| Purpose:In this study,we use prospective research methods to study the changes of TCM syndromes and syndrome types of patients with advanced esophageal cancer before and after paclitaxel combined with nedaplatin chemotherapy,to explore the influence of chemotherapy drugs on the changes of TCM syndromes and syndrome types of patients with advanced esophageal cancer,to clarify the distribution and change regulation of esophageal cancer pathogenesis and syndrome types,to determine the best time for TCM combined with chemotherapy,and to provide important theoretical basis for disease prognosis,which guides clinical treatment with integrated traditional Chinese and Western medicine,in order to achieve the overall grasp of disease progress and development,predicting the prognosis of patients,early use of intervention treatment,improving the quality of life,and prolonging the life of patient.Method:From September 2018 to December 2019,54 patients with advanced esophageal cancer who met the inclusion criteria were collected from the wards and outpatients of Jiangsu Province hospital of Chinese medicine and Jiangsu cancer hospital.Making the questionnaire survey,recording the basic information of patients,the four diagnosis of traditional Chinese medicine and laboratory examination of the day before chemotherapy,the d8 of chemotherapy,and the d21 day of chemotherapy and classify the patients according to the reference standards.After statistics and sorting out the data,establish a database established using SPSS software for analysis to obtain statistically significant data.Result:(1)among 54 cases of advanced esophageal cancer,43 cases were male,accounting for 79.6%;29 cases aged 56-65 were high incidence.About the pathological types,squamous cell carcinoma was the most in 48 cases(88.9%),adenocarcinoma in 5 cases(9.3%),and small cell neurosecretory carcinoma in 1 case(1.9%).before chemotherapy,the TCM Syndromes of d0 were mainly the syndrome of phlegm stagnation,qi stagnation and blood stasis,accounting for 24.07%,22.2%and 16.67%respectively,while the syndrome of deficiency was relatively small;the syndrome types were mainly the syndrome of phlegm Qi mutual obstruction and the syndrome of blood stasis and phlegm stagnation,accounting for 48.15%and 37.04%respectively,while the syndrome of yin deficiency and internal heat and the syndrome of qi deficiency and yang deficiency were relatively small;at d8 after chemotherapy,the proportion of deficiency began to rise gradually,(2)before chemotherapy,the TCM Syndromes of d0 were mainly the syndrome of phlegm stagnation,qi stagnation and blood stasis,accounting for 24.07%,22.2%and 16.67%respectively,while the syndrome of deficiency was relatively small;the syndrome types were mainly the syndrome of phlegm Qi mutual obstruction and the syndrome of blood stasis and phlegm stagnation,accounting for 48.15%and 37.04%respectively,while the syndrome of yin deficiency and internal heat and the syndrome of qi deficiency and yang deficiency were relatively small;at d8 after chemotherapy,the proportion of deficiency began to rise gradually,However,the proportion of phlegm syndrome,qi stagnation syndrome,blood stasis syndrome and cold dampness syndrome began to decline gradually,accounting for 20.37%of phlegm syndrome,followed by 18.5%of blood deficiency syndrome.In the changes of syndrome types,phlegm Qi mutual obstruction syndrome and blood stasis phlegm stagnation syndrome decreased,yin deficiency and internal heat syndrome and Qi deficiency and Yang Micro syndrome increased,accounting for the largest proportion of phlegm Qi mutual obstruction syndrome and Qi deficiency and Yang Micro syndrome,accounting for 29.63%;in d21 after chemotherapy,the main syndrome types of TCM in patients were Yang deficiency,Qi deficiency and blood deficiency,accounting for 22.2%and 20.37%respectively(the syndrome of qi deficiency and blood deficiency are the same),while phlegm turbidity syndrome and Qi deficiency syndrome The proportion of syndrome of stagnation,blood stasis and cold dampness is very small.In the aspect of syndrome type change,the main syndrome types are Qi deficiency