| Background:Gastric cancer is a popular malignant tumor of digestive tract.According to the global cancer statistics in 2020,the incidence of gastric cancer ranks the fifth and the mortality ranks the fourth worldwide,while the incidence of gastric cancer ranks the third in China.Due to the lack of specificity of clinical manifestations of gastric cancer,some patients have advanced stage at initial diagnosis,distant metastasis,or local recurrence or metastasis after gastric cancer surgery,and recurrence and metastasis is the primary reason for the poor prognosis of patients with gastric cancer.Previous studies have shown that qi deficiency and yang deficiency are more common in patients with stage IV gastric cancer,and spleen and stomach deficiency-cold type is a common syndrome of advanced gastric cancer.It can be seen that yang deficiency is the main pathological factor of advanced gastric cancer.Previous studies by our team have shown that yang deficiency and qi deficiency after gastric cancer surgery are more likely to have recurrence and metastasis than other constitutions,while the most common biased TCM constitution,distribution characteristics of factors and their correlation with biological indicators in patients with recurrence and metastasis of gastric cancer,as well as the intervention effect of Fuzheng Jiedu Decoction on the most common biased constitution-related symptoms and clinical biological indicators are not clear.Objective:(1)To investigate the general information of patients with gastric cancer recurrence and metastasis;(2)To observe the most common biased constitution and the distribution characteristics of factors in patients with gastric cancer recurrence and metastasis;(3)To analyze the possible correlation between physical fitness,factors and biological parameters in patients with recurrent and metastatic gastric cancer;(4)To observe the effect of Fuzheng Jiedu Decoction on the symptoms and biological parameters of patients with recurrent and metastatic gastric cancer before and after treatment.Methods:A prospective,single-arm study design was adopted,and patients who met the criteria of inclusion and exclusion were filled out with the General Information Form of Patients with Gastric Cancer Recurrence and Metastasis,the TCM Syndrome Element Score Table,and the TCM Constitution Classification Judgment Table..The intervention period was 8 weeks.At the time of the first enrollment and the end of the intervention,fill in the qi deficiency syndrome severity scale,deficiency-cold syndrome differentiation factor grade quantitative standard scale,KPS score table,and conduct blood routine,biochemical tests and body mass index(BMI)TCM constitution,syndrome distribution characteristics and BMI,neutrophil-lymphocyte ratio(NLR),and platelet-lymphocyte ratio(PLR)in patients with gastric cancer recurrence and metastasis were measured.,monocyte/lymphocyte ratio(MLR),and the correlation of prognostic nutritional index(PNI),to observe the effect of Fuzheng Jiedu recipe on the symptoms of qi deficiency,yang deficiency and function in patients with gastric cancer recurrence and metastasis Intervention effect of status score,and its effect on BMI,NLR,MLR,and PNI index levels.Results:(1)General conditions:Of the 55 patients in this study,34 were male and 21 were female,with a male to female ratio of 1.62:1.The age distribution was between 32 and 84 years,the mean age was 61±12.38 years,the age was 64 years,23 patients had a previous history of smoking,and 32 patients had no previous history of smoking.Twenty-one patients had a previous history of alcohol use and 34 patients had no previous history of alcohol use.There were 21 patients with a family history of cancer and 34 patients without a family history of cancer.Thirty patients with recurrent and metastatic gastric cancer received surgical treatment after diagnosis of gastric cancer,and 25 patients did not undergo surgical treatment.The majority of the primary lesions of gastric cancer were located in the cardia,followed by the body of the stomach and the pyloric part of the antrum.In patients with recurrent and metastatic gastric cancer,the site of recurrence was common at the anastomosis,cardia,and gastroesophageal junction,and distant metastasis was mainly the peritoneum,followed by the liver and lymph nodes.In patients with recurrence and metastasis,35 patients had recurrence or metastasis confined to one site,14 patients had two sites,2 patients had three sites,and 4 patients had more than three sites.Chemotherapy was the most common treatment for patients with recurrent and metastatic gastric cancer,and 33 cases were treated with chemotherapy.(2)Among the patients with recurrence and metastasis of gastric cancer,the frequency of the main constitution types from more to less was,yang deficiency>peaceful>qi deficiency>phlegm-dampness>qi stagnation=damp-heat=yin deficiency>blood stasis>special endowment,and the constitution types with concurrent constitution from more to less were qi deficiency=qi stagnation>yang deficiency>phlegm-dampness>yin deficiency=damp-heat>blood stasis>special endowment.The syndrome elements of disease location were mainly spleen and stomach,liver,from more to less spleen=liver>stomach>kidney>large intestine>small intestine>heart>gall bladder>lung.The frequency of pathological syndrome elements from high to low is qi deficiency>qi stagnation>yang deficiency>dampness>cold=yin deficiency>blood deficiency>jin deficiency>dryness>phlegm>heat>food accumulation>blood stasis>drinking,the solid syndromes are mainly qi stagnation,dampness,and cold,while the deficiency syndromes are mostly qi deficiency,yang deficiency,and yin deficiency.(3)Correlation between TCM constitution,syndrome elements and biological indicators:BMI and MLR were related to the type of constitution of patients.Compared with those of Pinghe constitution,the BMI of patients with Qi deficiency constitution was lower(P<0.05),the MLR was higher(P<0.01),and the BMI of Yang deficiency constitution was lower(P<0.01),MLR was high(P<0.01).There was a significant positive correlation between disease-related element cold and BMI(P<0.05),and there was a significant positive correlation between NLR and disease-related element-qi deficiency(P<0.05);BMI,NLR,PLR,MLR,and PNI were associated with There was no obvious correlation between the syndrome elements of each disease site.(4)Modification of Fuzheng Jiedu Fang can improve the symptoms of qi deficiency and yang deficiency in patients with gastric cancer recurrence and metastasis,such as shortness of breath,mental fatigue,spontaneous sweating,cold limbs,chills,sound of water in the bowels,body crouching,abdominal fullness and abdominal distention;There was no significant change in the KPS score of the patients before and after treatment(P>0.05).After treatment,the BMI,NLR,and PNI of the patients were slightly decreased,and the MLR level was slightly increased,but the differences were not statistically significant(P>0.05).Conclusions:(1)The sex of patients with recurrence and metastasis of gastric cancer is mainly male,and most of them are distributed between 50 and 69 years old.The primary site of gastric cancer is the cardia,the recurrence site is mainly the anastomotic stoma,and the peritoneum accounts for the highest proportion of distant metastasis.(2)Yang deficiency and qi deficiency are the most common biased constitution in patients with recurrence and metastasis of gastric cancer;the disease location syndrome elements are mainly spleen and stomach,liver,and the disease syndrome elements are mainly qi deficiency,yang deficiency,and qi stagnation.(3)Patients with qi deficiency and Yang deficiency had lower BMI and higher MLR,suggesting that BMI and MLR may be the biological basis of qi deficiency constitution and yang deficiency constitution.There was a significant positive correlation between cold and BMI,and between qi deficiency and NLR,suggesting that BMI may be the material basis of cold and NLR may be the material basis of qi deficiency.(4)Fuzheng Jiedu Decoction can improve the symptoms of qi deficiency and yang deficiency in patients with recurrent and metastatic gastric cancer,such as shortness of breath,fatigue,spontaneous sweating,cold limbs,fear of cold and fear of cold,borborygmus,body curling up,abdominal distension. |
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