Zhang Yuan-Hui, Qin Xiao, Xu Jing
Shanghai University of Traditional Chinese Medicine, Shanghai 201203.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2012 Sep;32(9):1171-4.
To observe the Chinese medical syndrome features of patients with primary liver cancer before and after transcatheter arterial chemoembolization (TACE).
Recruited were 106 primary liver cancer (PLC) patients treated with TACE at the Department of Hepatobiliary Surgery, First Affiliated Hospital of Guangxi Medical University from May to November 2009. Using self-control study, the distributions of 8 syndrome types were compared, such as qi stagnation syndrome, blood stasis syndrome, excess-heat syndrome, fluid and damp syndrome, qi deficiency syndrome, blood deficiency syndrome, yin deficiency syndrome, and yang deficiency syndrome. The scoring for each syndrome quantization was performed to all patients before and after TACE.
Eight syndromes occurred in the 106 patients before treatment, amounting to 412 cases. The proportions of syndrome types in PLC patients before TACE were ranked from high to low as blood stasis syndrome [(92 cases, 86.8%)], excess-heat syndrome [(73 cases, 68.9%)], qi stagnation syndrome [(62 cases, 58.5%)], qi deficiency syndrome [(62 cases, 58.5%)], yin deficiency syndrome [(60 cases, 56.6%)], blood deficiency syndrome [(30 cases, 28.3%)], yang deficiency syndrome [(18 cases, 17.0%)], fluid and damp syndrome [(15 cases, 14.2%)]. The 8 syndromes occurred in 456 cases after TACE. The proportions of syndrome types in PLC patients after TACE were ranked from high to low as blood stasis syndrome [(89 cases, 84.0%)], qi deficiency syndrome [(87 cases, 82.1%)], excess-heat syndrome [(85 cases, 80.2%)], qi stagnation syndrome [(52 cases, 49.1%)], yin deficiency syndrome [(49 cases, 46.2%)], blood deficiency syndrome [(42 cases, 39.6%)], yang deficiency syndrome [(32 cases, 30.2%)], fluid and damp syndrome [(20 cases, 18.9%)]. After TACE the proportions of qi deficiency syndrome and yang deficiency syndrome increased with statistical difference (P<0.01, P<0.05). There were no statistical difference in terms of other syndromes between before and after TACE (P>0.05). Blood stasis syndrome and qi stagnation syndrome got the highest quantization scores before TACE. After TACE blood stasis syndrome and qi deficiency syndrome got the highest quantization scores. After TACE the score of qi stagnation syndrome decreased, while that of excess-heat syndrome, qi deficiency syndrome, blood deficiency syndrome, yang deficiency syndrome increased (all P<0.05).
It's necessary to pay attention to regulating qi, clearing heat, replenishing qi, and removing stasis for treating liver cancer patients. Clearing heat, replenishing qi, enriching blood, and warming yang after TACE should also be paid equal attention to while using syndrome typing methods.
观察原发性肝癌患者经肝动脉化疗栓塞术(TACE)前后的中医证候特点。
选取2009年5月至11月在广西医科大学第一附属医院肝胆外科接受TACE治疗的106例原发性肝癌(PLC)患者。采用自身对照研究,比较气滞证、血瘀证、实热证、痰湿证、气虚证、血虚证、阴虚证、阳虚证8种证候类型的分布情况。对所有患者在TACE前后进行各证候量化评分。
106例患者治疗前出现8种证候,共412例次。PLC患者TACE术前证候类型所占比例由高到低依次为血瘀证(92例次,86.8%)、实热证(73例次,68.9%)、气滞证(62例次,58.5%)、气虚证(62例次,58.5%)、阴虚证(60例次,56.6%)、血虚证(30例次,28.3%)、阳虚证(18例次,17.0%)、痰湿证(15例次,14.2%)。TACE术后出现8种证候,共456例次。PLC患者TACE术后证候类型所占比例由高到低依次为血瘀证(89例次,84.0%)、气虚证(87例次,82.1%)、实热证(85例次,80.2%)、气滞证(52例次,49.1%)、阴虚证(49例次,46.2%)、血虚证(42例次,39.6%)、阳虚证(32例次,30.2%)、痰湿证(20例次,18.9%)。TACE术后气虚证和阳虚证所占比例升高,差异有统计学意义(P<0.01,P<0.05)。TACE前后其他证候差异无统计学意义(P>0.05)。TACE术前血瘀证和气滞证量化评分最高。TACE术后血瘀证和气虚证量化评分最高。TACE术后气滞证评分降低,实热证、气虚证、血虚证、阳虚证评分升高(均P<0.05)。
肝癌患者治疗应注重理气、清热、补气、化瘀。TACE术后采用辨证分型方法时,清热、补气、养血、温阳也应予以同等重视。