自贡地区原发性支气管肺癌中医证型分布规律研究

Distribution of Traditional Chinese Medicine Syndrome Types of Primary Bronchogenic Lung Cancer in Zigong Area

摘要: 目的：探讨自贡市中医医院就诊的原发性支气管肺癌患者的中医证型分布规律，为肺癌中医辨证规范化及个体化诊疗提供客观依据。方法：采用前瞻性研究方法，纳入2020年12月~2023年10月自贡市中医医院门诊及住院的原发性支气管肺癌患者410例，采集一般资料、肿瘤情况与四诊信息，依据八纲、气血及脏腑辨证原则，以“先辨单证、单证相合构成复证”的方法进行辨证分型，并分析证型与病理类型、临床分期的相关性。结果：410例患者中，男女比例约1:1；年龄26~89岁，平均(60.0 ± 10.9)岁，以40~70岁为高发。病理类型以腺癌(297例，72.4%)最多，其次为鳞癌(73例，17.8%)；临床分期以III、IV期为主(266例，64.9%)。病性证素以气虚(220例，53.7%)居首，其后依次为痰湿(122例，29.8%)、血瘀(86例，21.0%)、痰热(73例，17.8%)、阴虚(45例，11.0%)、气滞(14例，3.4%)。单一证候以气虚证、痰湿证为主；复合证候以气虚痰湿、气虚阴虚、气虚血瘀最为多见。病位以肺为核心(410例，100%)，兼及脾(139例，33.9%)、肾(82例，20.0%)为主。结论：自贡市中医医院就诊的原发性支气管肺癌患者以“正气亏虚为本，痰、瘀、热、毒为标”，病位主要在肺，与脾、肾密切相关；证型呈本虚标实、虚实夹杂之特点。确立以气虚为主、兼夹痰瘀的证候格局，对肺癌中医辨证分型标准化及中西医结合全程管理具有参考意义。

Abstract: Objective: To investigate the distribution of traditional Chinese medicine (TCM) syndrome types among patients with primary bronchogenic lung cancer admitted to Zigong Hospital of Traditional Chinese Medicine, so as to provide objective evidence for the standardization of TCM syndrome differentiation and individualized diagnosis and treatment of lung cancer. Methods: A prospective study was conducted. A total of 410 patients with primary bronchogenic lung cancer admitted to the outpatient and inpatient departments of Zigong Hospital of Traditional Chinese Medicine from December 2020 to October 2023 were enrolled. General data, tumor characteristics and four-diagnosis information were collected. Syndrome differentiation was performed based on the principles of eight-principle, qi-blood and zang-fu differentiation, using the method of “first identifying single syndromes and then combining them to form compound syndromes”, followed by analysis of the correlations of syndrome types with pathological type and clinical stage. Results: The male-to-female ratio was about 1:1, and the age ranged from 26 to 89 years, with a mean of (60.0 ± 10.9) years, with a high incidence in the 40~70-year age group. Adenocarcinoma was the most common pathological type (297 cases, 72.4%), followed by squamous cell carcinoma (73 cases, 17.8%). Stage III and IV accounted for the majority (266 cases, 64.9%). Among disease-nature syndrome elements, qi deficiency ranked first (220 cases, 53.7%), followed by phlegm-dampness (122 cases, 29.8%), blood stasis (86 cases, 21.0%), phlegm-heat (73 cases, 17.8%), yin deficiency (45 cases, 11.0%) and qi stagnation (14 cases, 3.4%), with single syndromes dominated by qi deficiency and phlegm-dampness and compound syndromes most commonly comprising qi deficiency with phlegm-dampness, qi deficiency with yin deficiency, and qi deficiency with blood stasis. The lung was the core disease location (410 cases, 100%), with the spleen (139 cases, 33.9%) and kidney (82 cases, 20.0%) as the main additional disease locations. Conclusion: Among patients with primary bronchogenic lung cancer admitted to Zigong Hospital of Traditional Chinese Medicine, the disease is characterized by “deficiency of vital qi as the root, and phlegm, blood stasis, heat and toxin as the branch”, with the disease mainly located in the lung and closely related to the spleen and kidney, showing a syndrome pattern of deficiency in root and excess in branch, and a mixture of deficiency and excess. Establishing the syndrome pattern dominated by qi deficiency complicated with phlegm and blood stasis is instructive for the standardization of TCM syndrome differentiation and the whole-course integrative management of lung cancer.