基于因子分析与聚类分析的原发性肝细胞癌不同分期中医证候及证素演变规律研究  

Research on the evolution of traditional Chinese medicine syndromes and syndrome elements in different stages of primary hepatocellular carcinoma based on factor analysis and cluster analysis

作　　者：余思邈 王睿林 李佳辉 景婧 何婷婷 孙永强 王丽苹 张傲哲 任岳波 YU Simao;WANG Ruilin;LI Jiahui;JING Jing;HE Tingting;SUN Yongqiang;WANG Liping;ZHANG Aozhe;REN Yuebo(Fifth Medical Center,Chinese People's Liberation Army General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第五医学中心,北京100039

出　　处：《中华中医药杂志》2025年第2期867-871,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.81673806);中国医药教育协会2020重大科学攻关问题和医药技术难题(No.2020KTY001)。

摘　　要：目的:明确原发性肝细胞癌(HCC)不同分期中医证候、证素演变规律。方法:收集2020年7月1日至2023年6月30日就诊于中国人民解放军总医院第五医学中心门诊及住院的HCC患者510例,基于因子分析及聚类分析对其不同分期的证候、证素进行判定及统计分析。结果:得到HCC中医证候类型6个,HCCⅠ期至Ⅳ期的证候、证素变化规律分别为:肝郁脾虚证、瘀血阻络证(Ⅰ期)→瘀血阻络证、肝郁脾虚证(Ⅱ期)→肝肾阴虚证、瘀血阻络证(Ⅲ期)→肝胆湿热证、水湿内阻证(Ⅳ期);气滞、血瘀(Ⅰ期)→血瘀、气虚(Ⅱ期)→阴虚、血瘀(Ⅲ期)→湿、热(Ⅳ期)。结论:HCC不同分期的证候、证素分布差异很大,其中正虚、血瘀贯穿HCC整个阶段,整体呈现本虚标实、虚实夹杂的证候特点。Objective:To elucidate the evolution of traditional Chinese medicine(TCM)syndromes and syndrome elements in different stages of primary hepatocellular carcinoma(HCC).Methods:To collecte data from 510 HCC patients who were treated at the Fifth Medical Center,Chinese People's Liberation Army General Hospital from July 1,2020 to June 30,2023.Factor analysis and cluster analysis were employed to determine and statistically analyze the TCM syndromes and syndrome elements in different stages.Results:Six TCM syndrome types were identified in HCC.The evolving patterns of syndromes and syndrome elements in HCC stages I to IV were as follows:liver-depression and spleen-deficiency syndrome,stasis of blood in collaterals syndrome(stage I)→stasis of blood in collaterals syndrome,liver-depression and spleen-deficiency syndrome(stage II)liver-kidney yin deficiency syndrome,stasis of blood in collaterals syndrome(stage II)liver-gallbladder damp-heat syndrome,dampness and heat internal obstruction syndrome(stage IV).Qi stagnation,blood stasis(stage I)blood stasis,qi deficiency(stage II)→yin deficiency,blood stasis(stage II)→dampness,heat(stage IV).Conclusion:There are significant differences in the distribution of TCM syndromes and syndrome elements in different stages of HCC.Deficiency and blood stasis are common features throughout all HCC stages,presenting an overall pattern of deficiency within excess and a mixture of deficiencyand excess.

关 键 词：原发性肝癌 分期 证候 证素 因子分析 聚类分析 

分 类 号：R273[医药卫生—中西医结合]