175例原发性肝癌中医证型与BCLC分期相关性研究

目的:探讨175例原发性肝癌患者的中医证型与巴塞罗那临床肝癌分期系统(BCLC分期)的相关性。方法:对原发性肝癌(PLC)初治患者175例进行BCLC分期,并将其分为肝气郁结、气滞血瘀、湿热聚毒、肝肾阴虚4组,分析其中医证型与BCLC分期的相关性。结果:1)4种证型PLC患者的BCLC分期情况不一致(P0.05)。肝气郁结型患者BCLC分期明显早于湿热聚毒型、肝肾阴虚型(P0.01),且早于气滞血瘀型的可能性大;气滞血瘀型患者BCLC分期明显早于湿热聚毒型(P0.01)。2)4个证型A期、B期、C期所占比率不一致(P0.05)。肝气郁结型A期比率明显高于其他证型(P0.01);湿热聚毒型B期比率明显低于气滞血瘀型(P0.01),且低于肝肾阴虚型可能性大;湿热聚毒型C期比率明显高于其他证型(P0.01)。结论:1)BCLC分期中A期是辨证肝气郁结型的临床参考;B期是湿热聚毒型与气滞血瘀型相互鉴别的临床参考,且对于湿热聚毒型与肝肾阴虚型的相互鉴别有一定的指导意义;C期是辨证湿热聚毒型的临床参考。2)PLC患者中医证型与BCLC分期存在一定的相关性。BCLC分期对于中医辨证分型有一定的指导意义。

Study on the Correlation between TCM Patterns and BCLC Staging of 175 Patients with Primary Liver Cancer

Objective:To explore the correlation between TCM patterns of 175 patients with primary liver cancer (PLC) and Barcelona clinic hver cancer (BCLC) staging system.Methods:All 175 PLC patients in initial treatment were grouped according to BCLC staging,and they were divided into four groups:depression of liver-Qi,Qi stagnation and blood stasis,dampness-heat gathering into the toxin,Yin-deficiency of liver and kidney,to analyze the correlation between TCM patterns and BCLC staging of PLC.Results:1) BCLC staging conditions of the PLC patients with four patterns were not identical (P＜0.05).BCLC stagings of the patients with depression pattern of liver-Qi were earlier remarkably than these of the ones with dampness-heat gathering into the toxin,Yin-deficiency of liver and kidney pattems (P＜0.01),and the possibility of earlier than Qi stagnation and blood stasis pattern was bigger;BCLC stagings of the patients with Qi stagnation and blood stasis pattern were earlier than these of the patients with dampness-heat gathering into the toxin pattern notably (P＜0.01).2) The ratios of four patterns at stage A,stage B and stage C were different (P＜0.05).The ratios of depression pattern of liver-Qi at stage A were higher than these of other patterns notably (P＜ 0.01);the ratios of dampness-heat gathering into the toxin pattern at stage B were lower than these of Qi stagnation and blood stasis pattern (P＜0.01),and the possibility of lower than Yin-deficiency of liver and kidney pattern was big;the ratios of dampness-heat gathering into the toxin pattern at stage C were higher than these of other patterns (P＜0.01).Conclusion:1) among BCLC staging,stage A is clinical reference for differentiating depression ofliver-Qi;stage B is clinical reference for differentiating dampness-heat gathering into the toxin pattern and Qi stagnation and blood stasis pattern mutually,and they are the guidance of differentiating dampness-heat gathering into the toxin pattern and Yin-deficiency of liver and kidney pattem mutually;stage C is clinical reference for differentiating dampness-heat gathering into the toxin pattern.2) TCM patterns of PLC patients are related to BCLC staging to a certain degree,BCLC staging could guide syndrome differentiation and treatment of TCM to a certain degrees.