结直肠癌术后患者中医证型及用药规律文献分析

详细信息    查看全文 | 推荐本文 |

英文篇名：Literature Evaluation of Chinese Medicine Syndrome Types and Medication Rules in Postoperative Patients with Colorectal Cancer 作者：张彤 ; 何文婷 ; 杨宇飞 英文作者：ZHANG Tong;HE Wen-ting;YANG Yu-fei;Oncology Department,Xiyuan Hospital,China Academy of Chinese Medical Sciences; 关键词：结直肠癌 ; 文献评价 ; 中医证型 ; 中药 ; 根治术后 英文关键词：colorectal cancer;;literature evaluation;;Chinese medicine syndrome types;;Chinese herbal medicine;;postoperative patients 中文刊名：ZZXJ 英文刊名：Chinese Journal of Integrated Traditional and Western Medicine 机构：中国中医科学院西苑医院肿瘤科;新疆维吾尔自治区中医医院肿瘤二科; 出版日期：2018-06-03 10:42 出版单位：中国中西医结合杂志 年：2019 期：v.39 基金：国家国际科技合作专项项目(No.2013DFE33050);; 中国中医科学院自主选题项目(No.ZZ070854) 语种：中文; 页：ZZXJ201901012 页数：5 CN：01 ISSN：11-2787/R 分类号：40-44

摘要

目的通过文献分析归纳结直肠癌术后中医证型分布和用药规律。方法收集整理自1996—2016年中医药治疗结直肠癌术后患者的文献,采用改良Jadad评分量表对随机对照临床试验进行评价,对所选文献中的中医证型分布、中药使用频次等进行统计归类。结果在检索出的1 746篇文献筛选出16篇文献,其中12篇为随机对照临床试验,纳入文献共涉及1 509例患者,其中966例患者接受中医治疗。12篇随机对照临床试验的Jadad评分均低于3分,为低质量临床试验。文献中证型分布频率依次是:脾肾阳虚(23.6%)、气血亏虚(23.2%)、脾虚湿盛(19.5%)、脾气亏虚(16.5%)、气滞血瘀(11.2%)、肝肾阴虚(6.0%)。方剂中涉及64味中药,其中以白术、茯苓、甘草、黄芪、党参为代表的健脾益气类中药比例较多。5篇文献(31.3%)报告了卡氏评分,差异均有统计学意义(P<0.05)。结论结直肠癌术后的中医证型以"脾虚"为主要表现,兼有肾虚、痰湿、气滞、血瘀等,中医治法以健脾益气最为常见。
        Objective To summarize the distribution of Chinese medicine(CM) syndrome types and the regularity of drugs used in postoperative patients with colorectal cancer by frequency analysis. Methods We collated the literature of postoperative patients with colorectal cancer treated by CM from 1996 to 2016. The modified Jadad scale was used to evaluate randomized controlled clinical trials. The CM syndrome types and the use of Chinese herbal medicine in the selected dissertation were statistically classified. Results Totally 16 papers were selected according to the criteria of the review in the retrieved 1 746 articles, including 12 randomized controlled clinical trials. A total of 1 509 patients were included in the literature, 966 patients were treated with CM. The Jadad scores of the 12 randomized controlled clinical trials were less than 3 points, which were low quality clinical trials. The pattern distribution frequency was: deficiency of Pi and Shen(23.6%), deficiency of qi and blood(23.2%),Pi deficiency induced damp abundance(19.5%), deficiency of Pi-qi(16.5%), qi stagnation and blood stasis(11.2%), Gan-Shen yin deficiency(6.0%). There were 64 Chinese herbs in the 16 papers. The proportion of herbs for invigorating Pi and benefiting Qi had obvious advantages, such as Atractylodes macrocephala Koidz., Poria cocos, Glycyrrhiza uralensis, Astragalus membranaceus, Radix Codonopsis. Five papers(31.3%) reported the KPS score, all of the differences were statistical significant(P<0.05). Conclusions CM syndrome type of postoperative patients with colorectal cancer were characterized by Pi deficiency complicated with Shen deficiency, phlegm dampness, qi stagnation and blood stasis syndrome. "Strengthening Pi and supplementing qi" was the most common CM treatment for postoperative patients with colorectal cancer.

