191例肿瘤相关性疲劳患者的中医病机研究
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摘要
目的:通过中医辨证来观察肿瘤相关性疲劳(CRF)患者的病性虚实、脏腑定位、病理产物,以阐明其中医病机,为中医药防治肿瘤相关性疲劳提供理论依据。方法:本研究采用问卷调查法,选取2016年3月至2016年6月广州中医药大学第一附属医院手指的恶性肿瘤患者191例,进行一般信息、疲劳评分判定、中医四诊资料采集后,判定其脏腑虚损情况、脏腑辨证定位和病理产物,并分析其虚损情况与疲劳程度间的关系。结果:肿瘤相关性疲劳患者证型以脾气虚型的发生率最高(占80. 6%),其次为肾气虚型(占43. 5%)、肺气虚型(占34. 6%)、肝气郁结(占21. 5%)。而病理产物方面,53. 4%肿瘤相关性疲劳患者夹有痰浊,15. 7%夹有瘀血,30. 9%同时合并痰浊、瘀血。肿瘤相关性疲劳患者出现肾阳虚型、肾气虚型、脾阳虚型、肝气郁结型的疲劳程度较重,差异均有统计学意义(P <0. 05)。结论:肿瘤相关性疲劳患者的中医辨证总体上以虚证为主,可出现虚实夹杂。该病的病位主要在脾、肾,涉及到肝、肺二脏,病机多为脾气不足、肾精亏虚、痰瘀互结。故其中医治疗应攻补兼投,以补虚为主,治以健脾益气、补肾填精、软坚散结为法。
Objective: To observe the nature,location in zang-fu organs and pathological products of disease in patients with cancer-related fatigue( CRF) by syndrome differentiation of Traditional Chinese Medicine( TCM). It may help to further clarify the TCM pathogenesis of CRF and provide an important theoretical basis for the use of TCM in the prevention and treatment of CRF.Methods: A total of 191 patients with CRF were treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2016 to June 2016. Demographic information,score of RPFS-CV and clinical data from four diagnostic methods were collected to assess the deficiency of zang-fu organs,location and pathological products of disease,and the correlation in deficiency of zang-fu organs and level of fatigue was analyzed. Result: The most frequent syndrome of CRF was deficiency of spleen-qi,accounting for 80. 6% of all patients,followed by deficiency of kidney-qi( 43. 5%),deficiency of lung-qi( 34. 6%),stagnation of liver-qi( 21. 5%). The analysis of pathological products indicated that 53. 4% of CRF patients developed phlegm,15. 7% developed static-blood and 30. 9% developed both of them. CRF patients with the syndromes of kidney-yang deficiency( P < 0. 001),kidney-qi deficiency( P < 0. 001),spleen-yang deficiency( P < 0. 05) and stagnation of liver-qi( P < 0. 05) were associated with a higher level of fatigue. Conclusion: The TCM syndromes of CRF patients were dominated by deficiency syndromes and presented with the appearance of intermingled deficiency and excess. The locations of disease mainly included spleen,kidney and were also related to liver and lung. The TCM pathogenesis of CRF was related to the deficiency of spleen-qi and kidney-essence,and the intermingled phlegm,blood-stasis. The principle of treatment is reinforcing deficiency,accompanied with eliminating pathogen. The TCM methods for CRF were reinforcing qi and strengthening spleen,reinforcing kidney and replenishing essence,softening and resolving hard mass.
