| This thesis is consisted of 2 parts, which are Literature Review and clinical research. There are 2 articles in Literature Review, of which the tile of the first article is "Research progress on treatment of non-small cell lung cancer with Gefitinib".This article mainly dedicates itself to the systematic exposition of the relative research progress on treatment of non-small cell lung cancer with Gefitinib in recent years in terms of mechanisms of action and resistance, curative effect, relative factors affecting the sensitiveness of Gefitinib, as well as genetic conditions of EGFR and the relationship between TCM syndrome types and the sensitiveness to Gefitinib.The second article gives a comparatively systematic exposition of the current research status of TCM syndrome differentiation of lung cancer.Gefitinib has its own comparatively advantaged people on the treatment of lung cancer by comprehensive analysis. Its curative effects are predicted according to the clinical factors of the patients and micro detection of relative molecular markers. But confusingly, those so-called "advantaged people with the treatment of Gefitinib" can't all benefit from the treatment, while a few "disadvantaged people with the treatment of Gefitinib" can also benefit from clinical treatment. Moreover, EGFR gene test is difficult for clinical promotion because it is subject to the limitations of clinical conditions and financial status of the patients.Can TCM solve these difficulties in a macroscopic view and find out the dialectical law from these beneficiary groups to provide a strong basis for more efficient treatment and expanding clinical indications of Gefitinib?Studies have confirmed that there is a certain correlation between TCM macro syndrome differentiation and the efficacy of Gefitinib. This type of TCM syndrome differentiation can be easily learned by doctors in comparation with relative molecular markers of Western medicine, and because of its low cost and no trauma, it is also easily acceptable for patients.However, TCM mainly depends on symptoms and signs and personal experience to divide syndrome differentiations of lung cancer; and due to its insuffient numbers of samples and low randomness of sample selection, it has not been recognized by the international oncology community, and still needs to be further proved in the aspect of clinical research.On the basis of establishment of a unified standard system of syndrome types of Lung cancer, TCM needs to further expand the number of cases, conducting evidence-based medical research of correlation between TCM syndrome types with the characteristics of big clinical samples, multi-center and the efficacy of treatment of lung cancer with Gefitinib.The part of clinical research focuses on the study of correlation between the treatment efficacy of Gefitinib over 58 cases suffering from advanced lung adenocarcinoma with EGFR mutations and the nature of disease and TCM of heat and cold.Objective:To explore the correlation between the treatment efficacy of Gefitinib over advanced lung adenocarcinoma with EGFR mutations and TCM differentiation of signs of heat and cold, to observe the evolution of symptoms of chills and fever after receiving the treatment of Gefitinib, to verify the hot or cold nature of Gefitinib with TCM theories and to explore the macro dialectic indicators of chills and fever of patients over whom Gefitinib has an curative advantage.Method:Selecting 61 patients of advanced lung adenocarcinoma who meet with the admission criteria, among which 2 patients quit research because of personal reasons,1 lost contact with the research and the rest of 58 patients completed the clinical observation. Dividing the 58 patients into two groups of cold and heat in accordance with TCM symptom characteristics, of which 38 patients belonged to the group of cold and 20 to the group of heat.Recording information of patients, such as gender, age, tobacco use, KPS score, primary tumor size, the tumor size of the transferring parts, TCM symptoms, etc. Treating the 2 groups of patients with Gefitinib 250mg half an hour after breakfast every day, oral intake with warm water and giving them the other treatments equally. Starting statistics from the day that patients started oral intake of Gefitinib. After a period of treatment of 30 days, to observe the patients'changes of symptoms of cold or heat according to TCM syndrome differentiations, to review examinations like chest CT for evaluation of efficacy after the treatment and to observe symptoms scores, scores of quality of life and other indicators after treatment and record them.Result:The efficiency of treatment with Gefitinib over the group of patients with cold symptomatic characteristics in TCM is as high as 86.84%, and disease control rate is 92.11%, while the contrast group with hot symptomatic characteristics in TCM has efficiency as high as 45.00%, and disease control rate is 60.00%.There are statistical differences in efficiency and disease control rate between these two groups (P<0.05).Conclusion:Gefitinib has a better curative efficacy over patients with advanced lung adenocarcinoma whose nature is cold in TCM; after treatment with Gefitinib, patients'nature of TCM syndrome differentiations gradually turned hot from cold; according to the theory of "measuring medicine from symptoms", Gefitinib may have a hot nature, but still needs to be further proved in clinical researches with the characteristics of big clinical samples, multi-center and randomized observation. |
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