| Background:The latest data of National Cancer Center show that the incidence and mortality of stomach cancer are located in the third place nationwide in our country.The overall strategy for the treatment of gastric cancer is comprehensive treatment based on surgery.Postoperative recurrence and metastasis seriously affect the prognosis of gastric cancer.The traditional Chinese medicine,as one of the main features in our country’s stomach cancer prevention,has certain advantages.Many studies have shown that late-stage patients with Yang deficiency and spleen and stomach deficiency cold syndrome are common.Our research group’s previous study found that the constitution is Yang deficiency quality,Qi deficiency quality,disease is Yang deficiency,Qi deficiency more prone to recurrence and metastasis.Based on this,our research group proposes that "Yang deficiency and toxic knot" is the core pathogenesis of postoperative gastric cancer patients,and focuses on the key role of "Yang deficiency" in the evolution of postoperative gastric cancer patients’ pathogenesis.However,the distribution of TCM syndromes and related factors of Yang deficiency syndrome after gastric cancer surgery remain unclear.Based on this,this study attempted to explore the distribution of TCM syndromes and related factors of Yang deficiency syndrome in postoperative patients with gastric cancer,providing a new evidence-based basis for the development of postoperative prevention and treatment of recurrence and metastasis.Objective:1.Explore the distribution of TCM syndromes and the distribution characteristics of Yang deficiency syndrome in postoperative patients with gastric cancer;2.Analyze and excavate the correlation between general data of patients and gastric cancer data and Yang deficiency syndrome,and explore the possible correlation between Yang deficiency syndrome of gastric cancer and biological prediction indicators;3.Explore factors related to the degree of Yang deficiency syndrome.Method:A total of 173 gastric cancer postoperative patients from the oncology outpatient department of Guang ’anmen Hospital of China Academy of Chinese Medical Sciences and the gastric cancer postoperative registration platform were included in the cross-section study design.General data,gastric cancer data and traditional Chinese medicine data of patients were collected,and the collected information was used for syndrome diagnosis and diagnosis according to the Guidelines for TCM Diagnosis and Treatment of Malignant Tumors.The score of Yang deficiency syndrome in patients with gastric cancer after operation was calculated and the degree of Yang deficiency syndrome was calculated by the Diagnostic Scale of Yang Deficiency syndrome of gastric cancer.The general data,TCM syndrome distribution and symptom group characteristics of postoperative patients with gastric cancer were summarized,and SPSS22.0 was used to analyze the data to explore the related factors of postoperative Yang deficiency syndrome and Yang deficiency degree.Results:1.Distribution of syndromes and symptom groups(1)Distribution of syndromes:In patients with gastric cancer after surgery,the number of TCM syndromes was two syndromes combined>single syndromes>three syndromes combined>four syndromes combined>no TCM syndromes>five syndromes combined.The distribution frequency of main syndroms was mainly Yang deficiency syndrome(26.44%),Qi deficiency syndrome(28.88%),Qi stagnation syndrome(15.20%),followed by phlegm-dampness syndrome(12.46%),blood stasis syndrome(6.38%),Yin deficiency syndrome(5.17%),heat toxicity syndrome(2.74%),blood deficiency syndrome(2.74%).Among the single syndroms,Yang deficiency syndrome(42.00%),Qi deficiency syndrome(22.00%)and phlegm-dampness syndrome(12.00%)were the main syndroms.Yang deficiency syndrome+Qi deficiency syndrome(38.27%),Qi deficiency syndrome+Qi stagnation syndrome(8.64%),Yang deficiency syndrome+Qi stagnation syndrome(7.41%),phlegm-dampness syndrome+Qi stagnation syndrome(7.41%).Among the patients with three syndrome-mixed symptoms,Yang deficiency syndrome+Qi deficiency syndrome+Qi stagnation syndrome(16.67%),Yang deficiency syndrome+Qi deficiency syndrome+phlegm-dampness syndrome(16.67%),Qi deficiency syndrome+Qi stagnation syndrome+heat toxicity syndrome(8.33%),Qi deficiency syndrome+Qi stagnation syndrome+phlegm-dampness syndrome(8.33%)were the main symptoms.Among the four syndroms,Yang deficiency syndrome+Qi deficiency syndrome+phlegm-dampness syndrome+Qi stagnation syndrome(40.00%),Yang deficiency syndrome+Qi deficiency syndrome+Yin deficiency syndrome+phlegm-dampness syndrome(30.00%)were the main syndroms.Patients with Yang deficiency syndrome accounted for 50.29%(more than half)of postoperative patients with gastric cancer,while patients with non-Yang deficiency syndrome accounted for 49.71%.Among the patients with Yang deficiency syndrome with concurrent syndrome,the concurrent Qi deficiency syndrome(52.00%),Qi stagnation syndrome(18.00%)and phlegm-dampness syndrome(16.00%)were the main ones.