中医肿瘤学杂志

目的 探索不同年龄段乳腺癌患者行内分泌治疗后出现类更年期综合征的中医证候分布规律，为该病的中西医协同治疗提供参考。方法 采用临床流行病学研究方法，收集乳腺癌行内分泌治疗出现类更年期综合征的患者，对其进行问卷调查。采集患者一般情况、中医四诊资料和Kupperman改良症状积分。比较不同年龄段患者一般情况的差异，并对其中医四诊资料进行层次聚类分析，归纳得出乳腺癌行内分泌治疗类更年期综合征的主要中医证候。结果 乳腺癌经内分泌治疗出现类更年期综合征的患者中，41岁～69岁的中年乳腺癌最多占74.37%，≤40岁的青年乳腺癌占14.24%，≥70岁的老年乳腺癌占11.39%。基于层次聚类法将患者中医四诊资料聚为4类，分别为气血两虚证、脾肾阳虚证、冲任失调证和肝郁气滞证。所有患者中气血两虚证占31.65%、脾肾阳虚证占23.73%、冲任失调证占27.53%、肝郁气滞证占17.09%。青年乳腺癌患者常见类更年期综合征的临床症状以月经先后不定期、盗汗、胸胁痛、抑郁/疑心、乳房痛为主，常见证型为冲任失调证（占44.44%）、肝郁气滞证（占40.00%）；中年患者以潮热面红、骨关节痛、神疲肢倦、少气懒言为主要症状，常见证型为气血两虚证（占34.47%）、冲任失调证（占28.51%）；老年患者则以头晕、畏寒肢冷、腰痛、出虚汗、夜尿频数、大便不实为主要症状，常见证型为脾肾阳虚证（占61.11%）、气血两虚证（占36.11%）。不同年龄段类更年期综合征患者四种中医证型的分布差异有统计学意义（P<0.05）。结论 乳腺癌患者经内分泌治疗后出现的类更年期综合征常见中医证型为肝郁气滞证、气血两虚证、脾肾阳虚证、冲任失调证四类，不同年龄段患者的证型分布存在明显差异：青年乳腺癌以冲任失调证、肝郁气滞证为主；中年乳腺癌以气血两虚证、冲任失调证为主；老年乳腺癌则以脾肾阳虚证、气血两虚证为主。

Objective To investigate the distribution patterns of traditional Chinese medicine(TCM) syndromes in breast cancer patients of different age groups with menopausal-like syndrome following endocrine therapy,aiming to provide valuable insights for TCM treatment strategies in breast cancer. Methods A clinical epidemiological research method was employed to conduct a questionnaire survey on 316 breast cancer patients who developed menopausal-like syndrome after endocrine therapy. Patients' general information, data from the four diagnostic methods of TCM,and Kupperman modified symptom scores were collected. The differences in general information among patients of different age groups were compared,and hierarchical clustering analysis on the data from the four diagnostic methods of TCM was performed to summarize and obtain the main TCM syndromes of menopausallike syndrome in breast cancer patients undergoing endocrine therapy. Results Among the breast cancer patients with menopausal-like syndrome after endocrine therapy,middle-aged breast cancer patients aged 41 to 69 years accounted for 74.37%,young breast cancer patients aged ≤ 40 years accounted for 14.24%,and elderly breast cancer aged ≥ 70 years accounted for 11.39%. Based on hierarchical clustering algorithm,the four TCM diagnosis data of patients was classified into four categories: qi and blood deficiency syndrome, spleen-kidney yang deficiency syndrome,Chong-ren disharmony syndrome,and liver qi stagnation syndrome. Among all patients,qi and blood deficiency syndrome accounted for 31.65%, spleen-kidney yang deficiency syndrome accounted for 23.73%,Chong-ren disharmony syndrome accounted for 27.53%,while liver qi stagnation syndrome accounted for 17.09%. Clinical symptoms of menopausal-like syndrome in young breast cancer patients included irregular menstruation,night sweats,chest and rib pain,depression/suspicion,and breast pain,with the common TCM syndrome being Chong-ren disharmony syndrome(44.44%)and liver qi stagnation syndrome(40.00%). Middleaged patients exhibited symptoms such as hot flashes, facial redness, bone and joint pain, fatigue, limb tiredness, and disinclination to talk due to lack of qi, with the common TCM syndromes being qi and blood deficiency syndrome(34.47%) and Chong-ren disharmony syndrome(28.51%). Elderly patients presented symptoms like dizziness, aversion to cold with cold limbs, lumbago, profuse sweating, nocturia, and loose stools, with the common TCM syndromes being spleen-kidney yang deficiency syndrome(61.11%)and qi and blood deficiency syndrome(36.11%). There were statistically significant differences in the distribution of the four TCM syndromes among menopausal-like syndrome patients of different age groups(P<0.05). Conclusion The common TCM syndromes of breast cancer patients with menopausal-like syndrome after endocrine therapy are four types:liver qi stagnation syndrome,qi and blood deficiency syndrome,spleen-kidney yang deficiency syndrome,and Chong-ren disharmony syndrome. There are significant differences in the distribution of syndromes among different age groups:Chong-ren disharmony syndrome and liver qi stagnation syndrome are predominant in young breast cancer patients,qi and blood deficiency syndrome and Chong-ren disharmony syndrome are predominant in middle-aged breast cancer patients,while spleen-kidney yang deficiency syndrome and qi and blood deficiency syndrome are predominant in elderly breast cancer patients.