不同营养状态胃肠肿瘤患者中医客观化舌象特征探究
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摘要
目的探讨不同营养状态胃肠肿瘤患者中医客观化舌象特征。方法选择胃肠肿瘤化疗患者161例,其中胃癌患者83例,大肠癌患者78例。对纳入患者进行营养风险筛查和营养状态评定,采集舌象,分析不同营养状态胃肠肿瘤化疗患者中医客观化舌象特征。结果两组营养风险比较差异有统计学意义(P<0.05),即胃癌营养风险高于大肠癌,两组营养状态比较差异无统计学意义(P>0.05)。胃癌患者不同营养风险的舌形指数比较差异无统计学意义(P>0.05);不同营养状态的瘀斑指数比较差异有统计学意义(P<0.05),重度营养不良组瘀斑程度高于营养良好组和中度或可疑营养不良组。大肠癌患者不同营养风险的瘀斑指数差异有统计学意义(P<0.05),即存在营养风险的患者瘀斑程度高;不同营养状态的齿痕指数差异有统计学意义(P<0.05),重度营养不良组齿痕程度高于营养良好组和中度或可疑营养不良组。不同营养风险胃肠肿瘤患者苔质厚薄指数差异无统计学意义(P>0.05);不同营养状态的苔质厚薄指数差异有统计学意义(P<0.01),经线性趋势检验,存在线性相关(P<0.01),即营养状态越差,苔质越薄。结论胃肠肿瘤化疗患者存在较高营养风险,且营养不良发生率高,胃癌患者营养风险高于大肠癌。中医客观化舌象能反映胃肠肿瘤患者的不同营养风险或营养状况,营养风险或营养状态差的患者主要表现为气虚血瘀证。
Objective To explore the characteristic of tongue image of gastrointestinal cancer patients with different nutritional status. Methods 161 cases of gastrointestinal tumor chemotherapy patients were selected,including 83 cases of gastric tumor and 78 cases of colorectal cancer. Nutritional risk screening and nutritional status assessment of the patients were performed,and the tongue image was collected to analyze the characteristics of tongue image in patients with gastrointestinal cancer chemotherapy in different nutritional status. Results Nutritional risk difference between two groups had statistically significant( P < 0. 05),the risk of gastric cancer was higher than that of colorectal cancer,there was no significant difference in nutritional status between the two groups( P > 0. 05). There was no statistically significantce in tongue-shaped index of gastric tumor patients with different nutritional risk. There were significant differences in Yuban index( P < 0. 05). Yuban index of severe malnutrition group was significantly higher than that of good nutrition group and moderate malnutrition group. There was statistical significance of Yuban index in different nutritional risk of patients with colorectal cancer( P < 0. 05),that means a highdegree of nutritional risk in patients with high degree of Yuban index. There was significant difference in the index of tooth marks in different nutritional status( P < 0. 05). The degree of tooth mark in the severe malnutrition group was higher than that in the nutrition group and the moderate or suspected malnutrition group. There was no statistical significance of different nutritional risk in patients with gastrointestinal carcinoma of tongue fur thickness index. There were significant differences of tongue fur thickness index of nutritional status( P < 0. 01),that is,the worse the nutritional status,the thinner the moss. Conclusions Gastrointestinal cancer chemotherapy patients with high nutritional risk,and the incidence of malnutrition is high,the risk of gastric cancer is higher than that of colorectal cancer. The objective tongue image can reflect the different nutritional risk or nutritional status of gastrointestinal cancer patients,the patients with nutritional risk or poor nutritional status of the main manifestations of qi deficiency and blood stasis.
Objective To explore the characteristic of tongue image of gastrointestinal cancer patients with different nutritional status. Methods 161 cases of gastrointestinal tumor chemotherapy patients were selected,including 83 cases of gastric tumor and 78 cases of colorectal cancer. Nutritional risk screening and nutritional status assessment of the patients were performed,and the tongue image was collected to analyze the characteristics of tongue image in patients with gastrointestinal cancer chemotherapy in different nutritional status. Results Nutritional risk difference between two groups had statistically significant( P < 0. 05),the risk of gastric cancer was higher than that of colorectal cancer,there was no significant difference in nutritional status between the two groups( P > 0. 05). There was no statistically significantce in tongue-shaped index of gastric tumor patients with different nutritional risk. There were significant differences in Yuban index( P < 0. 05). Yuban index of severe malnutrition group was significantly higher than that of good nutrition group and moderate malnutrition group. There was statistical significance of Yuban index in different nutritional risk of patients with colorectal cancer( P < 0. 05),that means a highdegree of nutritional risk in patients with high degree of Yuban index. There was significant difference in the index of tooth marks in different nutritional status( P < 0. 05). The degree of tooth mark in the severe malnutrition group was higher than that in the nutrition group and the moderate or suspected malnutrition group. There was no statistical significance of different nutritional risk in patients with gastrointestinal carcinoma of tongue fur thickness index. There were significant differences of tongue fur thickness index of nutritional status( P < 0. 01),that is,the worse the nutritional status,the thinner the moss. Conclusions Gastrointestinal cancer chemotherapy patients with high nutritional risk,and the incidence of malnutrition is high,the risk of gastric cancer is higher than that of colorectal cancer. The objective tongue image can reflect the different nutritional risk or nutritional status of gastrointestinal cancer patients,the patients with nutritional risk or poor nutritional status of the main manifestations of qi deficiency and blood stasis.
