中国中药杂志

2020, v.45(05) 1174-1179

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结肠恶性肿瘤证候分布及用药特点的真实世界研究
Real-world study on syndrome distribution and medication characteristics of colonic malignant tumors

吴丽娜;谢雁鸣;刘峘;张寅;鹿琦;庄严;
WU Li-na;XIE Yan-ming;LIU Huan;ZHANG Yin;LU Qi;ZHUANG Yan;Institute of Basic Research in Clinical Chinese Medicine, China Academy of Chinese Medical Sciences;Wangjing Hospital of China Academy of Chinese Medical Sciences;School of Statistics, Renmin University of China;the PLA Navy General Hospital;

摘要(Abstract):

为探讨我国结肠恶性肿瘤患者的中医证候及用药特点,提取2001—2016年全国33家三甲医院信息系统的结肠恶性肿瘤患者的临床资料,对其疾病特征、证候分布、用药特点及治疗状况进行描述性分析。全国22 691例结肠恶性肿瘤患者纳入分析,男-女1.59∶1,中位年龄62岁,好发年龄50~79岁。结肠恶性肿瘤术后患者占47.10%,肝转移患者达36.02%。520例结肠恶性肿瘤患者中,居前3位的中医证候分别是:脾气亏虚证(21%)、气阴两虚证(17%)和肝胃不和证(15%)。结肠恶性肿瘤患者西药使用频率最高的是抗代谢细胞毒类(61.23%),与铂剂类细胞毒类药联合使用频率最高(支持度42.40%),居前3位的西药品种分别是奥沙利铂(42.26%)、亚叶酸钙注射液(38.58%)和地塞米松(34.67%);使用频率最高的中药是清热解毒类(39.59%),与益气扶正类药联合使用频率最高(支持度12.72%),居前3位的中药品种分别是复方苦参注射液(14.62%)、参芪扶正注射液(10.18%)和艾迪注射液(6.48%)。该研究表明,脾气亏虚可能是结肠恶性肿瘤的主导证候,化疗是其主要治疗方式之一。中医药在减轻化疗毒副作用及防止复发、转移等方面显示出独特优势,采用中西医结合治疗能够显著提高临床疗效。
In order to explore the characteristics of traditional Chinese medicine(TCM) syndromes and medications in patients with colonic malignant tumors in China, the clinical data of patients with colonic malignant tumors from the information system of 33 Grade-A tertiary hospitals in China from 2001 to 2016 were extracted and a descriptive analysis was conducted on their disease characteristics, syndrome distribution, drug characteristics and treatment status. A total of 22 691 patients with colonic malignancies nationwide were included in the analysis, with male to female ratio of 1.59∶1, median age of 62 years, susceptible age of 50-79 years. Postoperative patients with colonic malignant tumors accounted for 47.10%, and patients with liver metastases reached 36.02%. Among the 520 patients with colonic malignant tumors, the top three TCM syndromes were: spleen deficiency syndrome(21%), Qi and Yin deficiency syndrome(17%) and liver and stomach disharmony syndrome(15%). The most frequently used Western medicine for patients with colonic malignant tumors was anti-metabolite cytotoxicity(61.23%), most frequently used in combination with platinum-based cytotoxic drugs(support degree 42.40%).The top three Western medicines were oxaliplatin(42.26%), leucovorin injection(38.58%) and dexamethasone(34.67%). The most frequently used traditional Chinese medicine type was heat-clearing and detoxifying drugs(39.59%), most frequently used in combination with Qi replenishing and body resistance strengthening drugs(support degree 12.72%). The top three traditional Chinese medicines were compound Kushen Injection(14.62%), Shenqi Fuzheng Injection(10.18%) and Aidi Injection(6.48%). This study shows that spleen and Qi deficiency may be the dominant syndrome of colonic malignant tumor, and chemotherapy is one of the main treatment methods. Traditional Chinese medicine has shown unique advantages in alleviating the toxic and side effects of chemotherapy and preventing recurrence and metastasis, so integrated TCM and Western medicine can significantly improve the clinical efficacy.

关键词(KeyWords): 真实世界研究;结肠恶性肿瘤;证候分布;用药特点;医院信息系统
real-world study;colonic malignant tumors;syndrome distribution;medication characteristics;hospital information system

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基金项目(Foundation): 中国中医科学院自主选题项目(Z0472)

作者(Author): 吴丽娜;谢雁鸣;刘峘;张寅;鹿琦;庄严;
WU Li-na;XIE Yan-ming;LIU Huan;ZHANG Yin;LU Qi;ZHUANG Yan;Institute of Basic Research in Clinical Chinese Medicine, China Academy of Chinese Medical Sciences;Wangjing Hospital of China Academy of Chinese Medical Sciences;School of Statistics, Renmin University of China;the PLA Navy General Hospital;

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