| Purpose:This topic adopts a prospective research method to observe the changes in clinical manifestations,signs,tongue coating,pulse and other aspects of erlotinib before and after targeted non-small cell lung cancer.The evolution law provides an entry point for early intervention of traditional Chinese medicine,and creates a clinical theoretical foundation platform for the treatment of advanced non-small cell lung cancer by combining Chinese and Western medicine to further improve the clinical efficacy.Method:From March 2019 to January 2020,50 patients with EGFR-sensitive mutations in advanced non-small cell lung adenocarcinoma were diagnosed at Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing Chest Hospital,and Jiangsu Provincial Cancer Hospital.TCM syndromes at three time points of d0,d15,and d30 for oral erlotinib treatment were collected by questionnaires,and the syndrome differentiation was performed.A database was established with SPSS22.0 to analyze the distribution and evolution of TCM syndromes before and after erlotinib.Results:(1)A total of 50 lung cancer patients were included in this study,including 31 males(62.0%)and 19 females(38.0%);29 patients with smoking history,accounting for 58.0%;17 patients with genetic history,The proportion of EGFR-sensitive mutations was in exon 19 deletion mutation(44.0%)and exon 21 point mutation(56.0%).The pathological stage of patients was mainly IVA,31 cases,accounting for 62.0%.Patients ranged in age from 46 to 82 years,with an average age of 63.87±9.15 years.(2)Before erlotinib treatment,d0(when enrolled)was mainly characterized by cough,sputum,white and sticky sputum,nausea,dullness,chest tightness and other symptoms,cough,fatigue,and lack of gas.,Shortness of breath,low frequency,and spontaneous sweating appear more frequently;the tongue is dominated by pale red tongue(54.0%)and tooth scar tongue(44.0%);tongue coating is thin white coating(50.0%)and less coating(30.0%)The main pulse patterns are fine veins(44.0%)and slippery veins(26.0%).The single syndrome type is mainly phlegm-dampness syndrome,with 26 cases,accounting for 52.0%of the total,followed by qi deficiency syndrome in 19 cases.(38.0%),16 cases of phlegm-heat syndrome(32.0%),14 cases of qi stagnation syndrome(28.0%),and 12 cases of yin deficiency syndrome(24.0%);TCM syndromes are more common in spleen deficiency,phlegm and dampness syndrome,with 22 cases.It accounted for 44.0%,followed by qi-yin deficiency syndrome and yin-deficiency syndrome,with 11 cases and 10 cases,accounting for 22.0%and 20.0%.(3)After treatment,d15 mainly increased symptoms such as fatigue,five upsets,dry throat,dry mouth,flushing,and loss of appetite,while coughing sputum,white and sticky sputum,dry cough,and chest tightness were symptoms The frequency is reduced,but symptoms such as pruritus(38.0%)and skin rash(38.0%)appear after treatment,which account for a large proportion;the proportion of red tongue in the tongue image increased to 40.0%.The proportion decreased,24.0%and 28.0%,respectively.The proportion of dark purple tongues increased to 22.0%.The tongue coating was still dominated by thin white moss(30.0%)and less moss(54.0%),but the proportion of less moss increased significantly Decreased;the number of fine pulses increased significantly in the pulse,accounting for 48%,and the proportion of fine pulses and slippery pulses decreased to 20.0%and 16.0%,respectively;the single syndrome types were Yin deficiency syndrome(46.0%)and Qi deficiency syndrome(32.0%).Mainly,the phlegm-dampness syndrome(20%)and phlegm-heat syndrome(22%)are relatively reduced.The proportion of blood-heat syndrome has increased significantly to 20%.The proportion of blood-stasis syndrome has also increased to(18%).The distribution was mainly due to the syndrome of internal deficiency of yin deficiency(42.0%)and syndrome of deficiency of both qi and yin(28.0%),followed by syndrome of spleen deficiency and phlegm dampness(16.0%).(4)At d30 after treatment,fatigue,five upsets,dry throat,dry mouth,flushing.loss of appetite,skin itching,skin rash and other symptoms increased significantly,while coughing sputum,white and sticky phlegm,The frequency of symptoms such as dry cough and chest tightness was further reduced;the tongue image did not change much compared with d15 after treatment;the pulse composition ratio did not change much compared with d15 after treatment,and the fine pulse slightly increased(52.0%);after treatment The distribution of the single syndromes of patients at d30 and d15 after treatment was basically the same,and the yin deficiency syndrome(52.0%)increased slightly;the distribution of TCM syndrome types at d30 and d15 after treatment was basically the same,and the syndrome of internal deficiency of yin deficiency(44.0%)increased slightly.Spleen deficiency and phlegm dampness syndrome(14.0%)decreased slightly.(5)Analysis of TCM syndrome types before and after treatment at d0 and d30 after treatment.The TCM syndrome types are more inclined to the evolution of Yin deficiency,internal heat syndrome and Qi deficiency syndrome.There was a significant difference in TCM syndrome types between d.before treatment and d30 after treatment(P<0.05).Conclusions:There are regular patterns of TCM syndromes before and after erlotinib targeted therapy for advanced non-small cell lung cancer.Patients with non-small cell lung cancer before treatment are mainly of single phlegm-dampness syndrome and qi-deficiency syndrome;yin-deficiency syndrome and qi-deficiency syndrome are predominantly treated with blood-heat syndrome;spleen-deficiency syndrome is used before TCM syndrome differentiation Phlegm-dampness syndrome is more common,followed by qi-yin deficiency syndrome and yin-deficiency syndrome.After treatment,the proportion of yin-deficiency syndrome and qi-yin deficiency syndrome significantly increased,and spleen-deficiency and phlegm-dampness certification decreased significantly.Therefore,it is shown that erlotinib can also consume yin fluid,damage the spleen and stomach,and aggravate the symptoms of yin deficiency and internal heat at the same time as targeted therapy.Therefore,early intervention measures of traditional Chinese medicine can be implemented to play a role in increasing efficiency and reducing toxicity. |
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