Analysis Of Influencing Factors And Chinese Medicine Use In Aromatase Inhibitor-related Joint Pain In Postmenopausal Breast Cance

Objective:The incidence,characteristics and influencing factors of aromatase inhibitor-associatedarthralgia(AIA)in postmenopausal breast cancer patients taking aromatase inhibitors were studied retrospectively,and the rule of traditional Chinese medicine use was analyzed.It provides some reference for clinical prevention and treatment of aromatase inhibitor related osteoarthralgia.Methods:The general and clinical data of breast cancer patients who met the criteria were collected from the inpatient department and outpatient department of Oncology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from November 2020 to November 2022.Use Excel2019 for data collation,data analysis using SPSSStatistic21.0.Univariate χ2 analysis was performed for the influencing factors of AIA,and P <0.05 indicated that the difference was statistically significant.The effective variable obtained from the single factor was taken as the independent variable,and whether AIA occurred was taken as the dependent variable.The logistic binary regression equation was included for multivariate analysis,and P<0.05 was considered as statistically significant difference.Excel2019 was used to summarize the sex and flavor normalization and efficacy of high-frequency traditional Chinese medicine,and SPSSStatistic21.0 was used for systematic cluster analysis of high-frequency traditional Chinese medicine.Results:1.A total of 77 patients participated in this study,of which 34 had AIA,accounting for 44.2% of the total number.The average onset time was 4.4±3.2 months,and55.9% had AIA within 3 months.The most common pain sites of AIA patients were finger/wrist joint in 23 cases(67.6%),knee joint in 11 cases(32.4%),toe/ankle joint in 7 cases(20.6%),wait in 6 cases(17.6%),and hip in 2 cases(5.9%).2.In univariate analysis,there were statistically significant differences in the incidence of AIA among different subgroups in age,menopause years,calcium supplementation/calcium promoting absorbent,exercise,chemotherapy,and TCM syndrome types(P<0.05).In multivariate analysis,age(≥60 years VS < 60 years,OR=0.071,P=0.028),history of chemotherapy(with OR without chemotherapy,OR=11.284,P=0.049),calcium supplementation/calcium-promoting absorbent(with or without calcium supplementation,OR=0.071,P=0.045),physical activity(regular exercise vs.never/occasionally exercise,OR=0.220,P=0.054),TCM syndrome type(liver-qi stagnation vs.liver-kidney Yin deficiency,.OR=0.052,P=0.004;Liver depression and spleen deficiency VS liver and kidney Yin deficiency,OR=0.064,P=0.015;Deficiency of qi and blood vs.deficiency of liver and kidney Yin,OR=0.062,P=0.007)was an independent factor affecting AIA.3.Through the analysis of traditional Chinese medicine of 34 patients with AIA,a total of 33 prescriptions were obtained,involving 93 kinds of traditional Chinese medicine,among which 29 kinds of drugs were frequently used ≥10 times.High frequency drugs were mainly deficiency tonifying drugs(37.4%)and heat-clearing drugs(16.7%).The five flavors were mainly sweet(32.7%),bitter(27.9%),and Xin(18.6%).The four qi were mainly warm(35.0%),flat(31.0%)and cold(25.0%),and the normalization channels were mainly liver channels(21.3%),spleen channels(19.2%),lung channels(18.1%)and kidney channels(14.3%).Cluster analysis was conducted on high-frequency drugs(≥10 times),and a total of 6 clustering prescriptions were obtained.The first category was bupleurum,Scutellaria,pinellia,keel,oyster,zedoary,sundried licorice,Fritillaria Thunbergii,soil poria,coix seed,which were commonly used prescriptions in our department.Bupleurum and keel Oyster decoction plus or less prescription had the effect of soothing the liver and regulating qi,clearing heat and detoxifying and anti-tumor.The second kind of drugs for paeony,cassia twig,floating wheat,astragalus,achyranthes,have nourishing liver and kidney,tonifying qi and strengthening bones;The third type was cholangxing,turmeric and rhizoma corydalis,all of which had the effect of removing blood stasis and relieving pain.The fourth drugs are eucommia ulmoides and psoralea psoralea,which are essential drugs for tonifying kidney and strengthening bones.The fifth type of medicine for cooked Rehmannia,yam,cornus meat,peony bark,replenishing the liver and kidney to fill essence,clearing heat and cooling blood work,so that the complement is not greasy;The sixth type of drugs were atractylodes atractylodes,poria cocos,Radix pseudostellariae,Schistoderma semilaria and Hedyshyotis officinalis,which had the function of clearing heat,detoxifying and anti-tumor while invigorating qi and spleen.Conclusions:1.Arthralgia related to aromatase inhibitors is a common disease in postmenopausal breast cancer patients who take AI drugs orally,with an incidence rate of about 50%.The most common sites are finger/wrist joint,knee joint,toe/ankle joint,wait and hip.2.Patients <60 years old(and ≥42 years old in this study),who have a history of chemotherapy,and whose TCM syndrome type is liver-kidney Yin deficiency have a higher risk of AIA;Patients who exercise regularly and take calcium/calcium enhancers orally have a lower risk of AIA.3.Clinical drugs used in AIA patients are mainly to tonify liver and kidney,strengthen muscles and bones,and invigorate spleen and stomach.Combined with drugs with anti-tumor effect studied in modern pharmacology and drugs for regulating qi and machinery,the obtained cluster prescriptions are reasonably compatible.