【作者】 罗振亮；

【导师】 陈群；

【作者基本信息】 广州中医药大学 ， 中医诊断学， 2011， 博士

【摘要】 肺癌是目前世界发达国家及我国大中城市发病率及死亡率最高的恶性肿瘤之一,并且近几十年来其发病率及死亡率在全部恶性肿瘤中上升幅度最大。血瘀证是肿瘤的基本证型、主要证型之一,瘀血舌象对肿瘤的辨证分型、指导诊治具有十分重要的意义。近年来应用中西医结合治疗肿瘤显示出其在稳定病灶、改善症状、延长生存期、改善生存质量等方面优势,因此中西医结合防治肿瘤已成为广大医学工作者的一种共识。瘀血舌象是肿瘤最常见舌象之一,在舌象研究中具有较强的代表性。本课题以导师课题组的前期瘀血舌研究成果为基础,以肺癌瘀血舌象为切入点,从文献研究、临床研究、实验研究等方面入手,拍摄有代表性的肺癌瘀血舌彩色照片,分析肺癌瘀血舌的临床分布特征,从部分凝血指标入手分析其微观机理,进一步分析其对肺癌临床诊治的指导意义。论文分为三个部分：第一部分文献研究本研究通过计算机检索结合手工检索的方法,系统整理了古代瘀血舌象、血瘀证、肿瘤相关文献进行系统论述；通过计算机检索的方法,系统整理了现代瘀血舌与肺癌及其它肿瘤相关研究的文献。文献研究结果显示：古代医家对瘀血舌象、血瘀证、肿瘤均有丰富的文献记载,对肿瘤与血瘀证之间的密切关系有非常深刻的认识。但纵览历代中医古文献,却未见肺癌等肿瘤瘀血舌象方面的描述,具体有待于进一步研究。近年来许多医学工作者对肺癌及其它肿瘤患者血瘀证舌象的研究发现,肿瘤患者血瘀证舌象的舌质、舌苔、舌下络脉在不同病程阶段的分布及表现皆有一定的规律性。肺癌及其它肿瘤患者存在血液高凝状态,主要表现为血液流变学异常、微循环障碍及血液凝固性升高,血小板增多等。肺癌患者血液高凝状态与肿瘤的发生、进展和转移有一定相关性,肺癌的中医辨证分型与临床TNM分期、病理类型,以及实验室指标(血液流变学、凝血四项指标等)存在一定的关系和规律性。第二部分临床观察目的通过肉眼诊察肺癌患者舌象,分析其舌象分布特征,对典型、有代表性的肺癌瘀血舌象进行采集。方法144例肺癌患者,包括血瘀证组(肺郁痰瘀证)93例,非血瘀证组(脾虚痰湿证、阴虚痰热证、气阴两虚证)中51例,肉眼诊察舌象与数码相机彩色舌象照片相结合。结果在144例研究对象中,舌质颜色表现为暗红舌、淡红舌、淡暗舌、红舌、暗舌、淡舌、紫舌、瘀斑瘀点舌,其中以暗红舌、淡红舌、淡暗舌所占比例最重,分别占34.03%,20.83%,19.44%。血瘀证组和非血瘀证组进行舌质分布比较,血瘀证组的瘀血舌象明显多于非血瘀证组,两组差异有统计意义(p<0.05)。在肺癌血瘀证组中舌色表现为暗红舌>淡暗舌>淡红舌>红舌>暗舌>淡舌>紫舌>瘀斑瘀点舌；其中以暗红舌最多,占44.09%；淡暗次之,占18.28%。肺癌非血瘀证组中舌质表现为淡红舌>淡暗舌>暗红舌>红舌>紫舌>暗舌>淡舌>瘀斑瘀点舌,主要以淡红舌、淡暗舌为主,分别占31.37%、21.57%。肺癌患者的舌色随着年龄、性别、是否有远处转移病灶、早晚分期、病理类型不同,其分布特征也不相同。早期、中晚期组肺癌血瘀证患者舌色均以暗红、淡暗、淡红为主,但从中晚期组紫舌、瘀斑瘀点舌、舌下络脉曲张均呈增高趋势,考虑可能与中晚期患者病情较重,其血瘀程度也较重有关。在144例研究对象中,白苔、薄白苔、白腻苔、薄黄苔所占比例较重,特别是白苔所占比例最重。