目的 研究肿瘤营养不良(CAM)患者的中医证型分布规律,并分析其证型与免疫炎症指标的相关性。 方法 2022 年 8 月至 2025 年 1 月在中国中医科学院望京医院肿瘤科开展横断面研究,采用调查问卷规范采集 191 例 CAM 患者的一般情况 资料、营养影响症状(NIS)、体测指标及免疫炎症指标。 对 NIS 进行描述性频数分析,基于因子分析和聚类分析归纳主要中医 证型分布,并在 CAM 各中医证型间进行免疫炎症指标的差异性检验。 结果 191 例 CAM 患者中,口干、纳差、恶心出现频次最 多,分别有 130、126 和 96 例。 对 11 项症状进行因子分析得出 4 个公因子,累积贡献率为 59. 63%。 聚类分析结果显示,中医 证型分为脾胃阴虚、脾胃气虚、脾虚湿蕴三证。 三头肌皮褶厚度、总蛋白、白细胞计数、全身免疫炎症指数(SII)在脾虚湿滞、脾 胃气虚和脾胃阴虚证 3 个证型间具有统计学差异(P<0. 05)。 二次分析发现脾虚湿蕴证的皮褶厚度小于脾胃气虚证,脾胃气 虚证的总蛋白和食欲视觉模拟评分法(VAS)、中性粒细胞计数(NEUT)、SII 高于脾胃阴虚证,而患者主观整体评估(PG-SGA) 评分则低于脾胃阴虚证(以上均 P<0. 05)。 结论 CAM 证型主要为脾胃阴虚、脾胃气虚、脾虚湿蕴。 脾胃阴虚证患者肿瘤营养 不良程度最重;脾胃气虚证患者的炎症状态更为剧烈;脾虚湿蕴患者的肌肉含量降低最显著。 综上,针对肿瘤营养不良患 者,中医治疗应以“健脾”为本,兼以益气、养阴、化湿以调节免疫炎症水平,改善营养不良状态。

Objective To investigate the distribution pattern of Traditional Chinese Medicine TCM syndromes in patients with cancer- associated malnutrition and analyze the correlation between these syndrome types and immune - inflammatory indicators. Method A cross-sectional study was conducted from August 2022 to January 2025 at the Oncology Department of Wangjing Hospital Chinese Academy of Traditional Chinese Medicine. A standardized questionnaire was used to collect general information nutrition impact symptoms physical examination indicators and immune - inflammatory indicators from 191 patients diagnosed with CAM. Descriptive frequency analysis was performed for NIS the distribution of major TCM syndrome types was summarized based on factor analysis and cluster analysis and intergroup difference analysis of immune-inflammatory indicators among different TCM syndrome types in CAM patients was conducted. Result Among the 191 CAM patients xerostomia anorexia and nausea had the highest frequencies of occurrence with 130 126 and 96 cases respectively. Factor analysis of 11 symptoms identified 4 common factors with a cumulative contribution rate of 59. 63%. Results of cluster analysis showed that TCM syndrome types were classified into three categories spleen-stomach yin deficiency syndrome spleen-stomach qi deficiency syndrome and spleen deficiency with dampness accumulation syndrome. Statistically significant differences P<0. 05 were observed in triceps skinfold thickness total protein white blood cells count and systemic immune-inflammation index among the three syndrome types. Secondary analysis revealed that TSF in patients with spleen deficiency with dampness accumulation syndrome was lower than that in patients with spleen-stomach qi deficiency syndrome TP appetite visual analog scale score neutrophils and SII in patients with Spleen-stomach qi deficiency syndrome were higher than those in patients with spleen - stomach yin deficiency syndrome while the PG- SGA score was lower all P< 0. 05 . Conclusion This study found that the main TCM syndrome types in CAM patients are spleen - stomach yin deficiency syndrome spleen-stomach qi deficiency syndrome and spleen deficiency with dampness accumulation syndrome. Patients with spleen-stomach yin deficiency syndrome have the most severe CAM patients with spleen - stomach qi deficiency syndrome present a more severe inflammatory state and patients with spleen deficiency with dampness accumulation syndrome show the most significant reduction in muscle mass. In conclusion for CAM patients TCM treatment should be based on " strengthening the spleen " combined with replenishing qi nourishing yin and resolving dampness to regulate immune-inflammatory levels and improve malnutrition.