摘要
目的
鼻咽癌是我国常见的恶性肿瘤之一,其死亡率占全国恶性肿瘤死亡率的2.8%,居第八位。该发病具有明显的区域性,以我国南部,特别是广东地区高发,据流行病学调查,广州市鼻咽癌的发病率,男性为11.62/10万,女性为4.89/10万,因此,对鼻咽癌防治的研究具有重要的社会意义。
放射治疗为鼻咽癌的首选治疗方法,但放射治疗具有一系列的并发症,如口干中耳炎等,严重影响患者的生存质量。因此,如何减轻放疗后副反应,提高放疗后患者生存质量是目前鼻咽癌治疗决策中急需解决的课题。然而提高鼻咽癌放疗敏感性、提高患者生存质量等方面,中医药有其独特的优势,有大量的临床报道为证。中医的精髓在于辨证论治,因此,证候研究成为当今鼻咽癌中医药研究的新热点。
通过文献检索,可以发现目前中医对鼻咽癌放疗后的证候规律多源于对个体资料的个人经验判断、简单的病例总结,缺少大样本的群体研究资料,对鼻咽癌放疗后的整体尚缺乏全面的认识,对放疗后不同时间段的证候认识识较粗糙,缺乏具体的时间段证候的总结,影响了鼻咽癌放疗后中医辨证临床运用及疗效的进一步提高。
本研究拟通过运用循证医学、临床流行病学及数理统计等数据挖掘技术,动态收集鼻咽癌放疗后患者的证候变化资料,采用数据库及流行病学研究方法进行分析,从而得出鼻咽癌放疗后中医证候演变的规律,为临床中医药治疗鼻咽癌提供证候学基础。
通过动态收集鼻咽癌放疗后患者的证候资料,采用流行病学研究方法进行分析,从而得出鼻咽癌放疗后中医证候演变的规律,为临床中医药治疗鼻咽癌提供证候学基础。结合中医体质调查量表,所收集鼻咽癌放疗后患者进行中医体质分析,并对其体质特点进行总结。
方法
根据文献资料及《中医量化诊断》、《中医诊断实验分析学》的中医四诊标准,制定的病例观察表,同时采用2009年中华中医药学会发布的中医体质分类与判定标准,详见附件。选择2008年12月至2010年3月期间在广东省中医院、广东省人民医院、广州军区总医院门诊及住院的鼻咽癌放疗后1年内患者198例,采用EpiData3.1、Microsoft Access软件包建立数据库。确定无误后将数据库转化生成SPSS13.0数据库文件。对连接好的SPSS13.0数据库的数据进行清理、逻辑检查、数据库字段的处理、生成新变量等数据量纲的转化及维护。对临床病例证型采用描述性分析,对中医证型变化情况运用聚类分析,初步得出鼻咽癌患者放疗后中医征候变化规律;同时运用中医体质辨识,了解体质分布情况。
结果
鼻咽癌患者放疗后中医证候变化规律:胃火炽盛、肝胆火盛逐渐向热盛伤阴(放疗后2个月)、气阴两虚夹瘀(放疗后7个月)过渡;胃火炽盛逐渐向阴虚有热(放疗后2个月)、气阴两虚(放疗后7个月)过渡;湿热内蕴向痰瘀互结(放疗后4个月)、脾胃失调(放疗后10个月)过渡;湿热内蕴向脾虚湿热夹瘀(放疗后7个月)变化。
随访病人中154例放疗后12个月的病人填写了体质观察量表,体质分布情况为平和质96例(其中68例出现偏颇质倾向,阴虚质倾向29例,气虚质倾向16例,痰湿质倾向10例,湿热质倾向5例,其他倾向8例),单纯气虚质13例,单纯阴虚质14例,气虚合并阴虚质3例,气虚合并痰湿质2例,痰湿质12例,湿热质6例,气郁质4例,其他4例。结论
鼻咽癌患者证侯在放疗后半年内以实证为主,半年后变为虚证或虚实夹杂,受年龄、烟酒嗜好影响不明显。体质出现偏颇变化,以平和质阴虚质、气虚质倾向所占比例最大。
Objective
Nasopharyngeal cancer is one of the most virulent cancers and there is high morbidity in China. At present, the most availability means is actinotheraphy. The Herbalist doctor plays an important part in enhancing sensitivity, preventing recrudesce and improving life quality,but the effect of traditional medicine is inimitable. The syndrome differentiate is the soul of TCM. The syndrome differentiation and treatment is so important that it became a new hot spot. But at present, the use of TCM about actinotheraphy just depends on individual experience and simple case summarization, which is short of a great lot of stylebook research. Cognizing is greadtly absence. The Herbalist doctor about after actinotheraphy differentiate is not unifiable. This will effect differentiate standard popularization and curative effect. This investigation objective is on base of TCM ZANGXIANG, introduce thinking and means of clinic epidemic, observed and investigate a great lot stylebook research, collecting Nasopharyngeal cancer after actinotheraphy Syndrome, probing into its rule and characteristic.