依据各种舌苔的出现频率,血瘀证组舌苔依次为白苔>薄白苔>薄黄苔>白腻苔>黄苔>白厚苔>黄腻苔>黄厚苔>少苔>黄厚腻苔>剥苔；非血瘀证组舌苔依次为白苔>白腻苔>薄白苔>少苔>薄黄苔>黄苔>剥苔>白厚苔>白厚腻苔>黄厚苔>无苔。肺癌血瘀证组与非血瘀证组舌苔分布比较,差异有统计意义。肺癌血瘀证组见舌下络脉瘀血征象者占24.73%,非血瘀证组见舌下络脉瘀血征象者占5.88%,血瘀证组明显高于非血瘀证组。结论淡红舌是正常舌质的表现,暗红舌、淡暗舌这两种瘀血舌象共占53.47%,提示肺癌患者多数有瘀血征象,与中医对癌瘤的认识一致,与临床辨证分型结果相符合。血瘀证组舌色以“暗”为主要特征,非血瘀证组以“淡”为主要特征,这与血瘀证组主要辨证为“肺郁痰瘀”的“瘀”证,非血瘀证组主要辨证为“脾虚痰湿、阴虚痰热、气阴两虚”的“虚”证一致。肺癌患者的年龄、性别、是否有远处转移病灶、早晚分期、病理类型不同,其舌苔分布特征也不相同。舌下络脉瘀血可能是肺癌血瘀证比较早期和敏感的指标。第三部分实验研究目的从实验层面探讨肿瘤瘀血舌象形成的病理机制。方法144例肺癌患者,包括血瘀证组(肺郁痰瘀证)93例,非血瘀证组(脾虚痰湿证、阴虚痰热证、气阴两虚证)中51例；32例健康人。早餐前静脉采血,用Sysmex CA1500、sysmex XE2100全自动血液分析仪检测以下指标：血浆凝血酶原时间(PT)测定：散射光测试法；活化部分凝血活酶时间(APTT)测定：散射光测试法；纤维蛋白原(FIB)测定：散射光测试法；血小板计数(PLT)测定：光学法(PLT-O)。结果(一)凝血酶原时间(PT)比较1.血瘀证组、非血瘀证组PT均较健康人对照组缩短,但差异无统计学意义(P>0.05)；血瘀证组PT较非血瘀证组缩短,但差异无统计学意义(P>0.05)。2.未转移组、远处转移组PT均较健康人对照组缩短,但差异无统计学意义(P>0.05)；未转移组PT较转移组缩短,但差异无统计学意义(P>0.05)。3.早期组、中晚期组PT均较健康人对照组缩短,但差异无统计学意义(P>0.05)；早期组PT较中晚期组缩短,但差异无统计学意义(P>0.05)。4.不同中医证型组比较,肺郁痰瘀证组、脾虚痰湿证组、阴虚痰热证组PT值均较健康人组缩短,但差异无统计学意义(P>0.05)；气阴两虚组与健康人组比较,差异有统计学意义(P<0.01),可认为气阴两虚组PT值高于健康人组；不同中医证型组之间比较,组间差异无统计学意义(P>0.05)。(二)活化部分凝血酶原时间(APTT)比较1.血瘀证组、非血瘀证组、健康人对照组之间相互比较,差异无统计学意义(P>0.05)；血瘀证组、非血瘀证组之间相互比较,差异无统计学意义(P>0.05)。2.未转移组、远处转移组、健康人对照组之间相互比较,差异无统计学意义(P>0.05)；未转移组、远处转移组之间相互比较,差异无统计学意义(P>0.05)。3.早期组、中晚期组、健康人对照组之间相互比较,差异无统计学意义(P>0.05)；早期组、中晚期组之间相互比较,差异无统计学意义(P>0.05)。4.不同中医证型组与健康人对照组之间相互比较,差异无统计学意义(P>0.05)；不同中医证型组之间相互比较,差异无统计学意义(P>0.05)。(三)纤维蛋白原(FIB)比较1.血瘀证组与健康人对照组FIB值比较,血瘀证组高于健康人对照组,差异有统计学意义(P<0.01)；非血瘀证组与健康人对照组FIB值比较,非血瘀证组FIB值高于健康人对照组,但差异无统计学意义(P>0.05)；血瘀证组与非血瘀证组FIB值比较,血瘀证组高于非血瘀证组,但差异无统计学意义(P>0.05)。