中药干预对老年晚期非小细胞肺癌氩氦刀冷冻术前后证型的影响

摘要

Objective To investigate the changing rules of TCM syndrome patterns, the possible factors contributing to changes of syndrome patterns, and the effects of the Chinese medicinal interventions based on syndrome differentiation before and after Argon-helium cryoablation on elderly patients with non-small cell lung cancer ( NSCLC). Methods 130 NSCLC Patients were divided into two groups. 65 patients from Combination Group ( Group I) were given the treatments of TCM combined with best supportive care (BSC) after argon-helium cryoablation. The rest 65 patients of Western Medicine Multi-modality ( group II) were given the treatments of BSC alone. TCM syndrome types were observed and analyzed on the 1st day before operation, 1 week, 1 month and 3 months after the surgery respectively. Results The patterns of syndrome could be mainly classified into 4 patterns: qi deficiency, yin deficiency, phlegm-damp and blood stasis. (1) Qi deficiency syndrome:the frequency of qi deficiency in group I was less than those in group II 1 month and 3 months after the surgery(P<0. 05). The frequency of qi deficiency in group II was increased 1 week and 3 months after the surgery with statistical difference (P<0. 05). (2) Yin deficiency syndrome: there were no statistical differences of the frequency of yin deficiency between 2 groups ( P > 0. 05). (3) Dampness-phlegm syndrome: the frequency of dampness-phlegm in group I was less than group II 1 month and 3 months after the surgery(P<0. 05). The frequency of dampness-phlegm in group II was increased 1 month and 3 months after the surgery, with statistical difference (P<0. 05). (4)Blood stasis: the frequency of blood stasis in group II was increased 1 month and 3 months after the surgery with statistical difference (P<0. 05). Conclusion TCM treatments based on syndrome differentiation can significantly improve effectiveness of treatments, especially for qi deficiency, phlegm-damp and blood stasis. Moreover, the following principles can be used to guide clinical treatments: reinforcing qi, nourishing yin, eliminating phlegm and resolving stasis.%目的：研究老年晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者氩氦刀冷冻治疗前后的证候类型变化规律,及基于辨证论治中药干预对老年晚期非小细胞肺癌患者氩氦刀冷冻治疗后证型的影响。方法收集自2011年9月至2014年9月期间老年晚期 NSCLC 并接受氩氦刀冷冻治疗患者共130例,分为中西医结合组65例(予辨证中药治疗+最佳对症治疗)和西医治疗组65例(仅予最佳对症支持),分别于术前1天、术后1周、术后1月、术后3月进行辨证,比较两组氩氦刀冷冻术前后证型变化情况。结果(1)老年晚期 NSCLC 患者氩氦刀冷冻术前后均以气虚、痰湿、阴虚、血瘀为主要证型；(2)气虚证：两组比较,术后1月和术后3月中西医结合组气虚证例数比西医治疗组少( P<0.05)；西医治疗组气虚证例数于术后1周和术后3月比术前增多(P<0.05)；(3)痰湿证：两组比较,术后1月、术后3月中西医结合组痰湿证例数比西医治疗组少(P<0.05)；西医治疗组术后1月、术后3月痰湿证例数比术前增多(P<0.05)；(4)血瘀证：西医治疗组术后1月、术后3月血瘀证例数比术前增多(P<0.05)。结论气虚、痰湿、阴虚、血瘀是老年晚期NSCLC 患者氩氦刀冷冻治疗前后最主要的证型。基于辨证论治使用中药能有效改善氩氦刀冷冻术后气虚证、痰湿证、血瘀证,明显优于单纯西医治疗患者,中医当以益气养阴、祛痰化瘀为主要治疗原则。