Methods
According to medical literature and "quantitative diagnosis of Chinese medicine", "Experimental Analysis of Traditional Chinese Medicine diagnostic study" of the four diagnostic criteria for Chinese medicine, the cases observation table, are at the Annex. Select 198 cases from Dec.2008 to March 2010 in Guangdong Province during the Chinese medicine hospital out-patients and hospitalization in patients with nasopharyngeal cancer after radiotherapy, and use EpiData3.1, Microsoft Access software to build up a database. Determine the correct database file into the database to generate SPSS13.0. SPSS13.0 database to connect a good clean-up of data and logic checks, the handling of the database field to generate new dimensionless variables, such as data conversion and maintenance. Clinical cases of the syndrome of symptoms and distribution of the analysis:the use of descriptive analysis. Clinical symptoms and syndromes will be analyzed through the multi-element analysis (the development of cluster analysis, principal component analysis) to draw relevance, separation of the various symptoms and syndromes, combination of elements of nasopharyngeal carcinoma after radiotherapy in order to get evidence-based traditional Chinese medicine. After radiotherapy for nasopharyngeal carcinoma TCM related factors x2 analysis of distribution patterns TCM.Also,we discuss constitution
Results
Changes of TCM syndrome in Nasopharyngeal carcinoma patients after radiotherapy:stomach fire ablaze, hepatobiliary H.-S. gradually leads to Yin xu (2 months after radiotherapy), Qi and Yin Deficiency folder stasis (7 months after radiotherapy) transition; Weihuo Flourishing Yin deficiency with heat gradually (radiotherapy after 2 months), Qi and Yin deficiency (7 months after radiotherapy) transition; to phlegm and dampness (4 months after radiotherapy), stomach disorders (after radiotherapy 10 months) transition; Spleen dampness folder to stasis (7 months after radiotherapy) change.
154 cases the patients were followed up for 12 months after radiotherapy, patients filled out the physical observation of inventory, physical distribution of 96 cases for the peaceful nature (of which 68 cases of biased and quality orientation, quality orientation of 29 cases of yin deficiency, qi deficiency and quality orientation in 16 cases, sputum tendency of the wet mass in 10 cases,5 cases of heat transfer orientation, other orientation 8), Qi deficiency alone in 13 cases,14 cases of simple yin deficiency, qi deficiency and yin deficiency combined in 3 cases,2 cases of deficiency combined phlegm, phlegm 12 cases,6 cases of heat transfer, Qi Yu quality in 4 cases, the other 4 cases.
Conclusions Patients with nasopharyngeal carcinoma after radiotherapy card within six months of evidence-based, six months into a deficiency, which is affected little by age, smoking, alcohol drinking. changes of constitution deficiency of quality tend to the largest proportion.
引文
[1]张峰,莫浩元,黄晓明,等.鼻咽癌高发家族的监控和筛查[J].癌症,2000,19(11):984~986.
[2]黎敬波,朱文锋.辨证规范化的难点和途径[J].医学与哲学1995,16(12):645.
[3]杨在纲.辨病与中医病名规范[J].贵阳中医学院学报,1999,21(1):4.
[4]孙志广.重视基础理论研究,推动中医现代化进程[J].南京中医药大学学报,2002,18(51):257.
[5]陈悦泰,张丽丽.浅谈建立中国医学病名及其系统的紧迫性[J].时珍国医国药,2001,12(4):343.
[6]陈士洲.现代医学及病中医辨证分型原则与方法初探[J].山东中医杂志,1993,12(5):11.
[7]吴承玉.统一、规范中医辨证体系——证候辨证系统研究[J]. 中国中医基础医学杂志,2001,7(4):25.
[8]谢静涛,黎敬波.中西病名对照的必要性、难点与途径[J].湖南中医药导报,1995,1(2):1.
[9]冯其海疣状胃炎中医辨证分型文献分析,浙江中医杂志,2008,4(43):198-199.
[10]陈涛,李丹.胃癌中医证型的文献分析.时珍国医国药,2006,17(4):661-662.