(2)Symptom group characteristics:The symptom group of gastric cancer patients after surgery can be summarized as:fear of cold limbs cold,fatigue,exhaustion,weak tongue,white tongue coating,loose stool,weak pulse,like hot drink,stomach/umbilical abdomen cold pain,like kneading,tongue with teeth marks,pulse,complexion white.According to clinical observation,treatment principle and previous research,it can be summarized as general Yang deficiency symptoms of cold,and cold limbs,weakness,god is exhausted,pale tongue,white coating on the tongue,teeth marks,pulse,complexion white),and the diagnosis of Yang deficiency symptom group(like hot drinks,stomach/umbilical abdominal pain,rubbing,defecate pond have diarrhoea,pulse weakness).2.Correlation factors of Yang deficiency Syndrome(1)Univariate analysis:The results showed that there was a statistical difference between drinking history and Yang deficiency syndrome.The probability of Yang deficiency syndrome in drinking patients was higher than that in non-drinking patients(64.8%vs.43.7%,P=0.010),and the relative risk of Yang deficiency syndrome in drinking patients was 1.483 times that of non-drinking patients(OR=1.483,95%CI:1.117-1.969).There was a linear relationship between the degree of pathological stage and Yang deficiency syndrome,and the higher the pathological stage,the higher the frequency of Yang deficiency syndrome(P=0.000).There was a linear relationship between the differentiation degree and Yang deficiency syndrome,and the lower the differentiation degree,the higher the frequency of Yang deficiency syndrome(P=0.037).The distribution of Yang deficiency syndrome in different Lauren grades was statistically different,and diffuse type tended to appear Yang deficiency syndrome(P=0.030).There were statistical differences between signet-ring cell carcinoma,vascular cancer thrombus,nerve invasion and distribution of Yang deficiency syndrome.Yang deficiency syndrome was more likely to occur in patients with signet-ring cell carcinoma(71.9%vs.39.7%,P=0.000),vascular thrombosis(64.3%vs.43.6%,P=0.011),and nerve invasion(65.5%vs.43.2%,P=0.006).The relative risk of Yang deficiency syndrome in signet ring cell carcinoma patients was 1.814 times that of non-signet ring cell carcinoma patients(OR=1.814,95%CI:1.375-2.397).The relative risk of Yang deficiency syndrome in patients with vascular cancer thrombus was 1.475 times higher than that in patients without vascular cancer thrombus(OR=1.475,95%CI:1.110-1.959).The relative risk of Yang deficiency syndrome in patients with nerve invasion was 1.514 times higher than that in patients without nerve invasion(OR=1.514,95%CI:1.142-2.008).(2)Multi-factor analysis:The results showed that history of alcohol consumption,sig-ring cell carcinoma,pathological stage and vascular cancer thrombus were independent risk factors for patients with Yang deficiency syndrome after gastric cancer surgery,and the probability of developing Yang deficiency syndrome in patients with alcohol consumption history was 2.584 times higher than that in patients without alcohol consumption history(OR=2.584,95%CI:1.136-5.880,P=0.024),the probability of Yang deficiency syndrome in signet-ring cell carcinoma patients was 3.042 times higher than that in non-signet-ring cell carcinoma patients(OR=3.042,95%CI:1.237-7.479,P=0.015),the incidence of Yang deficiency syndrome in stage Ⅲ and Ⅳ patients was 6.751 times(OR=6.751,95%CI:2.277-20.016,P=0.001)and 11.970 times(OR=11.970,95%CI:1.637-87.520,P=0.014),patients with vascular cancer thrombus were 2.283 times more likely than patients with Yang deficiency syndrome without vascular cancer thrombus(OR=2.283,95%CI:1.008-5.169,P=0.048).