【作者】 付云；

【导师】 周劬志；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2010， 硕士

【摘要】 目的乳腺癌的综合治疗包括手术、化疗、放疗、内分泌治疗及分子靶向治疗等,这些治疗方法可对机体产生一定的影响,但对中医体质类型的影响目前尚不明确,本研究通过手术及化疗对初诊乳腺癌治疗前后中医体质类型的变化进行初步研究,总结其变化规律,为乳腺癌的中医个体化治疗提供参考依据。方法收集2008年12月～2010年2月在广东省中医院乳腺科住院,符合纳入标准的乳腺癌患者,于术前发放我院体检中心根据王琦教授创制的体质量表而编制的《中医体质及健康状况自填式问卷表》进行调查。问卷独立填写,当场自填收回,对无能力填写者,则由调查员询问填写；在患者系统完成6次化疗后1个月内(放疗前),再次同样的方法填写上表,采集其体质变化信息,共收集符合纳入标准的病例161例。由调查员据王琦教授《9种中医体质类型判断标准》进行评分,评估其中医体质。资料整理完善,数据录入后,采用SPSS17.0 for Windows软件包其进行描述性分析、卡方检验及秩和检验等。结果1.本组乳腺癌患者治疗前的中医体质以平和质(27.3%)、气郁质(19.9%)、气虚质(18.0%)和阳虚质(13.0%)为主,四种体质合占78.2%。病理质—气郁质、气虚质、阳虚质三种病理体质共占50.9%。血瘀质(6.2%)、痰湿质(5.6%)、阴虚质(4.3%)、湿热质(4.3%)、特禀质(1.2%)五种体质共占21.6%。治疗后的中医体质以气郁质(26.7%)、气虚质(26.7%)、阳虚质(19.9%)、血瘀质(8.2%)为主,四种病理体质共占81.5%,平和质(4.3%),痰湿质(4.3%)、阴虚质(5.6%)、湿热质(3.1%)、特禀质(1.2%)四种病理体质共占14.2%。乳腺癌患者治疗前后体质类型构成比比较,差异有统计学意义(P=0.01<0.05)。2.本组乳腺癌患者治疗后体质发生变化,平和质患者治疗后多转化为气虚质；气虚质、气郁质、阳虚质患者治疗后仍多为气虚质、气郁质、阳虚质；血瘀质患者治疗后多为气郁质；痰湿质患者治疗后多为气郁质；阴虚质、湿热质、特禀质各组样本量较小；治疗前后体质不变的患者有54例；3.不同年龄段的乳腺癌患者体质类型的分布差异有统计学意义；四种治疗方案中：保乳术+CEF×6有20例,改良根治术+CEF×6有60例,保乳术TAC×6有9例,改良根治术+TAC×6有72例,四种治疗方案对体质的改变程度没有统计学意义；4.特禀质患者在本组乳腺癌患者手术前后均仅占1.2%,比例较小。结论1.本组乳腺癌患者治疗前的体质类型分布集中在平和质、气郁质、气虚质、阳虚质；治疗后的体质类型分布集中在气郁质、气虚质、阳虚质、血瘀质；2.乳腺癌患者经过治疗后多数体质类型将会发生变化,平和质患者治疗后多转化为气虚质；气虚质、气郁质、阳虚质患者治疗后仍多为气虚质、气郁质、阳虚质；血瘀质患者治疗后多为气郁质；痰湿质患者治疗后多为气郁质；3.乳腺癌患者手术及化疗前后的这种体质类型的变化趋势,将对中医临床辅助治疗提供辨体依据。更多还原

