Clinical Investigation On The Effect Of Inflammatory Indicators On The Prognosis Of Malignant Intestinal Obstruction And Study On The Stratification Of TCM Syndrome Type

Purpose:In this study,a retrospective study was adopted,and the research direction was formulated through literature study.Patients with malignant bowel obstruction(MBO)were selected as a specific population,and the general status,hematological indicators,symptoms,signs,primary diseases,and received treatments were collected and recorded.Methods and other clinical data were used to statistically analyze the impact of various data on the prognosis and survival time of MBO patients and their relationship with TCM syndrome types,objectively describe the disease characteristics of MBO,and provide some reference for the prevention,diagnosis and treatment of MBO.Material and method:According to the MBO diagnostic criteria and inclusion and exclusion criteria,a total of 86 patients with MBO were screened from September 2018 to September 2021 in the Oncology Department of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,and 60 of them had complete medical records.Record its clinical data.The patients were grouped according to the calculated optimal cut-off value,and survival analysis was performed.Univariate analysis was performed by Kaplan-Meier survival method,and multivariate analysis was performed by COX regression method.The effect of each factor on prognosis and survival was statistically analyzed.According to the severity,the patients’ intestinal obstruction-related symptoms were scored,and the rank correlation test was performed with the clinical data.The nonparametric rank sum test was performed on the patients’ syndrome types,prognostic factors and survival time to analyze their correlation.Results:1.The overall median survival time of 60 MBO patients was 18.5 days,and the average survival time was 25.60 days.2.There were statistical differences in PS score,combined ascites,NLR high and low groups,CRP/ALB high and low groups,and ALB high and low groups ～ 4 ～.The average survival time of 31 cases with low PS score(0-2 points)was 35.12 days,and the average survival time of 29 cases with high PS score(3-4 points)group was 13.96 days(P=0.000).The average survival time of 29 patients without ascites was 31.55 days,and the average survival time of31 patients with ascites was 20.03 days(P=0.046).The average survival time of 21 cases with ALB<34g/L group was 18.71 days,and the average survival time of 39 cases with ALB≥34g/L group was 29.31 days(P=0.048).The average survival time of 29 cases with low NLR(<5.9)group was 34.35 days,and the average survival time of 31 cases with high NLR(≥5.9)group was 17.42 days(P=0.001).The average survival time of 32 cases of low CRP/ALB(<1.4)group was 31.50 days,and the average survival time of 28 cases of high CRP/ALB(≥1.4)group was 18.86 days(P=0.032).3.Multivariate COX analysis showed that high PS score,ascites,and high NLR level were independent prognostic factors for survival time of MBO patients,with P values of 0.000,0.018,and 0.031,respectively.The risk of death in the high PS score(3-4)group was 15.732 times that of the low PS score(0-2)group;the risk of death in the group with ascites was5.575 times that in the group without ascites;the risk of death in the high NLR group 4.646 times that of the low NLR group.However,CRP/ALB and ALB levels may not be prognostic risk factors for MBO patients(P>0.05).4.The numerical range of symptom score is 4-20 points,the median score is 13 points,and the average score is 12.43±3.03 points.The symptom score of damp-heat toxin accumulation syndrome was the highest,and the symptom score of Qi-yin deficiency syndrome was the lowest.According to the rank correlation test,symptom scores were correlated with NLR and ALB,with P values of 0.001 and 0.007,respectively.5.There was a statistically significant difference in the distribution of syndrome types of combined ascites and NLR levels,with P values of 0.004 and 0.018,respectively.Combined ascites accounted for the highest proportion in spleen-kidney yang deficiency syndrome,reaching 91.67%,and the proportion of liver stagnation and qi stagnation syndrome was the lowest,accounting for 23.53%.High NLR levels accounted for the highest proportion in the damp-heat toxin accumulation syndrome,reaching 91.67%,and the lowest proportion in the Qi-yin deficiency syndrome,36.84%.6.The difference in survival time of the 4 TCM syndrome types was statistically significant(P=0.016).The average survival time of liver stagnation and qi stagnation syndrome was the longest,reaching 36.65 days,followed by qi and yin deficiency syndrome of 29.11 days,and damp-heat toxin accumulation syndrome of 16.08 days.The average survival time of spleen-kidney-yang deficiency syndrome was the shortest,13.92 days.Conclusion:1.MBO has a poor prognosis,and the primary site is gastrointestinal tumors,which are more common in people over 60 years old.2.High PS score(3-4 points),combined ascites and increased inflammatory index NLR level are independent risk factors for the prognosis of MBO.3.Different TCM syndrome types have guiding significance for predicting prognosis,and can guide the treatment of TCM external therapy.