beijing 100039,China;Xiyuan Hospital,China Academy of Chinese Medical Sciences,Beijing 100091,China;Shanxi Cancer Hospital,Taiyuan 030013,Shanxi,China)

机构地区：[1]北京中西医结合医院,北京100039 [2]中国中医科学院西苑医院,北京100091 [3]山西省肿瘤医院,山西太原030013

出　　处：《辽宁中医杂志》2025年第3期49-52,共4页Liaoning Journal of Traditional Chinese Medicine

基　　金：首都卫生发展科研专项项目(2024-3-7044);中国中医科学院科技创新工程重大公关项目(CI2021A01803);北京市中医药科技发展资金项目(BJZYQN-2023-42)。

摘　　要：目的探索中晚期不可切除原发性肝癌(primary liver carcinoma,PLC)的中医证型分布及预后因素。方法采用前瞻性队列研究设计,纳入97例经诊断为不可切除中晚期PLC患者,其中50例为暴露组,47例为非暴露组。非暴露组患者接受西医常规治疗,暴露组在西医常规治疗的基础上,联合中医辨证论治,并酌情选用中成药的综合治疗,治疗至少2个月。比较两组生存率、证型分布,采用单因素和多因素Cox回归分析对影响预后的变量进行分析。结果①两组证型分布频次依次为脾虚痰凝证、肝郁血瘀证和肝肾阴虚证;②暴露组1年生存率(45.8%,22/48)和1年半生存率(36.2%,17/47)与非暴露组1年生存率(34.9%,15/43)和1年半生存率(19.5%,8/41)比较均差异无统计学意义(P>0.05);而暴露组2年生存率(27.9%,12/43)与非暴露组1年生存率(10.3%,4/39)比较,差异有统计学意义(P<0.05);③单因素COX回归分析显示中医治疗、病理诊断、门脉癌栓、肝外转移、东部肿瘤协作组体能状态评分(Eastern Cooperative Oncology Group Performance Status,ECOG PS)评分、巴塞罗那临床肝癌(Barcelona Clinic Liver Cancer,BCLC)分期和基线症状评分与预后相关(P<0.05);而多因素COX回归分析则显示中医治疗、病理诊断和ECOG PS评分与预后相关(P<0.05)。结论中医辨证论治对中晚期不可切除PLC患者的生存有积极影响,值得临床推广。Objective To analyze the prognostic factors and distribution of syndromes of TCM of intermediate and advanced unresectable primary liver carcinoma(PLC).Methods A prospective cohort study was conducted to enroll 97 patientswith intermediate and advanced unresectable PLC,of which 50 were in the exposed group and 47 were in the non-exposed group.The patients in the non-exposed group received conventional treatment with Western medicine,while those in the exposed group were treated with Western medicine combined with traditional Chinese medicine(TCM)based on syndrome differentiation and proprietary prepared prescription of TCM as appropriate for at least 2 months.Survival rate and distribution of syndromes of TCM were compared between the two groups,and variables affecting prognosis were analyzed by using univariate and multivariate Cox regression analyses.Results(1)The frequency of syndromes of TCM in both groups were spleen deficiency and phlegm coagulation,liver depression and blood stasis,and Yin deficiency of liver and kidneyin order.(2)There was no statistical difference(P>0.05)between the 1-year survival rate(45.8%,22/48)and 1.5-year survival rate(36.2%,17/47)in the exposed group compared with the 1-year survival rate(34.9%,15/43)and 1.5-year survival rate(19.5%,8/41)in the non-exposed group.Whereas,the 2-year survival rate in the exposed group(27.9%,12/43)was statistically different(P<0.05)from the 2-year survival rate of the non-exposed group(10.3%,4/39).(3)One-way COX regression analysis showed that TCM treatment,pathological diagnosis,portal vein cancer embolism,extrahepatic metastasis,Eastern Cooperative Oncology Group Performance Status(ECOG PS)score,Barcelona Clinic Liver Cancer(BCLC)stagingand baseline symptom scores were correlated with the prognosis(P<0.05).However,multifactorial COX regression analysis showed that TCM treatment,pathological diagnosis and ECOG PS score were associated with prognosis(P<0.05).Conclusion TCM based on syndrome differentiation has a positive impact on the survival of pati

关 键 词：中晚期不可切除原发性肝癌 中医辨证论治 队列研究 预后因素分析 

分 类 号：R273[医药卫生—中西医结合]