【Abstract】 ObjectiveThe complex treatments of the breast cancer include surgery, chemo-treatment, radiation treatment, endocrine therapy and molecular target therapy, etc.These treatments can make certain impact on the physical condition, but the impact on TCM(Traditional Chinese Medicine) constitution type has not been proved. This research will do a pilot study according to the TCM constitution condition alteration among those first-diagnosed breast cancer patients with therapies of surgery and chemo-treatment. Therefore the rule will be summarized and supplied as the theory basis for the TCM individualized treatment.MethodSelecting the breast cancer inpatients qualified to the revenue standard in mammary gland department of Guangdong Provincial TCM Hospital from year 2008 December to year 2010 February. Each inpatient received a "TCM constitution and health state questionnaire" preoperatively referred to the measuring scale complied by professor Wangqi in medical examination center of our hospital. The questionnaire was filled in by the inpatients themselves and retook on the spot. The researcher would fill in the questionnaire with consultation to those inpatients who could not write. Within one month after the inpatients’six systemic chemo-therapies (before the radiation treatment), the inpatients would fill in the questionnaire in the same way, then the information was collected subsequently. There were in total 161 medical cases up to the standard. The researcher evaluated TCM constitution by grading the marks according to the criterion of nine TCM constitutional types compiled by professor Wangqi. The information was complete. The data was evaluated by the descriptive analysis, chi square test, rank-sum test with the help of SPSS 17.0 for Windows software package.Results1. The breast cancer inpatients’constitution prior-treatment were mainly normal constitution(27.3%), qi-obstruction constitution (19.9%), qi-deficiency constitution, yang-deficiency constitution, which took up 78.2% totally. Pathological constitution——qi-obstruction constitution, qi-deficiency constitution, yang-deficiency constitution took up 50.9%; blood-stasis constitution(6.2%), phlegm-damp constitution(5.6%);yin-deficiency const i tut ion (4.3%), damp-heat constitution (4.3%), special constitution(1.2%), the five kinds of constitution took up 21.6%; After the treatment, TCM constitution were mainly qi-obstruction constitution(26.7%), yang-deficiency constitution(19.9%), blood-stasis constitution(8.2%), the four kinds of pathological constitution took up 81.5%, normal constitution(4.3%), phlegm-damp constitution(4.3%), yin-deficiency constitution (5.6%), damp-heat constitution (3.1%), special constitution (1.2%), the four pathological constitution took up 14.2%.The comparison on the constituent ratio of the constitution type between prior-treatment and post-treatment had statistical significance (P=0.01<0.05)2. The constitution of the breast cancer inpatients in this group has changed after the treatment, the normal constitution changed to qi-deficiency constitution, qi-deficiency constitution, qi-obstruction constitution, yang-deficiency constitution remained the same as what prior-treatment were. blood-stasis constitution changed to qi-obstruction constitution after the treatment, phlegm-damp constitution changed to qi-obstruction constitution after the treatment. The sample size in yin-deficiency constitution, damp-heat constitution and special constitution was small. There were 54 inpatients remained the same constitution after the treatment.3. There was no statistical significance on breast cancer inpatients’ constitution in different age brackets. In these four treatment:there were 20 cases with the breast conserving treatment and CEF×6,9 cases with the modified radical mastectomy TAC×6,72 cases with the modified radical mastectomy and TAC×6, there was no statistical significance for the constitution alteration among these four kinds of treatment.4. The special constitution in the breast cancer inpatients group was only up to 1.2%during the whole process, the ratio was small.conclusion1. The distribution on prior-treatment constitution of the breast cancer inpatients in this group mainly were normal constitution, qi-obstruction constitution, qi-deficiency constitution and yang-deficiency constitution. The distribution on post-treatment constitution of the breast cancer inpatients mainly were qi-obstruction constitution, qi-deficiency constitution, yang-deficiency constitution, blood-stasis constitution.2. The constitution of the breast cancer inpatients in this group has changed after the treatment, the normal constitution changed to qi-deficiency constitution, qi-deficiency constitution, qi-obstruction constitution, yang-deficiency constitution remained the same as what prior-treatment were.blood-stasis constitution changed to qi-obstruction constitution after the treatment, phlegm-damp constitution changed to qi-obstruction constitution after the treatment.3. There was no statistical significance on breast cancer inpatients’ constitution in different age brackets during the whole process. There was no statistical significance on breast cancer inpatients’constitution alteration with these four kinds of treatment.更多还原