结直肠癌术后中医证型分布规律及预后因子水平的初步分析

目的：总结结直肠癌患者术后早期中医辨证分型的规律并初步观察预后标志物的表达情况。方法：回顾性分析2009年9月至2013年8月本院收治的174例患者的临床资料，分析其早期中医证候分布情况，观察其预后标志物水平，包括肿瘤TNM分期、肿瘤组织雌激素受体（ ER）、抗转移癌基因（ nm23）、基质金属蛋白酶-9（ MMP-9）、结直肠癌抑癌基因p53、血管内皮生长因子（ VEGF）的水平，分析重点证型结直肠癌预后因子的差异，推断常见证型的预后。结果：气血虚衰型、湿瘀毒热型、脾肾阳虚型是最常见的3个证型，其中TNM分期、ER、nm23、p53表达无统计学意义（ P〉0.05）；气血虚衰型的MMP-9、VEGF阳性率最低（ P〈0.05）；湿瘀毒热型的MMP-9、VEGF阳性率最高（ P〈0.05）。结论：结直肠癌术后早期中医证候以本虚标实、虚实夹杂为主，不同中医证型的结直肠癌患者的预后标志物存在一定差异。

Preliminary analysis on distribution rules and prognostic factor level of TCM syndrome after the operation of colorectal carcinoma

Objective：To summarize the distribution rules and investigate the expression of prognostic indicators of syndrome pattern in TCM with colorectal carcinoma in postoperative period. Methods：Clinical data of 174 patients admitted in our hospital from November 2009 to August 2013 were retrospectively analyzed. The early TCM syndrome distribution after operation was analyzed and the levels of prognostic indicators were observed, including TNM staging, estrogen receptor （ ER） , nm23 gene, matrix metalloproteinase-9 （ MMP-9） , anti-oncogene of colorectal cancer p53 and vascular endothelial growth factor （ VEGF ） . The differences of key syndrome of prognostic factors on colorectal cancer were analyzed. Results：There were 3 common kinds of TCM syndrome patterns, including Qi and blood deficiency, Dampness and heat toxin and asdthenic splenonephro-yang. There were no significant differences of TNM staging and the expression of ER, nm23 and p53 among the three syndrome patterns （P〉0.05）. However, the syndrome of Qi and blood deficiency had the lowest MMP-9 positive rate and VEGF positive rate （ P〈0.05）; Dampness and heat toxin had the highest MMP-9 positive rate and VEGF positive rate （ P〈0.05） . Conclusion：The main symptoms in TCM are deficiency in origin and excess in superficiality, mingled with deficiency and excess with colorectal carcinoma in postoperative period. The expression of prognostic factors varies in different syndrome patterns.