| Objective:In this study,PG-SGA was introduced for nutritional evaluation,and syndrome elements were extracted by syndrome elements differentiation method.The general situation,tumor status,symptoms,syndrome elements and syndrome distribution characteristics of gastric cancer patients under different nutritional conditions were compared,and the substantial connotation of "spleen and stomach are the foundation of acquired constitution" was explored through the correlation analysis between syndrome elements and biological parameters of various nutritional conditions,so as to provide theoretical and practical basis for the treatment of malnutrition of gastric cancer patients from the perspective of evidence-based.Methods:In the first part:152 cases of gastric cancer were selected according to the criteria of diagnosis,acceptance and discharge.The general and tumor conditions were collected,and the nutritional status was determined by PG-SGA nutrition evaluation scale,the symptom and symptom score were determined by symptom collection scale,and the syndrome elements were assessed by syndrome elements differentiation factor scale based on symptoms,and the main syndrome was based on the existing diagnosis criteria of gastric cancer.On this basis,statistical analysis was carried out to summarize and compare the data on the scale of malnutrition or not,and to summarize the distribution characteristics of patients’ general conditions,tumor conditions and TCM syndromes under different nutritional conditions In the second part: 104 cases of malnutrition from the first part were included.The main nutritional status evaluation indexes were collected and the correlation between them and main syndrome elements was analyzed.We intend to explore their suggestive effects on syndrome elements differentiation from the perspective of evidence-based medicine.Results:Part Ⅰ1.Comparison of general information: most of the patients with malnutrition come from the ward,and the patients with good nutrition mainly come from the outpatient(P<0.05).The patients with malnutrition have lower kappa score(P<0.05),and higher proportion of the first wasting symptoms(P<0.05).2.Tumor status: there was no significant difference in pathological type and location of primary focus(P>0.05).Lymph node metastasis was common in malnutrition and well nourished patients.Other metastasis was rare in well nourished patients.Distal metastasis was common in malnutrition patients.The order was abdominal cavity,liver,bone and lung.In terms of treatment,surgical treatment of malnutrition patients was more common than that of well nourished patients(P < 0.05).3.Symptom distribution: according to the statistics of upper digestive tract symptoms,digestive tract symptoms and non-specific symptoms,the symptom distribution of malnutrition patients is similar to that of well nourished patients,and their symptom score is higher than that of well nourished patients(P < 0.05).4.Distribution of syndrome elements: In malnutrition patients,stomach,spleen and liver were more common,phlegm,dampness and qi stagnation were more common in solid syndrome elements,Qi deficiency,blood deficiency,Yang deficiency and yin deficiency were common in deficiency syndrome elements,liver,spleen and stomach were common in patients with good nutrition,Qi deficiency and yin deficiency were common in deficiency syndrome elements,qi stagnation,dampness and heat of solid syndrome elements were more common.In the comparison of the weighted value of syndrome elements,the patients with malnutrition were higher than those with good nutrition(P < 0.05).5.The distribution of 5 syndromes: the main syndromes of malnutrition were stomach heat and Yin injury,spleen and stomach deficiency and cold,Qi and blood deficiency,liver Qi invading stomach,phlegm and dampness congealing,qi stagnation and blood stasis.The main syndromes of patients with good nutrition are liver Qi invading stomach,stomach heat Yin injury,phlegm dampness coagulation,Qi and blood deficiency,qi stagnation and blood stasis,spleen and stomach deficiency and cold.It can be seen that the main syndrome of malnutrition is deficiency.Part II1.muscle reserve: the difference in the distribution of phlegm syndrome was statistically significant(P < 0.05).Patients with decreased muscle reserve have more phlegm syndrome.2.Fat reserve: the difference in the distribution of spleen syndrome was statistically significant(P<0.05).Patients with reduced fat reserve have more spleen syndrome.3.BMI: Patients with blood deficiency and spleen syndrome had lower BMI(P<0.05).4.Albumin: Patients with blood deficiency and stomach syndrome had lower albumin(P<0.05).5.Upper arm circumference: Patients with Yin deficiency and spleen syndrome had lower upper arm circumference(P<0.05),and patients with dampness syndrome had higher upper arm circumference(P<0.05).6.Triceps skinfold thickness: Patients with stomach syndrome and spleen syndrome had lower triceps skinfold thickness(P<0.05),and patients with dampness syndrome had higher triceps skinfold thickness(P<0.05).7.Hemoglobin concentration: Patients with spleen syndrome had lower hemoglobin concentration(P <0.05).Conclusion:1.Based on the distribution of symptoms,syndrome elements and main syndromes,we think that patients with tumor malnutrition should be in a state of "damage".2.The disease location of "damage" lies in the spleen and stomach.It is of great significance to treat malnutrition of gastric cancer patients based on "spleen and stomach are the foundation of acquired constitution" and trace the cause and pathogenesis of gastric cancer and malnutrition.3.For the relevant nutritional indicators:the differential distribution of muscle reserve,fat reserve,BMI,ALB,upper arm circumference,triceps skinfold thickness,hemoglobin concentration under different syndrome factors can be used as a reference for clinical syndrome factors,trying to provide more detailed practical evidence and management strategies for clinical attention to "stomach based","spleen based treatment throughout all stages of TCM syndrome differentiation" 。... |
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