Yang Micro syndrome and yin deficiency internal heat syndrome,accounting for 48.15%and 38.8%respectively,and the phlegm Qi mutual obstruction syndrome and blood stasis phlegm stagnation syndrome are significantly reduced,accounting for 7.41%and 5.56%respectively;(3)in the changes of clinical indicators before and after chemotherapy,the positive rates of d0 and d21 of CEA were 22.2%and 18.5%,respectively,with no significant difference;the positive rates of d0 and d21 of CA199 were 12.9%and 9.3%,respectively,with no significant difference;the positive rates of d0 and d21 of CA125 were 29.6%and 12.9%,respectively,with significant difference(P=0.034<0.05);the number of myelosuppression of?-? was reduced from 3 cases at d8 to 0 cases at d21,the difference of ?-? myelosuppression was statistically significant(P=0.007<0.05);at d8,there were 13 cases of ?-? myelosuppression,accounting for 24.07%of the total number of cases,3 cases of ?-? myelosuppression,accounting for 5.56%of the total number of cases,at d21,3 cases of ?-? myelosuppression,accounting for 5.56%of the total number of cases,0 cases of ?-? myelosuppression,accounting for 0%of the total number of cases;according to the statistical analysis of digestive tract response at d21 compare with d8,The number of the cases decreased,accounting for 25.92%and 46.29%respectively.(4)Before chemotherapy,51.85%of the patients had red tongue,25.92%had light tongue,20.37%had dark purple tongue,1.85%had crimson tongue,64.81%had white and greasy tongue coating,18.5%had yellow and greasy tongue coating,7.41%had light and white tongue coating,18.5%had little tongue coating.On the d8 after chemotherapy,30.03%,27.77%,31.48%and 3.7%were light tongue,red tongue,purple dark tongue and crimson tongue,respectively;7.41%,46.30%,11.11%and 35.19%were yellow and greasy tongue coating,white greasy tongue coating,thin white tongue coating and little tongue coating,respectively;on the d21 after chemotherapy,55.56%,24.07%,18.5%and 1.85%were light tongue,red tongue,purple dark tongue and crimson tongue,respectively;3.7%,33.33%,38.89%and 24.07%were yellow and greasy tongue coating,white greasy tongue coating,thin white tongue coating and little tongue coating,respectively.The difference of tongue distribution before and after chemotherapy was statistically significant(P<0.05).Before and after chemotherapy,48.14%,38.89%,7.41%and 5.56%of them were stringy smooth pulse,stringy weak pulse,stringy weak pulse and sunken fine pulse respectively;after chemotherapy,37.04%,18.5%,11.1%and 33.33%of pulse condition were stringy smooth pulse,stringy weak pulse,stringy weak pulse and sunken fine pulse respectively;after chemotherapy,33.33%,11.1%,33.33%and 22.2%of pulse condition were stringy smooth pulse,stringy weak pulse and sunken fine pulse respectively.The difference of pulse condition distribution before and after chemotherapy was statistically significant(P<0.05).Conclusion:Before and after chemotherapy of paclitaxel liposome combined with nedaplatin in the treatment of advanced esophageal cancer,the changes of TCM syndrome types are regular.Before chemotherapy,the main syndromes were phlegm turbid syndrome and qi stagnation syndrome.After chemotherapy,the main syndromes were Qi deficiency syndrome,blood deficiency syndrome and yang deficiency syndrome.Before chemotherapy,the main syndromes were phlegm Qi block syndrome and blood stasis phlegm stagnation syndrome.After chemotherapy,the syndrome of qi deficiency and Yang Micro syndrome and yin deficiency and internal heat syndrome increased significantly.It is suggested that paclitaxel liposome combined with nedaplatin chemotherapy,as an external evil,can not only inhibit the tumor,but also damage the healthy qi,Qi and blood,spleen and kidney,not only in the change of syndrome type,but also in the inhibition of bone marrow and gastrointestinal side effects.When it is used in the early intervention of traditional Chinese medicine treatment,we should pay attention to attacking and supplementing simultaneously,invigorating the spleen and kidney,and strengthening and protecting Qi. |
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