引文

[1] Rebecca L, Siegel MPH, Kimberly D, et al. Global cancer statistics, 2015[J]. CA Cancer J Clin, 2015, 65(1): 5-29.
    [2] Chen W, Zheng R, Zeng H, et al. Annual report on status of cancer in China, 2011[J]. Chin J Cancer Res, 2015, 27(1): 2-12.
    [3] 杜欣, 杨宇飞, 许云, 等. 中医药减少Ⅱ、Ⅲ期结直肠癌根治术后复发转移的用药规律分析[J]. 世界科学技术, 2014, 16(1): 21-26.
    [4] 李佳, 王文海. 中医药防治大肠癌复发转移的研究概况[J]. 中医杂志, 2012, 53(3): 255-258.
    [5] 郑筱萸主编. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 140, 223.
    [6] 吴静芳, 魏星, 裘华森. 大肠癌围手术期中医证候动态变化规律临床研究[J]. 浙江中西医结合杂志, 2014, 24(6): 277-279.
    [7] 吴国琳, 余国友, 李剑平, 等. 扶脾益胃方治疗大肠癌术后化疗患者的近期疗效及其对免疫功能的影响[J]. 中国中药杂志, 2010, 35(6): 782-785.
    [8] 尤建良, 周留勇. 扶正和胃合剂治疗大肠癌48例[J]. 药学与临床研究, 2007, 15(1): 60-62.
    [9] 李国章, 徐港. 扶正解毒汤对结直肠癌根治术后患者的近期临床疗效[J]. 辽宁中医杂志, 2015, 42(7): 1279-1280.
    [10] 杨腾飞. 化疗联合中药汤剂治疗术后气血双亏型大肠癌的疗效观察[J]. 临床医药文献杂志, 2016, 3(3): 461-464.
    [11] 王志峰. 化疗联合中药汤剂治疗术后气血双亏型大肠癌的疗效研究[J]. 临床医药文献杂志, 2015, 2(12): 2331.
    [12] 王怀璋, 王东飞, 王翠翠, 等. 化疗联合中药治疗大肠癌的临床观察[J]. 医药论坛杂志, 2015, 36(10): 33-34.
    [13] 包益洁, 邱艳艳, 胡送娇, 等. 健脾补肾方对大肠癌术后辅助治疗的疗效[J]. 上海医学, 2014, 37(11): 984-986.
    [14] 韩力, 潘永福, 黄春锦, 等. 健脾清肠方结合化疗治疗大肠癌术后临床观察[J]. 上海中医药杂志, 2012, 46(5): 42-44.
    [15] 周浩, 沈克平. 胃肠安治疗大肠癌术后脾虚证的临床研究[J]. 上海中医药杂志, 2009, 43(6): 36-38.
    [16] 潘敏求, 潘博, 黎月恒. 益气调腑汤配合化疗治疗大肠癌43例临床观察[J]. 湖南中医药导报, 2003, 9(11): 12-14.
    [17] 刘静安, 张悦红. 中西医结合治疗大肠癌术后154例临床观察[J]. 中草药, 2000, 31(5): 367-368.
    [18] 王文萍, 王垂杰, 刘放, 等. 中药复方肠安泰预防大肠癌术后转移 80 例临床观察[J]. 北京中医药大学学报, 2003, 26(2): 60-62.
    [19] 杨祖贻, 刘超, 罗洁, 等. 中药联合化疗治疗Ⅲ期大肠癌术后患者的临床研究[J]. 中国肿瘤临床与康复, 2005, 12(2): 190-192.
    [20] 雷海龙. 中药结合FOLFOX4方案对术后结直肠癌患者治疗实效性探讨[J]. 中国现代医生, 2016, 54(4): 271-274.
    [21] 屠德敬, 赵海燕, 谷建钟, 等.75例大肠癌患者化疗前后中医证候变化临床研究[J]. 中华中医药学刊, 2009, 27(8): 1678-1680.
    [22] 许云, 赵爱光, 谷晓红, 等. 218例大肠癌根治术后中医辨证规律的临床研究[J]. 世界科学技术, 2011, 13(6): 938-942.
    [23] 赵海燕, 屠德敬, 夏溪, 等. 151例辅助治疗期大肠癌患者中医证候分布研究[J]. 中华中医药杂志, 2011, 26(4): 861-864.
    [24] 徐玉芬, 王辉, 郭勇, 等. 围手术期大肠癌患者中医症状特点及证型分布规律初步分析[J]. 中华中医药杂志, 2013, 28(3): 849-851.
    [25] 司富春, 岳静宇. 近30年大肠癌中医证型和用药规律分析[J]. 中华中医药杂志, 2012, 27(7): 1929-1931.
    [26] 杜欣, 许云, 王建彬, 等. 中医药减少Ⅱ、Ⅲ期结直肠癌根治术后复发转移的用药规律分析[J]. 世界科学技术, 2014, 16(1): 21-25.
    [27] 蒋立文, 郭勇. 郭勇教授中医治疗辅助期大肠癌经验浅析[J]. 中国中医急症, 2013, 22(12): 2055-2056.