[11]孟虹,王忆勤,贺宪民,等.慢性胃炎中医证型辨证标准初探.上海中医药杂志,2004,38(2):33-35.
[12]武嫣斐,王素萍,孙健民,等.原发性支气管肺癌中医证型规范化研究.山西中医药学报,2007,8(2):21-22.
[13马科,马玲,施志明.原发性肝癌中医证型临床分布及证型标准.辽宁中医杂志,2007,34(4):421-422.
[14]曲晓璐,王湘林,方肇勤,等.从循证医学角度152例糖尿病肾病患者的中医证型分布特点.中医杂志,2005,46(2):131-133.
[15]高坤,孙伟,周栋,等.慢性肾脏病中医证型分布及演变规律研究.江苏中医药,2008,40(6):33-35.
[16]熊莉华,曾建勋,李赛美,等.糖尿病慢性并发症中医证型规律探讨.中药材,2007,30(8):1050-1051.
[17]王凤云,唐旭东,刘燕玲,等.慢性乙型肝炎患者中医证型特点及分布差异.世界华人消化杂志,2008,16(7):716-720.
[18]刘旭生,刘兴烈,刘敏,等.慢性肾衰中医证型分布特征的临床研究.江苏中医药,2007,28(8):964-966.
[19]高坤,孙伟,周栋,等.慢性肾脏病中医证型分布及演变规律研究.江苏中医药,2008,40(6):28-30.
[20]罗社文,李友林,等.咳嗽变异性哮喘中医证型的初步探讨.中华中医药杂志,2007,22(10):708-709.
[21]候新安.烧伤败血症的舌象变化及预后.中医研究,2007.20(10):55-56.
[22]李燕,梁嵘,万冬桂等.大肠癌化疗前后舌象变化的临床观察.江西中医学院学报,2008.20(1):38-39.
[23]崔红生,武维屏,任传云等.激素依赖型哮喘撤减激素过程中的证候学变化及其治疗特点.中医杂志,2005.46(5):371-373.
[24]樊永平,周纡,熊飓等.258例急性中风中医证型变化的观察及小复方辨证治疗在卒中单元中的疗效评价.中华中医药杂志(原中国医药学报),2006.21(1):23-26.
[25]李响,刘尚建,李靖等.肾移植术前后中医证候学变化.中医杂志2007.48(6)542-544.
[26]陈伯均潘宗奇苏学旭等.冠心病介入治疗前后中医证型变化的研究.中国中西医结合杂志2007.27(8):689-691.
[27]刘蓬.王德鉴教授学术思想介绍.新中医,2004,36(8):5-6.
[28]邓宏,徐凯.鼻咽癌放疗后毒副反应的中医药治疗.中国肿瘤,2002,11(6):337-338.
.[29]钟艳萍,丘宝珊,王士贞,等.从脾胃论治鼻咽癌放疗副反应作用『J』.新中医,2003,35(5):5.
[30]卢文娜,刘琳.辨证治疗鼻咽癌放疗副反应272例『J』.新中医,2002,34(11):55.
[31]龚春贵.辨证治疗鼻咽癌放疗毒副反应89例『J』.江西中医药,2004,35(255):31.
[32]高萍.辨证治疗鼻咽癌放疗不良反应126例『J』.贵阳医学院学报,2005,3(1):60.
[33]刘宇龙,徐凯,等.鼻咽癌中医证型与TNM分期相关性研究[J].四川中医,2005,23(9):90.
[34]何裕民.现代中医肿瘤学[M].北京:中国协和医科大学出版社,2005:247-248.
[35]张悦红.辨证治疗鼻咽癌放疗后口腔干燥症145例.湖南中医杂志,2002,18(1):35.
[36]任军,何伟,刘宜敏,等.中药黏膜保护剂治疗鼻咽癌放射性黏膜炎临床观察.广东药学院学报,2006,22(3):344-345.
[37]朱欠元.养阴清热法治疗鼻咽癌放疗后口腔粘膜反应的疗效观察.江西中医药, 2001,32(5):24.
[38]邹雨荷,潭丽蓉.中药防治鼻咽癌患者急性放射性口咽炎的临床研究.中华放射医学与防护杂志,2006,26(1):77.
[39]朱效勤.康复新液治疗鼻咽癌放疗后口腔反应.中华现代中西医杂志,2003,1(11):964.
[40]董峻桦,常学智.中华临床医学实践杂志,2005,4(6):570.