(3)Biological predictors:The results of exploratory univariate analysis showed that the NLR distribution of patients with and without Yang deficiency syndrome was statistically different,and the NLR value of patients with Yang deficiency syndrome may be higher than that of patients without Yang deficiency syndrome(2.09 vs.1.85,P=0.044).Univariate analysis showed that every 1 unit increase in NLR,The risk of Yang deficiency syndrome increased by 47.8%(OR=1.478,95%CI:1.073-2.036,P=0.017).The VAI distribution of patients with and without Yang deficiency syndrome was statistically different,and the VAI value of patients with Yang deficiency syndrome might be higher than that of patients without Yang deficiency syndrome(1.60 vs.0.98,P=0.049).3.Factors related to the degree of Yang deficiency syndrome(1)Univariate analysis:The results showed that there was a statistical difference in age between mild Yang deficiency syndrome and severe Yang deficiency syndrome,and the average age of patients with severe Yang deficiency syndrome was older than those with mild Yang deficiency syndrome(61.65±10.21 vs.55.36±11.38,P=0.008).There was a linear positive correlation between the pathological stage and the degree of Yang deficiency syndrome.The higher the pathological stage,the higher the probability of Yang deficiency syndrome(P=0.007).There was a correlation between precancerous lesions and the distribution of Yang deficiency syndrome,and the distribution of Yang deficiency syndrome in patients with precancerous lesions was more than that in patients without precancerous lesions(87.5%vs.45.6%,P=0.030).Moreover,the probability of Yang deficiency syndrome in patients with precancerous lesions was 1.920 times higher than that in patients without precancerous lesions(OR=1.920,95%CI:1,345-2.741).There was a statistical difference between the BMI classification and the distribution in Yang deficiency severe syndrome and Yang deficiency mild syndrome.Low body weight tended to have Yang deficiency severe syndrome,while normal body weight tended to have Yang deficiency mild syndrome(P=0.028).(2)Multivariate analysis:The results showed that age,low body weight and pathological stage(stage Ⅲ,stage Ⅳ)were independent risk factors for patients with severe syndrome of Yang deficiency after gastric cancer surgery.The probability of Yang deficiency syndrome in patients with low body weight was 12.114 times higher than that in patients with normal range(OR=12.114,95%CI:2.562-57.272,P=0.002),the incidence of Yang deficiency syndrome in stage Ⅲ and Ⅳ patients was 25.414 times higher than that in stage I patients(OR=25.414,95%CI;2.334-276.754,P=0.008)and 27.286 times(OR=27.286,95%CI:1.668-446.351,P=0.020).With each increase of one year of age,the probability of patients with Yang deficiency syndrome increased by 8.7%(OR=1.087,95%CI:1.030-1.147,P=0.002).Conclusion:(1)The distribution of TCM syndroms in postoperative patients with gastric cancer is dominated by Yang deficiency syndrome,Qi deficiency syndrome and qi stagnation syndrome,of which Yang deficiency syndrome accounts for more than half,often accompanied by Qi deficiency syndrome,Qi stagnation syndrome and phlegm-dampness syndrome.(2)The distribution of the main symptom groups of patients with Yang deficiency syndrome after gastric cancer surgery can be summarized as systemic Yang deficiency symptom group and gastric Yang deficiency symptom group.(3)Alcohol consumption,pathological stage(Ⅲ and Ⅳ),sig-ring cell carcinoma,and the presence of vascular cancer thrombus were independent risk factors for Yang deficiency syndrome in postoperative patients with gastric cancer,and the risk of Yang deficiency syndrome was 2.56,3.04,6.75,11.97,2.28 times,respectively.Lauren’s classification(diffuse type),neurological invasion and lower degree of differentiation are related factors to Yang deficiency syndrome,and such patients are more likely to have Yang deficiency syndrome.The higher the NLR,the higher the probability of Yang deficiency syndrome.VAI value may be higher in patients with Yang deficiency syndrome.(4)Age was an independent risk factor for severe syndrome of Yang deficiency in patients with gastric cancer after surgery,and the risk of severe syndrome of Yang deficiency was 1.09 times with the increase of age of 1 year.Low body weight and pathological stage(Ⅲ and Ⅳ)were the independent risk factors of severe syndrome of Yang deficiency,and the risk of severe syndrome of Yang deficiency was 12.11,25.41 and 27.29 times,respectively.The presence of precancerous lesions is a related factor of Yang deficiency syndrome,and such patients are more likely to develop Yang deficiency syndrome. |
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