引文
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[12]Unsal D,Mentes B,Akmansu M,et al.Evaluation of nutritional status in cancer patients receiving radiotherapy:a prospective study[J].Am J Clin Oncol,2006,29(2):183-188.
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[16]Potten CS.A Comprehensive study of the radiobiologicalresponse of the murine small intestine[J].Int Radiat Biol,1990,58(6):925.
[17]田同德,储真真,陈信义.恶性肿瘤高凝状态与血瘀证相关性及中医防治对策研究[J].北京中医药,2009,28(6):425-427.
[18]吴正治,郭振球.舌苔原理的综合实验研究[J].中国中医药科技,1996,3(6):5-8.
[2]秦健,李炜弘,曾跃琴,等.中医药在恶性肿瘤治疗中的优势[J].临床合理用药杂志,2012,5(1):88.
[3]石强,石宇,陆小左.引入量级(值)的概念对中医舌象分类[J].浙江中医杂志,2006,41(3):140.
[4]Kondrup J,Allison SP,Elia M,et al.ESPEN guidelines for nutrition screening 2002[J].Clin Nutr,2003,22(4):4152-4211.
[5]梁晓坤,揭彬,蒋朱明.营养风险理念解读[J].中国临床营养杂志,2007,15(2):180-186.
[6]Detsky AS,Mc Laughlin JR,Baker JP,et al.What is subjective global assessment of nutritional status[J].JPEN,1987,11(1):82-131.
[7]Stratton RJ,Hackston A,Longmore D,et al.Malnutrition in hospital outpatients and inpatients:prevalence concurrent validity and ease of use of the‘malnutrition universal screeningtool’(‘MUST’)for adults[J].Br J Nutr,2004,92(5):7992-8081.
[8]王忆勤,吴巧教,鲍惠铸,等.ZBOX-I型舌脉象数字化分析仪的研制与临床应用[C]//第二次全国中西医结合诊断学术研讨会论文集,2008:26-28.
[9]Dzieniszewski J,Jarosz M,SzczygieB,et al.Nutritional status of patients hospitalised in Poland[J].Eur J Clin Nutr,2005,59(4):552-560.
[10]Waitzberg DL,Caiaffa WT,Correia MI.Hospital malnutrition:the Brazilian national survey(IBRANUTRI):a study of 4000patients[J].Nutrition,2001,17(7-8):573-580.
[11]Pham NV,Cox-Reijven PL,Wodzig WK,et al.SGA and measures for muscle mass and strength in surgical Vietnamese patients[J].Nutrition,2007,23(4):283-291.
[12]Unsal D,Mentes B,Akmansu M,et al.Evaluation of nutritional status in cancer patients receiving radiotherapy:a prospective study[J].Am J Clin Oncol,2006,29(2):183-188.
[13]Kondrup J,Rasmussen H,Hamberg O,et al.Nutritional risk screening(NRS-2002):a new method based on an analysis of controlled clinical trials[J].Clin Nutr,2005,22(3):321-336.
[14]Squier CA,Kermer MJ.Biology of oral mucosa and esophagus[J].J Natl Cancer Inst Monogr,2001,(29):7-15.
[15]Rowat JS,Squier CA.Rates of epithelial cell proliferation in the oral mucosa and skin of the tamarin monkey(Saguinus fuscicollis)[J].J Dent Res,1986,65(11):1326-1331.
[16]Potten CS.A Comprehensive study of the radiobiologicalresponse of the murine small intestine[J].Int Radiat Biol,1990,58(6):925.
[17]田同德,储真真,陈信义.恶性肿瘤高凝状态与血瘀证相关性及中医防治对策研究[J].北京中医药,2009,28(6):425-427.
[18]吴正治,郭振球.舌苔原理的综合实验研究[J].中国中医药科技,1996,3(6):5-8.