基于骨转移分析570例前列腺癌患者中医证素分布规律*

作者：刘长鑫1，王浩瞩1，张子淑1，吴泳蓉2，周 青1，田雪飞2

单位：1.湖南中医药大学第一中医临床学院，湖南 长沙 410007； 2.湖南中医药大学中西医结合学院，湖南 长沙 410208

引用：引用：刘长鑫，王浩瞩，张子淑，吴泳蓉，周青，田雪飞.基于骨转移分析570例前列腺癌患者中医证素分布规律[J].中医药导报,2025,31(4):157-160,225.

DOI：10.13862/j.cn43-1446/r.2025.04.027

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摘要：目的：探析基于骨转移的前列腺癌中医证素分布规律，为前列腺癌的证候研究及诊疗提供参考。方法：回顾性收集570例前列腺癌患者的临床资料，分为289例无骨转移组和281例骨转移组，对两组患者的病位证素、病性证素等进行研究。结果：570例前列腺癌患者中有429例的病位证素在肾，其中无骨转移组有207例，骨转移组有222例；189例病位在脾，其中无骨转移组有109例，骨转移组有80例；118例病位在肺。主要病性证素为气虚、血虚、阳虚、血瘀，无骨转移组病性证素阳虚的患者多于骨转移组，骨转移组病性证素气虚、血虚、血瘀、湿、阴虚、痰的患者多于无骨转移组。病性-病位二项关联分析结果显示，在支持度方面，无骨转移组与骨转移组气虚+肾支持度均最高；在置信度方面，无骨转移组阳虚+肾置信度最高，骨转移组血瘀+肾置信度最高。三项关联分析结果显示，在支持度方面，无骨转移组阳虚+气虚+肾支持度最高，骨转移组血瘀+气虚+肾支持度最高；在置信度方面，无骨转移组阳虚+气虚+肾置信度最高，骨转移组血瘀+阳虚+肾置信度最高。结论：前列腺癌的核心病位在肾，主要病位还包括脾、肺。无骨转移患者病位证素以肾、脾为主，骨转移患者病位证素以肾、脾、肺为主。阳虚、气虚、血虚、血瘀、湿、阴虚、痰是主要病性证素。无骨转移患者病性证素以阳虚为主，骨转移患者主要病性证素除血瘀外，还涉及气虚、阳虚、血虚、阴虚、湿、痰。肾虚血瘀是前列腺癌的核心病机。

关键词：前列腺癌；骨转移；证素；肾虚；血瘀；回顾性研究

Abstract：

Objective: To explore the distribution pattern of traditional Chinese medicine (TCM) syndrome elements in prostate cancer based on bone metastasis, and provide reference for the syndrome research, diagnosis and treatment of prostate cancer. Methods: The clinical data of 570 prostate cancer patients were retrospectively collected and divided into 289 cases without bone metastasis group and 281 cases with bone metastasis group. The syndrome elements of disease location and disease nature of the two groups of patients were studied. Results: Among the 570 prostate cancer patients, 429 cases had the syndrome element of disease location in the kidney, including 207 cases in the non-bone metastasis group and 222 cases in the bone metastasis group. 189 cases had the disease location in the spleen, including 109 cases in the non-bone metastasis group and 80 cases in the bone metastasis group. 118 cases had the disease location in the lung. The main pathognomonic elements were Qi deficiency, blood deficiency, Yang deficiency and blood stasis. There were more patients with yang deficiency in the group without bone metastasis than in the group with bone metastasis, and there were more patients with Qi deficiency, blood deficiency, blood stasis, dampness, Yin deficiency and phlegm in the group with bone metastasis than in the group without bone metastasis. The results of the two-item pathogenicity-pathogenicity association analysis showed that in terms of support degree, both the non-bone metastasis group and the bone metastasis group had the highest degree of support for Qi deficiency + kidney. In terms of confidence degree, the non-bone metastasis group had the highest degree of confidence for Yang deficiency + kidney, and the bone metastasis group had the highest degree of confidence for blood stasis + kidney. The results of the three-item association analysis showed that in terms of support degree, the support degree of Yang deficiency + Qi deficiency + kidney was the highest in the non-bone metastasis group, and the support degree of blood stasis + Qi deficiency + kidney was the highest in the bone metastasis group. In terms of confidence degree, the confidence degree of Yang deficiency + Qi deficiency + kidney was the highest in the non-bone metastasis group, and the confidence degree of blood stasis + Yang deficiency + kidney was the highest in the bone metastasis group. Conclusion: The core disease location of prostate cancer is in the kidney, and the main disease location also include the spleen and lung. The syndrome elements of disease location in patients without bone metastasis are mainly the kidney and the spleen, while those in patients with bone metastasis are mainly the kidney, the spleen, and the lung. Yang deficiency, Qi deficiency, blood deficiency, blood stasis, dampness, Yin deficiency, and phlegm were the main pathognomonic elements. The syndrome element of disease nature in patients without bone metastasis is mainly Yang deficiency, and the main syndrome elements of disease nature in patients with bone metastasis, in addition to blood stasis, also involve Qi deficiency, Yang deficiency, blood deficiency, Yin deficiency, dampness, and phlegm. Kidney deficiency and blood stasis are the core pathogenesis of prostate cancer.

Key words：prostate cancer; bone metastasis; syndrome elements; kidney deficiency; blood stasis; retrospective study

发布时间：2025-12-20

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