【摘要】：目的:本課題通過前瞻性的臨床研究,觀察非小細(xì)胞肺癌鉑類和非鉑類化療前后中醫(yī)證候演變規(guī)律,掌握其病機(jī)發(fā)展轉(zhuǎn)歸,為更好地指導(dǎo)中醫(yī)在非小細(xì)胞肺癌中的治療,優(yōu)化非小細(xì)胞肺癌中醫(yī)診療方案,進(jìn)一步構(gòu)建中西醫(yī)結(jié)合治療非小細(xì)胞肺癌的規(guī)范化診治體系提供依據(jù)。方法:符合納入標(biāo)準(zhǔn)的115例非小細(xì)胞肺癌患者,接受鉑類與非鉑兩類化療方案進(jìn)行化療。鱗癌采用GP(吉西他濱GEM+順鉑DDP)一線化療方案,腺癌采用PC(培美曲塞MTA+順鉑DDP)一線化療方案,非鉑類二線化療方案采用培美曲塞(MTA)單藥化療。收集化療前一天和化療結(jié)束后第七天各組癥狀體征、證候資料,探討非小細(xì)胞肺癌中醫(yī)證候演變規(guī)律。結(jié)果:(1)非小細(xì)胞肺癌的中醫(yī)證候主要包括氣虛血瘀型45例(39.1%),氣虛痰熱型22例(19.1%),脾虛痰濕型25例(21.7%),氣陰兩虛型23例(20%)。(2)非小細(xì)胞肺癌的中醫(yī)證候分布差異與臨床分期、病理分型及既往化療史無統(tǒng)計(jì)學(xué)相關(guān)性(P0.05)。(3)化療前以氣虛血瘀型為多。鉑類組(GP組和PC組)化療后氣虛痰熱型和脾虛痰濕型占比最大,氣虛血瘀型明顯減少,差異有統(tǒng)計(jì)學(xué)意義(P0.05);培美曲塞組化療后以脾虛痰濕型最多,化療前后中醫(yī)證候變化差異無統(tǒng)計(jì)學(xué)意義(P0.05);就單證來看,化療后氣虛證和痰濕證加重,血瘀證減輕,氣陰兩虛型變化不明顯。結(jié)論:(1)非小細(xì)胞肺癌的臨床證候復(fù)雜多變,多以復(fù)證出現(xiàn),虛實(shí)夾雜為主,本課題觀察的115例患者中以氣虛、陰虛、痰濕、血瘀、痰熱、脾虛為基本證候,其中氣虛血瘀型為最多,并且氣虛證貫穿了疾病的化療前后。(2)鉑類方案治療非小細(xì)胞肺癌后血瘀證減輕,加重氣虛證和痰濕證;培美曲塞組在化療前后,均以氣虛證為主,夾雜血瘀、痰濕及熱痰等實(shí)邪。
[Abstract]:Objective: through prospective clinical research, we observed the changes of TCM syndromes before and after chemotherapy of non-small cell lung cancer (NSCLC), and mastered its pathogenesis and prognosis, in order to better guide the treatment of non-small cell lung cancer (NSCLC). To optimize the scheme of traditional Chinese medicine diagnosis and treatment of NSCLC and to establish a standardized diagnosis and treatment system for NSCLC. Methods: 115 patients with non-small cell lung cancer were treated with both platinum and non-platinum chemotherapy regimen. GP (gemcitabine GEM cisplatin DDP) regimen was used for squamous cell carcinoma, PC (pemetrexed MTA cisplatin DDP) for adenocarcinoma and pemetrexed (MTA) for non-platinum second line chemotherapy. The symptoms, signs and syndromes of each group were collected one day before chemotherapy and 7 days after chemotherapy, and the evolution of TCM syndromes of non-small cell lung cancer was discussed. Results: (1) TCM syndromes of non-small cell lung cancer mainly included 45 cases (39.1%) of qi deficiency and blood stasis type, 22 cases (19.1%) of qi deficiency and phlegm heat type, 25 cases (21.7%) of spleen deficiency phlegm dampness type. 23 cases (20%). (2) of non-small cell lung cancer with deficiency of qi and yin had no statistical correlation with clinical stage, pathological type and previous chemotherapy history (P0.05). (3). The proportion of qi deficiency phlegm heat type and spleen deficiency phlegm dampness type was the largest in platinum group (GP group and PC group), and the difference was statistically significant (P0.05). In Pemetrusa group, spleen deficiency and phlegm dampness type was the most after chemotherapy, and the change of TCM syndromes before and after chemotherapy had no statistical significance (P0.05); according to the documents, Qi deficiency syndrome and phlegm dampness syndrome aggravated after chemotherapy, blood stasis syndrome alleviated, and Qi and Yin deficiency syndrome did not change obviously. Conclusion: (1) the clinical syndromes of non-small cell lung cancer are complicated and changeable, with multiple syndromes appearing in multiple syndromes, with deficiency and deficiency mainly. The basic syndromes are qi deficiency, yin deficiency, phlegm dampness, blood stasis, phlegm heat and spleen deficiency in 115 patients observed in this study. Qi deficiency and blood stasis type is the most, and Qi deficiency syndrome runs through the disease before and after chemotherapy. (2) Platinum regimen after the treatment of non-small cell lung cancer blood stasis syndrome reduced, aggravated Qi deficiency syndrome and phlegm dampness syndrome; Before and after chemotherapy, Pemetrex group was characterized by Qi deficiency syndrome, blood stasis, phlegm dampness and heat phlegm.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R273

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