Objective: To observe the nature,location in zang-fu organs and pathological products of disease in patients with cancer-related fatigue( CRF) by syndrome differentiation of Traditional Chinese Medicine( TCM). It may help to further clarify the TCM pathogenesis of CRF and provide an important theoretical basis for the use of TCM in the prevention and treatment of CRF.Methods: A total of 191 patients with CRF were treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2016 to June 2016. Demographic information,score of RPFS-CV and clinical data from four diagnostic methods were collected to assess the deficiency of zang-fu organs,location and pathological products of disease,and the correlation in deficiency of zang-fu organs and level of fatigue was analyzed. Result: The most frequent syndrome of CRF was deficiency of spleen-qi,accounting for 80. 6% of all patients,followed by deficiency of kidney-qi( 43. 5%),deficiency of lung-qi( 34. 6%),stagnation of liver-qi( 21. 5%). The analysis of pathological products indicated that 53. 4% of CRF patients developed phlegm,15. 7% developed static-blood and 30. 9% developed both of them. CRF patients with the syndromes of kidney-yang deficiency( P < 0. 001),kidney-qi deficiency( P < 0. 001),spleen-yang deficiency( P < 0. 05) and stagnation of liver-qi( P < 0. 05) were associated with a higher level of fatigue. Conclusion: The TCM syndromes of CRF patients were dominated by deficiency syndromes and presented with the appearance of intermingled deficiency and excess. The locations of disease mainly included spleen,kidney and were also related to liver and lung. The TCM pathogenesis of CRF was related to the deficiency of spleen-qi and kidney-essence,and the intermingled phlegm,blood-stasis. The principle of treatment is reinforcing deficiency,accompanied with eliminating pathogen. The TCM methods for CRF were reinforcing qi and strengthening spleen,reinforcing kidney and replenishing essence,softening and resolving hard mass.
引文
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[2]田利,胡雁.2017版NCCN癌因性疲乏临床实践指南要点解读[J].上海护理,2017,17(1):9-13.
[3]Barsevick A,Frost M,Zwinderman A,et al.I'm so tired:biological and genetic mechanisms of cancer-related fatigue[J].Qual Life Res,2010,19(10):1419-1427.
[4]Cleeland CS,Bennett GJ,Dantzer R,et al.Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism?A cytokineimmunologic model of cancer symptoms[J].Cancer,2003,97(11):2919-25.
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[8]Portenoy RK,Itri LM.Cancer-related fatigue:guidelines for evaluation and management[J].Oncologist,1999,4(1):1-10.
[9]Piper BF,Dibble SL,Dodd MJ,et al.The revised Piper Fatigue Scale:psychometric evaluation in women with breast cancer[J].Oncol Nurs Forum,1998,25(4):677-684.
[10]李立群,樊蕴辉,王红阳,等.葡萄籽原花青素辅助治疗对中度OSAHS患者睡眠质量的影响及其机制[J].山东医药,2016,56(48):24-27.
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[12]钱丽燕,郭勇.浅谈李东垣脾胃学说对中医恶性肿瘤治疗的启发[C].北京:全国中医肿瘤学术年会,2013:659-660.
[13]孙广仁.中医基础理论[M].北京:中国中医药出版社,2002:72-98.
[14]张志强,任喜尧.虚损病类钩沉[C].江苏:首届著名中医药学家学术传承高层论坛,2005:242-263.
[15]陈金德.五脏所恶浅论[J].光明中医,2004,19(5):5-6.
[16]蔡国英.补中益气汤加减治疗肿瘤相关性乏力临床效果分析[J].内蒙古中医药,2016,35(7):12-13.
[17]任红兵.重用黄芪联合培本扶正法对康复期乳腺癌患者癌因性疲乏的影响[D].广州:广州中医药大学,2015.
[18]任剑书.补中益气丸治疗脾气虚型癌症相关性疲劳的临床研究[D].武汉:湖北中医药大学,2011.
[19]周楠.补中益气汤加减治疗肿瘤相关性乏力疗效观察[J].北方药学,2015,12(11):40-41.
[20]江灶坤.柴可群运用“温补脾肾法”治疗结直肠癌癌症相关性疲乏的经验探析[D].杭州:浙江中医药大学,2016.
[21]李志明.健脾益肾法治疗化疗期间中晚期大肠癌癌因性疲乏的临床观察[D].广州:广州中医药大学,2015.
[22]向先玉,周荣耀.健脾补肾方加减联合华蟾素治疗消化道恶性肿瘤的临床疗效观察[J].世界中医药,2013,8(3):300-303.
[23]马文苑,裴中美,丁奇龙,等.参附注射液穴位注射对慢性充血性心力衰竭患者NT-proBNP和6MWD的影响[J].世界中医药,2017,12(5):1053-1056.
[24]李红晨,李丽.参附注射液对肺癌患者化疗后癌因性疲乏的疗效观察[J].中国药房,2011,22(48):4570-4571.
