| Objective:Evaluate the clinical efficacy of simple traditional Chinese medicine in the treatment of pulmonary nodules,and explore the influencing factors of the efficacy of traditional Chinese medicine in the treatment of pulmonary nodules,to provide a reference for the traditional Chinese medicine treatment of pulmonary nodules.Methods:A retrospective case series study was conducted,and patients with pulmonary nodules who had been treated with traditional Chinese medicine for 6 months or more were continuously included according to the inclusion and exclusion criteria.General data such as demographic,past medical history,personal history,family history,medical records of traditional Chinese medicine and imaging data of pulmonary nodules were collected.The diameter of pulmonary nodules,malignant risk score,risk degree and the changes of symptoms before and after treatment were compared to evaluate the efficacy of simple traditional Chinese medicine in the treatment of pulmonary nodules,and to explore the correlation between the general information of patients,nodule characteristics and the efficacy.Results:A total of 269 patients were included in this study,including 203 patients who could provide medical records of traditional Chinese medicine.(1)Baseline data of patients:In terms of gender distribution,females were more than males,with a ratio of males to females of 1:3.14;In terms of age distribution,middle-aged and elderly patients were significantly more than young patients.In terms of body mass index(BMI),51.67%were above the normal range.In terms of economy,86.25%of households with per capita monthly income of more than 2,000 yuan,88.10%of urban residents,78.07%of medical insurance payers,69.14%of patients with the financial burden of treatment.In terms of education,78.81%of those with a high school degree or above.In terms of tumor history,71.38%of patients had a history of tumor,52.79%of patients had been diagnosed with lung cancer,18.59%of patients had been diagnosed with other malignant tumors besides lung cancer,and 7.43%of patients had a history of thoracic malignant tumors for more than 5 years.In terms of other previous history,13.01%of patients had a history of respiratory diseases,2.23%had a history of emphysema,and 12.27%had a history of other respiratory diseases(except emphysema).In terms of personal history,13.01%had a history of smoking,and 15.61%had a history of dust exposure or high-risk occupational exposure.Family history of lung cancer accounted for 26.02%.(2)Baseline nodule data:50.56%of patients with a diameter≤5 mm,45.72%of patients with a diameter between 5-10mm,and 3.72%of patients with a diameter≥10mm.Nodules located in the upper lobe of lung accounted for 34.20%.In terms of density,the number of ground glass nodules was the largest,accounting for 42.01%,followed by solid nodules,accounting for 11.90%,and partial solid nodules were the least,accounting for 2.60%.As for the imaging features of nodules,there were 9 cases of cavitation sign,7 cases of blurred edges,4 cases of burr sign and pleura sag(pulling),2 cases of lobulation sign and irregular shape.In terms of risk degree,low-risk nodules accounted for 71.00%,medium-risk nodules accounted for 29.00%,and no high-risk nodules.(3)TCM symptoms and syndrome elements:The symptoms with high frequency mainly included insomnia(44.83%),cough(33.00%),fatigue(29.06%),sputum(28.57%),sweating(27.09%),pain(24.14%),shortness of breath(21.67%),dry mouth(16.26%),loose stool(16.26%),and chills(12.32%),etc.Single syndrome element accounted for 52.22%,multiple syndrome element accounted for 36.45%,and no discernable syndrome accounted for 11.33%.The specific syndrome elements ranked by incidence as qi deficiency syndrome(60.10%)>yin deficiency syndrome(39.41%)>phlegm-dampness syndrome(12.81%)>yang deficiency syndrome(5.91%)>blood stasis syndrome(3.45%)>heat toxicity syndrome(2.96%)>kidney deficiency syndrome(1.48%)=liver depression syndrome(1.48%)>qi stagnation syndrome(0.99%).(4)Curative effect evaluation of pulmonary nodules:The effective rate of traditional Chinese medicine in the treatment of pulmonary nodules was 8.55%,the stabilization rate was 78.81%,and the progression rate was 12.64%.There were no significant differences in lung nodule diameter,malignant risk score and risk grade before and after treatment(P>0.05).(5)Evaluation of the efficacy of TCM symptoms:TCM intervention can effectively improve the clinical symptoms of patients with pulmonary nodules.The effective rates of insomnia,cough,fatigue,expectoration and sweating were 59.34%,62.69%,67.80%,67.24%and 74.55%,respectively.(6)Correlation analysis:Multivariate Logistic regression analysis showed that nodule diameter,density,TCM syndrome elements and Mayo’s malignant risk score were all independent factors influencing the curative effect(P<0.05),and the increase of lung nodule diameter,non-partial solid nodule and non-yin deficiency syndrome all suggested a higher possibility of effective treatment(OR>1).The increase in Mayo’s malignant risk score and non-heat toxicity suggested a higher likelihood of nodule progression(OR<1).(7)Comparison between the effective group and the progressive group:The effective group and the progressive group were mainly female,middle-aged and elderly people,with BMI much higher than the normal range,and the proportion of patients with a history of malignant tumor was 69.60%and 76.50%,respectively.The proportion of patients with family history of lung cancer was 30.40%and 29.40%,respectively.Some patients had a history of occupational dust exposure and smoking,with no statistical difference between groups(P>0.05).The diameter of nodules in the effective group was 7.00(6.00,8.00)mm,and that in the progressive group was 5.00(4.00,7.00)mm,with statistical significance(P<0.05).The proportion of ground glass nodules in both groups was the largest,and the middle and low risk nodules were the main nodules,and there was no statistical difference in distribution between groups(P>0.05).Conclusions:(1)The symptoms with high frequency in patients with pulmonary nodules include insomnia,cough,fatigue,sputum,sweating,pain,shortness of breath,dry mouth,loose stool,fear of cold,etc.Qi deficiency syndrome,yin deficiency syndrome,phlegm-dampness syndrome were the most common symptoms,and some patients have no distinguishable syndrome.(2)Simple treatment with traditional Chinese medicine can control the progression of nodules well.(3)Simple treatment with traditional Chinese medicine can effectively improve the clinical symptoms of patients with pulmonary nodules.(4)The independent influencing factors of TCM intervention on pulmonary nodules include diameter,density,TCM syndrome elements and Mayo malignant risk score,which is the most widely used in the world.The increase of lung nodule diameter,non-partial solid nodule,and non-yin deficiency syndrome all suggested higher possibility of effective treatment;the increase of Mayo’s malignant risk score and non-heat toxicity syndrome suggested higher possibility of nodule progression. |
PDF Full Text Request