基于临床数据分析原发性肝癌的证治规律
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摘要
目的分析原发性肝癌证治规律。方法选取来自湖南省中医药研究院附属医院近5年住院的原发性肝癌病历资料。使用SPSS 21.0软件,采用频次统计和聚类分析对肝癌四诊信息及用药进行数据挖掘。结果依据纳入标准和排除标准,最终获取628份合格病历。对628例患者病历的四诊信息进行逐一提取,共获得73个四诊信息表现字段,总频次达4 978次,出现频次在30次以上的核心四诊有50个。628例患者生存期>6个月以上原发性肝癌患者病历中,共使用中药348味,药物总频次28 547次,使用频次在100次以上的核心药物共57味。从原发性肝癌四诊信息聚类分析及用药规律发现原发性肝癌以肝区疼痛、倦怠乏力、纳呆恶食、夜寐差、形体消瘦为主要临床特点;黄芪、甘草、白术、白花蛇舌草、半枝莲、茯苓、重楼为主要药物;其四个基本证型分别是肝瘀脾虚证、湿热蕴脾证、湿热毒结证、肝肾阴虚证。结论 "瘀、毒、虚"为原发性肝癌基本病机,益气健脾、化瘀软坚、清热解毒法为中医治疗肝癌的主要治法,其中益气健脾为治疗根本。
Objective To analyze the diagnostic and therapeutic rules for primary liver cancer. Methods The medical records of primary liver cancer in The Affiliated Hospital of Hunan Academy of Chinese Medicine in recent 5 years were collected.SPSS 21.0 was used to process the information obtained by four diagnostic methods and medication used with frequency analysis and cluster analysis in order to obtain rules. Results According to the inclusion criteria and exclusion criteria, 628 valid medical records were obtained. The information obtained by four diagnostic methods from 628 patients was collected, and 73 information fields were obtained, with a total frequency of 4978 times; there were 50 core information fields that appeared more than 30 times.A total of 348 traditional Chinese medicines were used in the medical records of the primary liver cancer patients with a survival time of >6 months among the 628 cases, with a total frequency of 28 547 times, and 57 core medicines were used more than 100 times. According to medication rules and the cluster analysis of the information obtained by four diagnostic methods, it was foundthat the main clinical features of primary liver cancer were pain in the liver area, fatigue, poor appetite and nausea, poor sleep quality, and emaciation; Astragalus membranaceus, Radix Glycyrrhizae, Atractylodes macrocephala, Hedyotis diffusa, Scutellaria barbata, Poria cocos, and Rhizoma Paridis were the main drugs used; the four basic syndrome types were liver stasis and spleen deficiency, damp-heat retention in spleen, damp-heat-toxin accumulation, and liver-kidney Yin deficiency. Conclusion Stasis, toxin, and deficiency are the basic pathogenesis of primary liver cancer. Tonifying Qi and strengthening the spleen, resolving stasis and softening hard mass, and clearing heat and detoxicating are the main therapies for liver cancer in traditional Chinese medicine, and tonifying Qi and strengthening the spleen is the basic treatment.
Objective To analyze the diagnostic and therapeutic rules for primary liver cancer. Methods The medical records of primary liver cancer in The Affiliated Hospital of Hunan Academy of Chinese Medicine in recent 5 years were collected.SPSS 21.0 was used to process the information obtained by four diagnostic methods and medication used with frequency analysis and cluster analysis in order to obtain rules. Results According to the inclusion criteria and exclusion criteria, 628 valid medical records were obtained. The information obtained by four diagnostic methods from 628 patients was collected, and 73 information fields were obtained, with a total frequency of 4978 times; there were 50 core information fields that appeared more than 30 times.A total of 348 traditional Chinese medicines were used in the medical records of the primary liver cancer patients with a survival time of >6 months among the 628 cases, with a total frequency of 28 547 times, and 57 core medicines were used more than 100 times. According to medication rules and the cluster analysis of the information obtained by four diagnostic methods, it was foundthat the main clinical features of primary liver cancer were pain in the liver area, fatigue, poor appetite and nausea, poor sleep quality, and emaciation; Astragalus membranaceus, Radix Glycyrrhizae, Atractylodes macrocephala, Hedyotis diffusa, Scutellaria barbata, Poria cocos, and Rhizoma Paridis were the main drugs used; the four basic syndrome types were liver stasis and spleen deficiency, damp-heat retention in spleen, damp-heat-toxin accumulation, and liver-kidney Yin deficiency. Conclusion Stasis, toxin, and deficiency are the basic pathogenesis of primary liver cancer. Tonifying Qi and strengthening the spleen, resolving stasis and softening hard mass, and clearing heat and detoxicating are the main therapies for liver cancer in traditional Chinese medicine, and tonifying Qi and strengthening the spleen is the basic treatment.
引文
[1]张爽,王锋,孟庆玲,等.原发性肝癌患者流行病学与乙型肝炎病毒感染调查[J].中国疫苗和免疫,2018,24(2):133-136,151.
[2]曾普华,潘敏求.浅析潘敏求辨治恶性肿瘤的学术思想观[J].辽宁中医杂志,2016,43(8):161-162.
[3]侯公瑾,柏正平,潘敏求,等.基于聚类分析探讨中医外治法治疗癌性疼痛用药规律[J].湖南中医药大学学报,2018,38(3):292-295.
[4]邵峰,曾普华,郜文辉,等.中医药治疗原发性肝癌用药规律的文献研究[J].湖南中医杂志,2018,34(11):117-119.
[5]中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].临床肿瘤学杂志,2011,20(10):929-946.
[6]朱文锋.实用中医辨证手册[M].长沙:湖南科技出版社,2009:32-74.
[7]高学敏.中药学[M].北京:中国中医药出版社,2007:1-8.
[8]张爽,王锋,孟庆玲,等.原发性肝癌患者流行病学与乙型肝炎病毒感染调查[J].中国疫苗和免疫,2018,24(2):133-136,151.
[2]曾普华,潘敏求.浅析潘敏求辨治恶性肿瘤的学术思想观[J].辽宁中医杂志,2016,43(8):161-162.
[3]侯公瑾,柏正平,潘敏求,等.基于聚类分析探讨中医外治法治疗癌性疼痛用药规律[J].湖南中医药大学学报,2018,38(3):292-295.
[4]邵峰,曾普华,郜文辉,等.中医药治疗原发性肝癌用药规律的文献研究[J].湖南中医杂志,2018,34(11):117-119.
[5]中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].临床肿瘤学杂志,2011,20(10):929-946.
[6]朱文锋.实用中医辨证手册[M].长沙:湖南科技出版社,2009:32-74.
[7]高学敏.中药学[M].北京:中国中医药出版社,2007:1-8.
[8]张爽,王锋,孟庆玲,等.原发性肝癌患者流行病学与乙型肝炎病毒感染调查[J].中国疫苗和免疫,2018,24(2):133-136,151.