[41]路军章,赵红,崔书详,等.中药含漱防治放射性口腔黏膜炎30例.北京中医药大学学报,2002,25(3):60.
[42]邓卓霞,周富玲.金银花含漱对鼻咽癌放疗所致口咽并发症预防作用的探讨.广西医学,2002,24(11):1744-1745.
[43]宋晓。赵岩,李辉.中药雾化吸入治疗放射性咽炎60例.Chinese Journal of Coal Industry Medicine,2004,7 (5):476.
[44]梁云燕.中西医结合治疗鼻咽癌放疗后咽喉部副反应42例.湖南中医杂志,2005,21(2):50-51.
[45]王文玉,王相.三黄液防治放射性皮炎临床疗效分析.西北药学杂志,2003,18(5):222~223.
[46]王淑芳,洪金花,邓淑琴.金因肽双料喉风散合用鼻咽癌放疗后皮肤湿反应的护理.江西医药,2005,40(11):774-775.
[47]王伟文.中药芦荟外敷治疗56例鼻咽癌放疗后皮肤损伤的疗效观察.广东医学院学报,1995,13(1):75-76.
[48]陈伊宁.鼻咽癌放疗前后耳鼻咽喉病调查分析.广西医药,2003,25(6):888-900.
[49]邝梓兴,梁雄辉.中医药干预治疗鼻咽癌患者放疗后分泌性中耳炎60例疗效观察.中国医学杂志,2006,4(7):350-351.
[50]邹雨荷,郑作深.放射性脑病的治疗体会.临床肿瘤学杂志,2001,6(3):266-267
[51]黄智芬,黎汉忠,檀美芳,等.双黄连粉针配合丹参注射液治疗鼻咽癌放疗后疼痛疗效观察.河北中医,2000,22(5):328-329.
[52]韦祝新.大剂量复方丹参治疗鼻咽癌放疗后颈部纤维化4例.实用中西医结合杂志,1998,11(7):626.
[53]郑沛仪,阮经文.针灸配合心理治疗对鼻咽癌放疗后患者生活质量的影响.中国中医药信息杂志,2002,9(11):63-64.
[54]邱宝珊,王士贞,等.鼻咽癌中医辨证分型与细胞超微结构关系研究[J].中国中西结合耳鼻咽喉科杂志,1996,4(2):51.
[55]邱宝珊,钟庭机,王士贞,等.鼻咽癌中医辨证分型与病理组织学关系初探[J].广州中医药大学学报,1998,15(2):5.
[56]李连华,张蓓,陈徐贤,等.鼻咽癌中医各型患者的植物神经功能与外周血淋 巴细胞亚群相关性初步研究[J].中医研究,2000,13(2):14.
[57]刘书静,田道法,李东方.鼻咽癌中医辨证分型与预后相关性基因活性表达关系的初步研究[J].中国中西医结合耳鼻咽喉科杂志,2005,13(1):1.
[58]田道法,刘书静,曾亮,等.鼻咽癌患者初诊证型的肿瘤转移相关基因活性表达特性[J].中国中医药信息杂志,2006,11(13):30.
[59]王贤文,田道法,何迎春,等.初诊鼻咽癌患者临床证型与外周血淋巴细胞核蛋白差异表达相关性的初步分析[J].湖南中医药大学学报,2007,27(1):44.
[60]中维玺,孙燕.论中医证化学本质是蛋白质和肽及证本质的分子标准[J].中国中西医结合杂志,1999,19(11):696-699.
[61]王琦.中医体质学说的研究现状与展望[J].山东中医学院学报,1994,18(2):30.
[62]宋红普.对中医体质调研的几点思考[J].上海中医药杂志,2007,41(3):50.
[63]韩永明,张六通.中医体质学研究的特点[J].中国临床康复,2005,9(47):130131.
[64]边海云,陈利国.中医体质学说理论研究回顾[J].江苏中医,2006,27(9)75-77.
[65]韦芳宁,王莉.41 4例慢性肾脏病患者中医体质特征研究[J].国际医药卫生导报,2009,15(1):5.
[66]陈勇,肖炉芳,蔡晶.慢性胆囊炎患者与中医体质相关性研究[J].福建中医药,2006,8,37(4):1.
[67]高洁,吕凤娟,林蒋海.中医瘀血体质与HLA-Ⅱ类基因相关性研究[J].中华临床医学研究杂志,2006,12(22):2977-2979.
[68]周小军,王士贞,阮岩等.鼻咽癌变过程中医体质证候调查.中华中医药学刊,2008,4,26(4):721-723.