Study On TCM Syndrome Characteristics Of Cardiac Adverse Reactions Caused By AC Regimen In Breast Cancer And Its Correlation With Glycolipid Metabolism

ObjectiveWith the development of breast cancer therapy and the prolongation of survival time,the adverse events induced by antitumor are increasing,especially cardiovascular toxicity.This study takes the two-drug chemotherapy regimen containing Adriamycin and Cytoxan,which was as a starting point to explore the distribution of TCM syndrome of cardiovascular toxicity by AC regimen.And in this way,weanalyzed the differences of glucose and lipid metabolism in patients with cardiotoxicity of breast cancer with different TCM syndromes,so as to provide ideas for the further clinical diagnosis and treatment of these patients.Methods1.According to the standard of rejection,277 patients with breast cancer were included in the chemotherapy with AC regimen to describe the adverse cardiac events.General data(name,age,registration number),medical history(diagnosis,staging,pathology,course of treatment,time of diagnosis,time of occurrence of cardiac symptoms,KPS score,cardiac function classification,etc.)and basic vital signs were collected.At the same time,the TCM diagnostic information of TCM(complexion,symptoms,signs,intake,second defecation,tongue,pulse,etc.)were collected,and with reference to the "Technical guidelines for Clinical Research of New traditional Chinese Medicine with Syndromes"(2018),the values of "0,1,2 and 3 points" were quantified according to the four levels of "none,light,moderate and severe".The database is established by Excel 2016 software,and the statistical analysis is carried out by SPSS 26.0 software:variable clustering analysis is used in systematic clustering analysis,that is,R-type clustering analysis,and chi-square test is used in disordered counting data.2.On the basis of the first part of the study,collect the patients’ blood glucose,blood lipids and other physical and chemical indicators.The indexes of the selected cases were counted by SPSS26.0.According to the classification standard of glucose metabolism and the clinical classification standard of dyslipidemia,and with reference to the results of TCM syndrome types in the first part,the glucose and lipid metabolism among different syndrome types were compared and analyzed.Results1.Cluster analysis:The TCM diagnosis data of patients with cardiotoxicity treated with AC regimen were used as variables to carry out cluster analysis.The results showed that the clustering of the number of cases and the representation of syndrome were appropriate when the case samples were grouped into five categories.According to the statistics of the frequency of clinical symptoms in each type of case group,the first category:acid regurgitation,slow pulse,cold limbs,lower limb edema,back sinking,frequent nocturnal urination,pale complexion;the second category: white and greasy moss,dark tongue,sticky mouth,constipation,phlegm,chest pain,head weight;the third category: red face,anorexia,abdominal distension,hiccup,pulse string,rib distension,loose stool,good rest,heavy limbs,precordial dull pain.Category 4: sore throat,constipation,sallow complexion,fatigue,dry mouth,fat tongue,palpitation,shortness of breath,sweating,deep pulse,less moss;category 5: nausea and vomiting,sore waist and knees,five-heart fever,hair early white,pulse count,dry eyes,insomnia and forgetfulness,vertigo tinnitus.2.Glucose metabolism status: A total of 60 patients in this study had complete fasting blood glucose data records.according to the classification criteria of glucose metabolism,there were21 patients in normal group,18 patients in impaired glucose regulation(prediabetes)group and 21 patients in diabetes group.There were significant differences in the distribution of syndrome types of different glucose metabolism(P < 0.05).Pairwise comparison showed that there was significant difference between normal group and impaired glucose regulation group(P < 0.05),and between normal group and diabetic group(P < 0.01).There was no significant difference between impaired glucose regulation group and diabetes group(P > 0.05).3.Lipid metabolism status:A total of 124 patients in this study had complete blood lipiddata records(total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein).According to the clinical classification criteria of dyslipidemia,there were 30 patients in normal group and 30 patients in hypercholesterolemia group.there were 6 patients in high triglyceride group,16 patients in mixed hyperlipidemia group and 42 patients in low high density lipoprotein group.There were significant differences in the distribution of syndrome types with different lipid metabolism(P < 0.05).Pairwise comparison showed that there was significant difference between normal group and hypercholesterolemia group,and there was significant difference between normal group and hypocholesterolemia group,hypercholesterolemia group and HDL-C group(P < HDL-C).There was no significant difference between hypercholesterolemia group and mixed hyperlipidemia group,mixed hyperlipidemia group and low HDL-C group,normal group and mixed hyperlipidemia group.Conclusion1 The cardiotoxicity of breast cancer containing AC regimen could be divided into five TCM syndromes: deficiency of kidney yang,stagnation of qi and dampness,deficiency of liver and spleen,deficiency of both yin and yang of heart and kidney and yin deficiency of liver and kidney.Among them,there was no significant difference in the distribution of people with different syndrome types,Combining the clustering results may provide ideas for clinical differentiation and treatment of such patients,thereby reducing the adverse effects of cardiotoxicity on the survival and quality of life of patients.2 Different states of glucose metabolism can be beneficial to TCM syndrome differentiation and treatment of such cardiotoxicity,compared with the normal blood sugar group,there were more patients in the impaired glucose regulation group and the diabetic group with the syndrome of deficiency of both kidney and yin and liver and kidney,kidney Yin deficiency may be the key to the pathogenesis of such patients with abnormal glucose metabolism status.3 The clinical groupings of different dyslipidemias are different in such patients,Compared with the normal group,the Qi stagnation and dampness block syndrome has a higher proportion of hypercholesterolemia and high-density lipoprotein reduction,the kidney-yang deficiency syndrome also has a higher proportion of high-density lipoprotein reduction.