[25]郭慧茹,刘苓霜,孙建立,等.参芪扶正注射液治疗晚期肺癌患者癌因性疲乏的临床疗效及生活质量评价[J].川北医学院学报,2017,32(2):163-166.
[26]刘志勇,周建伟,潘龙赐,等.参芪扶正注射液联合甲地孕酮改善晚期恶性肿瘤患者癌因性疲乏的临床研究[J].临床和实验医学杂志,2016,15(3):216-219.
[27]张琪,卢成美,方文岩.中西医结合治疗中晚期肺癌癌因性疲乏临床观察[J].山西中医,2016,32(1):20-21,25.
[28]魏小玲.参麦注射液对行姑息治疗的肺癌患者癌性疲乏的影响[J].临床合理用药杂志,2016,9(32):43-44.
[29]吴晶,徐艳,蒋志红,等.参麦注射液配合西药治疗肺癌及对癌因性疲乏的影响[J].陕西中医,2014,35(10):1358-1359.
[30]张恩欣,周岱翰,侯超.益气除痰方含药血清对顺铂耐药肺癌细胞增殖和细胞周期的影响[J].山东医药,2016,56(6):13-15.
[31]吕文姣,欧阳明子,林丽珠,等.益气除痰方对非小细胞肺癌患者化疗相关性疲劳的防治作用[J].中医药导报,2015,21(10):31-34.
[32]徐凇.健脾化瘀方对晚期大肠癌化疗患者癌因性疲乏的影响[D].南京:南京中医药大学,2016.
[33]段哲萍,于新江,吕艳玲,等.复方苦参注射液对非小细胞肺癌放疗患者放射性肺损伤及骨髓抑制的防治作用及机制[J].山东医药,2016,56(32):81-83.
[34]王俊,卢宏达.康艾注射液联合化疗治疗非小细胞肺癌患者癌因性疲乏临床研究[J].湖北中医杂志,2015,37(5):5-6.
[35]张鹤,单丽珠,张洁,等.康艾注射液联合化疗治疗胰腺癌癌因性疲劳[J].中国中西医结合外科杂志,2012,18(5):438-440.
[36]张艳玲.艾迪注射液改善鼻咽癌患者癌症相关性疲劳的疗效观察[J].中国医学工程,2014,22(6):115-115.
[37]王海军,宋娜,冯志伟.肿瘤精准医学研究进展[J].新乡医学院学报,2017,34(10):867-870.
[2]田利,胡雁.2017版NCCN癌因性疲乏临床实践指南要点解读[J].上海护理,2017,17(1):9-13.
[3]Barsevick A,Frost M,Zwinderman A,et al.I'm so tired:biological and genetic mechanisms of cancer-related fatigue[J].Qual Life Res,2010,19(10):1419-1427.
[4]Cleeland CS,Bennett GJ,Dantzer R,et al.Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism?A cytokineimmunologic model of cancer symptoms[J].Cancer,2003,97(11):2919-25.
[5]张永慧,林丽珠.癌因性疲乏患者的中医证候聚类分析[J].广州中医药大学学报,2016,33(4):485-489.
[6]中国华人民共和国卫生部.中国常见恶性肿瘤诊治规范[S].北京医科大学、中国协和医科大学联合出版社,1991:1-620.
[7]Edge SB,Compton CC.The American Joint Committee on Cancer:the7th edition of the AJCC cancer staging manual and the future of TNM[J].Ann Surg Oncol,2010,17(6):1471-1474.
[8]Portenoy RK,Itri LM.Cancer-related fatigue:guidelines for evaluation and management[J].Oncologist,1999,4(1):1-10.
[9]Piper BF,Dibble SL,Dodd MJ,et al.The revised Piper Fatigue Scale:psychometric evaluation in women with breast cancer[J].Oncol Nurs Forum,1998,25(4):677-684.
[10]李立群,樊蕴辉,王红阳,等.葡萄籽原花青素辅助治疗对中度OSAHS患者睡眠质量的影响及其机制[J].山东医药,2016,56(48):24-27.
[11]朱文锋.中医诊断学[M].北京:中国中医药出版社,2002:163-208.
[12]钱丽燕,郭勇.浅谈李东垣脾胃学说对中医恶性肿瘤治疗的启发[C].北京:全国中医肿瘤学术年会,2013:659-660.
