弥漫大B细胞淋巴瘤中医证候、证素动态分布规律及与化疗结局相关性OA

Objective To investigate the dynamic distribution patterns of Chinese medicine(CM)patterns and pattern elements in diffuse large B-cell lymphoma(DLBCL),as to explore the correlation between CM patterns and chemotherapy outcomes.Methods DLBCL patients treated at the Department of Hematology,The Third Affiliated Hospital of Fujian University of Traditional Chinese Medicine,from January 2023 to December 2024 were enrolled.Syndrome differentiation information was collected at three time points:initial treatment(before chemotherapy),mid-chemotherapy(after 4 cycles of R-CHOP regimen),and end-of-chemotherapy(after 8 cycles of R-CHOP regimen).Pattern elements were extracted,and CM pattern differentiation was performed.Differences in clinical indicators among different patterns,the dynamic distribution of patterns and pattern elements,and their correlation with mid-and end-of-chemotherapy outcomes were analyzed.Results A total of 412 patient visits were included(286 at initial treatment,95 at mid-chemotherapy,and 31 at end-of-chemotherapy).Five CM patterns showed dynamic evolution:Yin deficiency with phlegm accumulation pattern had the highest proportion at initial treatment(39.2％),which decreased over time(29.5％at mid-chemotherapy,19.3％at end-of-chemotherapy);vital qi deficiency with lingering pathogen pattern showed the lowest proportion at initial treatment(3.2％),which increased during treatment(33.7％at mid-chemotherapy,32.3％at end-of-chemotherapy);qi depression with phlegm obstruction pattern remained stable across stages(21.1％～32.3％);whereas cold-phlegm congelation and stagnation pattern and phlegm-blood stasis toxin pattern accounted for smaller proportions across all stages.Regarding pattern elements distribution,cold-phlegm congelation and stagnation pattern was dominated by vital qi deficiency;phlegm-blood stasis toxin pattern was dominated by excess pathogen;yin deficiency with phlegm accumulation pattern manifested as yin deficiency with heat signs;qi depression with phlegm obstruction pattern manifested as qi stagnation with the Gan as the disease location;lingering pathogen due to deficient vital qi pattern manifested as vital qi deficiency with the Pi as the disease location.Clinically,the phlegm-blood stasis toxin pattern and yin deficiency with phlegm accumulation pattern exhibited higher levels of Beta-2 microglobulin(β2-MG)and neutrophil count(NEUT)and lower platelet count(PLT)levels(P＜0.05),while the vital qi deficiency with lingering pathogen pattern showed lower β2-MG and higher PLT levels(P＜0.05).CM patterns were significantly associated with mid-chemotherapy outcomes(P＜0.05,Cramer's V=0.330),with the phlegm-blood stasis toxin pattern showing a lower PR rate(0/7)and a higher PD rate(4/7)compared to other patterns.No statistically significant association was observed between CM patterns and end-of-chemotherapy outcomes(P＞0.05),although a moderate effect size was observed(Cramer's V=0.432).Conclusions Five CM patterns in DLBCL exhibit dynamic evolution,while the composition of pattern elements remains relatively stable across treatment stages.CM patterns are significantly associated with mid-chemotherapy outcomes but not with end-of-chemotherapy outcomes.Patterns conforming to the pathophysiological characteristics of DLBCL"originating from qi,developing into phlegm,and culminating in phlegm-stasis interlocking"are associated with relatively favorable prognosis.