气管支气管腺样囊性癌的临床特征及中医证候研究

Clinical characteristics and traditional Chinese medicine syndrome patterns of tracheobronchial adenoid cystic carcinoma

关键词:  气管支气管腺样囊性癌  临床特征  证候特征  多元统计分析

Key words:  tracheobronchial adenoid cystic carcinoma  clinical characteristics  syndrome characteristics  multivariate statistical analysis

摘要:

[目的] 探究气管支气管腺样囊性癌（Tracheobronchial Adenoid Cystic Carcinoma，TACC）人群的临床特征及中医证候特征，为TACC的中医临床诊疗提供科学依据。[方法] 通过开展双中心横断面研究，统计TACC人群的临床特征、中医证候特征，基于R语言运用因子分析、多重对应分析、K-means聚类、层次聚类、潜在类别分析等多种统计模型对证候条目进行聚类与结构挖掘，结合拓扑网络分析识别核心证候变量，并运用潜在类别分析进行证型分类合理性验证。[结果] 该研究共纳入双中心112例TACC患者，女性多于男性，病变主要累及主气道中下段。肿瘤原发部位、浸润类型级转移情况等多项临床特征男女之间未见明显差异。TACC患者中医证候以咳嗽（84.82%）、喘促（59.82%）、痰质黏稠（46.43%）、自汗（45.54%）多见，常见舌脉为白苔（72.32%）、舌络滞（49.11%）、脉滑（36.61%）、脉数（33.93%）。经因子分析、聚类分析及应用潜在类别分析，归纳出3个TACC主要中医证候。[结论] TACC病机特点为虚实交错、病程缠绵且始终夹杂癌毒，主要中医证候包括气虚津亏-痰热郁络证、肺脾两虚-湿浊滞络证、瘀毒内结-络损血溢证。

Abstract:

[Objective] To explore the clinical and traditional Chinese medicine（TCM）syndrome characteristics of patients with tracheobronchial adenoid cystic carcinoma（TACC），providing scientific evidence for TCM clinical diagnosis and treatment of TACC. [Methods] A dual-center cross-sectional study was conducted to collect clinical and TCM syndrome data from 112 TACC patients. Statistical analysis included factor analysis，multiple correspondence analysis，K-means clustering，hierarchical clustering，and latent class analysis using R software to cluster and mine the structure of syndrome entries. Topological network analysis was employed to identify core syndrome variables，and latent class analysis validated syndrome classification rationality. [Results] A total of 112 TACC patients were enrolled from two centers，with a higher prevalence in females than in males. The lesions predominantly involved the middle and lower segments of the major airways. No significant sex differences were observed in clinical characteristics such as the primary tumor site，patterns of infiltration，or metastatic status. The most common TCM syndrome manifestations included cough（84.82%），dyspnea（59.82%），viscous sputum （46.43%），and spontaneous sweating（45.54%）. The most frequent tongue and pulse features were white tongue coating（72.32%），stagnated tongue vessels（49.11%），slippery pulse（36.61%），and rapid pulse（33.93%）. Through factor analysis，cluster analysis，and latent class analysis，three major TCM syndrome patterns of TACC were identified. [Conclusion] The pathogenesis of TACC is characterized by a complex interplay of deficiency and excess，with a protracted disease course consistently complicated by cancer toxin. The three predominant TCM syndrome patterns were summarized as follows：1）Qi deficiency with fluid depletion accompanied by phlegm-heat obstructing the collaterals；2）Lung-spleen deficiency with damp-turbidity stagnating the collaterals；3）Blood stasis and toxin accumulation with collateral damage leading to hemorrhage.