[13]孙广仁.中医基础理论[M].北京:中国中医药出版社,2002:72-98.
[14]张志强,任喜尧.虚损病类钩沉[C].江苏:首届著名中医药学家学术传承高层论坛,2005:242-263.
[15]陈金德.五脏所恶浅论[J].光明中医,2004,19(5):5-6.
[16]蔡国英.补中益气汤加减治疗肿瘤相关性乏力临床效果分析[J].内蒙古中医药,2016,35(7):12-13.
[17]任红兵.重用黄芪联合培本扶正法对康复期乳腺癌患者癌因性疲乏的影响[D].广州:广州中医药大学,2015.
[18]任剑书.补中益气丸治疗脾气虚型癌症相关性疲劳的临床研究[D].武汉:湖北中医药大学,2011.
[19]周楠.补中益气汤加减治疗肿瘤相关性乏力疗效观察[J].北方药学,2015,12(11):40-41.
[20]江灶坤.柴可群运用“温补脾肾法”治疗结直肠癌癌症相关性疲乏的经验探析[D].杭州:浙江中医药大学,2016.
[21]李志明.健脾益肾法治疗化疗期间中晚期大肠癌癌因性疲乏的临床观察[D].广州:广州中医药大学,2015.
[22]向先玉,周荣耀.健脾补肾方加减联合华蟾素治疗消化道恶性肿瘤的临床疗效观察[J].世界中医药,2013,8(3):300-303.
[23]马文苑,裴中美,丁奇龙,等.参附注射液穴位注射对慢性充血性心力衰竭患者NT-proBNP和6MWD的影响[J].世界中医药,2017,12(5):1053-1056.
[24]李红晨,李丽.参附注射液对肺癌患者化疗后癌因性疲乏的疗效观察[J].中国药房,2011,22(48):4570-4571.
[25]郭慧茹,刘苓霜,孙建立,等.参芪扶正注射液治疗晚期肺癌患者癌因性疲乏的临床疗效及生活质量评价[J].川北医学院学报,2017,32(2):163-166.
[26]刘志勇,周建伟,潘龙赐,等.参芪扶正注射液联合甲地孕酮改善晚期恶性肿瘤患者癌因性疲乏的临床研究[J].临床和实验医学杂志,2016,15(3):216-219.
[27]张琪,卢成美,方文岩.中西医结合治疗中晚期肺癌癌因性疲乏临床观察[J].山西中医,2016,32(1):20-21,25.
[28]魏小玲.参麦注射液对行姑息治疗的肺癌患者癌性疲乏的影响[J].临床合理用药杂志,2016,9(32):43-44.
[29]吴晶,徐艳,蒋志红,等.参麦注射液配合西药治疗肺癌及对癌因性疲乏的影响[J].陕西中医,2014,35(10):1358-1359.
[30]张恩欣,周岱翰,侯超.益气除痰方含药血清对顺铂耐药肺癌细胞增殖和细胞周期的影响[J].山东医药,2016,56(6):13-15.
[31]吕文姣,欧阳明子,林丽珠,等.益气除痰方对非小细胞肺癌患者化疗相关性疲劳的防治作用[J].中医药导报,2015,21(10):31-34.
[32]徐凇.健脾化瘀方对晚期大肠癌化疗患者癌因性疲乏的影响[D].南京:南京中医药大学,2016.
[33]段哲萍,于新江,吕艳玲,等.复方苦参注射液对非小细胞肺癌放疗患者放射性肺损伤及骨髓抑制的防治作用及机制[J].山东医药,2016,56(32):81-83.
[34]王俊,卢宏达.康艾注射液联合化疗治疗非小细胞肺癌患者癌因性疲乏临床研究[J].湖北中医杂志,2015,37(5):5-6.
[35]张鹤,单丽珠,张洁,等.康艾注射液联合化疗治疗胰腺癌癌因性疲劳[J].中国中西医结合外科杂志,2012,18(5):438-440.
[36]张艳玲.艾迪注射液改善鼻咽癌患者癌症相关性疲劳的疗效观察[J].中国医学工程,2014,22(6):115-115.
[37]王海军,宋娜,冯志伟.肿瘤精准医学研究进展[J].新乡医学院学报,2017,34(10):867-870.