| Objective(1)Using the SMF-ⅢTCM Comprehensive Diagnostic System to explore and establish a digital and quantitative identification system for advanced non-small cell lung cancer cachexia and analyze and summarize the distribution of TCM syndrome types of advanced non-small cell lung cancer cachexia.(2)To study the clinical efficacy of Xiaoyan Tang in the cure of advanced NSCLC cachexia patients with Qi deficiency and toxin stasis,and to provide reference and reference for clinical and scientific research.Method(1)Collect the patients with advanced non-small cell lung cancer cachexia hospitalized in the Oncology Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from December 2018 to December 2020,and use the SMF-ⅢTCM Comprehensive Diagnostic System to objectively differentiate TCM syndromes and establish digital quantification.The identification system adopts the method of document differentiation based on the combination of documents to form a composite syndrome type and document cluster analysis to analyze the characteristics and distribution law of the syndrome types.(2)A collection of patients with advanced non-small cell lung cancer cachexia of Qi-deficiency,Toxin-Stasis type after comprehensive analysis of syndromes by the comprehensive diagnosis and treatment system of traditional Chinese medicine and physicians were randomly divided into control group and combined group.Both groups were given basic treatments such as nutritional support,and the control group was given A place For progesterone,the combined group took Chinese medicine Xiaoyan Decoction.A total of 8weeks of treatment.Before and after treatment,the body weight and BMI were recorded,appetite,nutritional status,quality of life,and Karnofsky score changes were evaluated,and the absolute count levels of hemoglobin,albumin,and lymphocyte subsets in the peripheral blood were detected.Use SPSS 21.0 statistical software to analyze the obtained data.Result(1)A total of 231 patients were enrolled in this study.Among the various documents,Qi deficiency was the most common,followed by phlegm and blood stasis.Qi deficiency and spleen Qi were more common,and phlegm was mostly phlegm-heat.The syndrome of yin deficiency is mostly in the syndrome of lung yin deficiency.The patient’s disease location is mainly in the lung,which is closely related to the spleen.Deficiency of Qi is the most common among patients with TCM constitution.The clinical syndromes of the patients are mainly compound syndromes,with double syndromes and three syndromes being the most,and the syndromes are mostly mixed with deficiency and excess.The dual syndromes are more common with Qi deficiency+phlegm syndrome and Qi deficiency+blood deficiency syndrome.Of the three syndromes,Qi deficiency+phlegm syndrome+blood stasis syndrome is the most common.Among the four syndromes,Qi deficiency+yin deficiency+phlegm syndrome+blood stasis syndrome is the most common,and the five syndromes are the most common.The number of combination cases is small,and the combination form is more scattered.Among the two combined syndromes,Qi deficiency+phlegm syndrome+phase combination syndrome,Qi deficiency+blood stasis+phase combination syndrome are the most common complex syndromes in patients,and Qi deficiency+Yin deficiency+phase combination syndromes are significantly increased during the refractory period of cachexia..There was no significant difference in the different pathological types,TNM staging,and cachexia staging of the patients’documents(p>0.05).According to the results of cluster analysis of single syndromes,the common TCM syndromes of lung cancer cachexia are:Qi deficiency and blood stasis syndrome,Yin deficiency,spleen deficiency and phlegm-dampness syndrome,and Yin and Yang deficiency.(2)The study finally included 81 qualified cases,41 in the control group,and 40 in the combined group.The comparison results are as follows:Body mass and BMI:After treatment,the body mass and BMI of the control group increased compared with the previous one,but there was no significant difference(p>0.05).The combination group had extremely significant difference compared with the previous one(p<0.01)and was better than the control group(p<0.05).Body weight curative effect:the combined group was significantly better than the control group(p<0.01).KPS score,appetite effect,and PG-SGA nutritional status score evaluation of curative effect:the combined group was better than the control group(p<0.05).TCM syndromes:The control group has no obvious clinical effect in improving the various syndromes of TCM and the overall syndrome scores.The combined group has great advantages in improving weight loss,fatigue,anorexia,and overall syndrome scores(p<0.01).It has advantages over the control group(p<0.05).The combination group has a significant difference in improving shortness of breath,and has no advantage over the control group.Overall curative effect evaluation:the combined group was significantly better than the control group(p<0.01).HGB and ALB levels:After treatment,the control group has no significant difference compared with the previous one;the combined group has a significant increase compared with the previous one,with significant difference and better than the control group(p<0.05).Absolute counts of lymphocyte subsets:In comparison between groups,the absolute counts of total T cells and NK lymphocytes in the combined group after treatment were higher than before,with significant differences(p<0.05),CD3~+CD4~+,CD3~+CD8~+,B lymph The cell count was higher than before,but there was no difference(p>0.05);after treatment,the counts of the control group were higher than before,but there was no significant difference(p>0.05).In comparison between groups,there was no statistical difference in the absolute counts of lymphocyte subgroups between the two groups after treatment(p>0.05).FAACT quality of life score:the control group has a significant effect in improving anorexia symptoms(p<0.05),and the remaining symptoms have no effect;the combination group has a very significant effect in terms of FAACT overall score and anorexia symptoms(p<0.01).There is an advantage in emotional status(p<0.05),but no advantage in social/family and functional status.Comparison between groups:Compared with the control group,the combined group has a significant effect on the overall FAACT score and anorexia symptoms(p<0.05),The remaining curative effect is not significant.Conclusions1.The clinical syndromes of patients with lung cancer cachexia are complex and scattered,with deficiency,phlegm,and blood stasis mixed with each other.The disease is mainly in the lungs,often involving the spleen.Through research,it can be extracted that Qi deficiency+phlegm syndrome,Qi deficiency+blood stasis,Qi deficiency+Yin deficiency,Yin deficiency+Yang deficiency syndromes are the most common compound syndromes.Qi deficiency+Yin deficiency syndromes are significantly increased during the refractory period of cachexia.Deficient syndrome may be the outcome of its syndrome type.2.Megestrol can improve the appetite and nutritional status of patients with lung cancer cachexia.The Xiaoyan Decoction combined with megestrol is better than the megestrol alone group in improving appetite and nutritional status,and can improve the patient’s body mass,BMI,Karnofsky score,hemoglobin and albumin levels,and effective improvement of TCM syndromes and quality of life. |
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