【摘要】 目的 了解晚期肿瘤患者多线治疗后贫血严重程度的影响因素，并探究其中医证素分布与组合规律。方法 回顾性收集2021年11月至2023年11月于中国中医科学院广安门医院住院治疗的多线治疗后晚期肿瘤患者的临床及四诊资料。采用频数统计、聚类分析提炼证素特征与组合规律，分析证素与贫血严重程度的相关性，并运用Logistic回归分析贫血程度的影响因素。结果 共有100例患者被纳入分析。男性40例(40%),女性60例(60%);中位年龄68岁。妇科肿瘤38例(38%),肺癌36例(36%),消化系统肿瘤23例(23%),淋巴瘤3例(3%)。贫血分级：1级51例(51%)、2级42例(42%)、3～4级7例(7%),血红蛋白平均98 g/L(64 g/L～119 g/L),以正细胞性贫血为主。主要病位证素为脾、肺、肾，主要病性证素为血虚、气虚、阳虚、湿。病位在脾、心与病性为阳虚与肿瘤相关性贫血严重程度相关(P<0.05)。高频证素聚类分析得出五种组合：气虚-血虚；脾-阳虚-湿；肺-痰；心-肝-肾；胃-气滞-阴虚-血瘀。多因素Logistic回归分析显示，卡氏功能状态(Karnofsky performance status, KPS)评分(OR=3.057,95%CI:1.067～8.756,P=0.037)、血清白蛋白水平(OR=0.785,95%CI:0.665～0.925,P=0.004)、妇科肿瘤(OR=4.012,95%CI:1.109～14.509,P=0.034)和淋巴结转移(OR=3.490,95%CI:1.162～10.477,P=0.026)与2级及以上贫血独立相关。结论 多线治疗后晚期肿瘤患者贫血病位主要在脾、肺、肾，血虚、气虚、阳虚、湿为主要病理因素，KPS评分、血清白蛋白水平、肿瘤类型和淋巴结转移与贫血程度独立相关。更多还原

【Abstract】 Objective To investigate the influencing factors of anemia severity in advanced cancer patients after multiple lines of treatment, and to explore the distribution and combination rules of Traditional Chinese Medicine(TCM) pattern elements.Methods A retrospective collection of clinical and four diagnostic data was conducted on advanced cancer patients who received multiple lines of treatment at Guang’anmen Hospital, China Academy of Chinese Medical Sciences, from November 2021 to November 2023. Frequency statistics and cluster analysis were employed to extract the characteristics and combination rules of syndrome elements, the correlation between pattern elements and the severity of anemia was assessed, and logistic regression was used to analyze the influencing factors of anemia severity.Results A total of 100 patients were included in the analysis. There were 40 males(40%) and 60 females(60%); the median age was 68 years. Gynecological tumors accounted for 38 cases(38%), lung cancer for 36 cases(36%), digestive system tumors for 23 cases(23%), and lymphoma for 3 cases(3%). Anemia grading: Grade 1 in 51 cases(51%), Grade 2 in 42 cases(42%), Grades 3-4 in 7 cases(7%). The average hemoglobin was 98 g/L(64 g/L ～ 119 g/L), primarily normocytic anemia. The main disease location pattern elements were spleen, lung, and kidney. The main disease location pattern elements are spleen, lung, and kidney, and the main disease nature pattern elements are blood deficiency, qi deficiency, yang deficiency, and dampness. The location of the disease in the spleen, heart, and the severity of(cancer-related anernial, CRA) were correlated with yang deficiency(P < 0.05). High frequency syndrome clustering analysis identified five combinations: Qi deficiency-blood deficiency; Spleen-yang deficiency-dampness; Lung-phlegm; Heart-liver-kidney; Stomach qi-stagnation-yin deficiency-blood stasis. Multivariate logistic regression analysis showed that Karnofsky Performance Status(KPS) scores(OR = 3.057, 95%CI:1.067-8.756, P = 0.037), serum albumin levels(OR = 0.785, 95%CI: 0.665-0.925, P = 0.004), gynecological tumors(OR = 4.012, 95%CI: 1.109-14.509, P = 0.034), and lymph node metastasis(OR = 3.490, 95%CI: 1.162-10.477, P = 0.026) were independently associated with grade 2 and above anemia.Conclusion After multi-line treatment, the anemia sites in advanced cancer patients are mainly in the spleen, lung, and kidney, with blood deficiency, qi deficiency, yang deficiency, and dampness as the main pathological factors. KPS score, serum albumin level, tumor type, and lymph node metastasis are independently correlated with the degree of anemia.更多还原