2.早期组与健康人组比较,早期组高于健康人组,差异有统计学意义(P<0.05)；中晚期组与健康人组比较,中晚期组高于健康人组,差异有统计学意义(P<0.05)；早期组、中晚期组比较,中晚期组高于早期组,但差异无统计学意义(P>0.05)。3.未转移组与健康人组比较,未转移组高于健康人组,差异有统计学意义(P<0.05)；转移组与健康人组比较,转移组高于健康人组,差异有统计学意义(P<0.05)；转移组与未转移组比较,转移组高于未转移组,但差异无统计学意义(P>0.05)。4.肺癌不同中医证型组FIB值与健康人组比较,肺癌不同证型组FIB值均明显高于健康人组,差异有统计学意义(P<0.05)；不同中医证型组FIB值比较,肺郁痰瘀证组>气阴两虚证组>阴虚痰热证组>脾虚痰湿证组,但组间比较差异无统计学意义(P>0.05)。(四)血小板计数(PLT)比较1.血瘀证组PLT明显高于健康人对照组,差异有统计学意义(P<0.01)；血瘀证组PLT高于非血瘀证组,但差异无统计学意义(P>0.05)；非血瘀证组高于健康人对照组,但差异无统计学意义(P>0.05)。2.早期组、中晚期组、健康人对照组PLT比较,差异有统计学意义(P<0.05)；早期组与健康人对照组比较,早期组PLT高于健康人组,差异有统计学意义(P<0.05)；中晚期组高于健康人组,但差异无统计学意义(P>0.05)。3.未转移组、转移组、健康人对照组PLT比较,差异有统计学意义(P<0.05)；未转移组PLT明显较健康人组增高,差异有统计学意义(P<0.01)；转移组PLT明显较健康人组增高,差异有统计学意义(P<0.05)；未转移组高于转移组,但差异无统计学意义(P>0.05)。4.不同中医证型组PLT比较,肺郁痰瘀证组高于非血瘀证组(脾虚痰湿证、阴虚痰热证、气阴两虚证),但差异没有统计意义(P>0.05)；肺郁痰瘀证组与健康人对照组比较,明显高于健康人组(P<0.01)。结论1.PT是血瘀证重要参考指标肿瘤患者PT缩短提示血液高凝状态,血瘀证组PT与非血瘀证组、健康人组比较,统计结果虽无统计学意义,但三组比较,体现了健康人组>非血瘀证组>血瘀证组的趋势,体现了血瘀证组比非血瘀证组,非血瘀证组比健康人组机体血液更加高凝的状态,与中医临床辨证为血瘀证(肺郁痰瘀证)、非血瘀证(脾虚痰湿证、阴虚痰热证、气阴两虚证)的认识相一致。2.APTT是血瘀证重要参考指标APTT缩短,常提示血液高凝状态。本研究结果显示血瘀证组APTT时间并没有比非血瘀证组缩短,但也没有比非血瘀证组APTT时间延长。考虑APTT并非血瘀证的特异性实验指标,只是重要参考指标有关。3.FIB值的升高是瘀血舌象形成的重要病理基础FIB值的升高与肺癌的发生、进展、转移相关,FIB的升高使肺癌患者的血液处于“浓、粘、凝、聚”的高凝状态,血瘀证组的FIB值高于非血瘀证组,且明显高于健康人对照组,推测FIB值的升高可能是肺癌瘀血舌象形成的重要病理基础。4.PLT值的升高是肺癌瘀血舌象形成的重要环节PLT值的升高,机体血小板增多,血小板大量堆积,形成血小板血栓,并且血小板表面粘附的蛋白复合物激活凝血酶,使得机体血液凝固性增高,血流减慢,组织缺氧,反映于舌出现瘀血舌象。血瘀证组的PLT值高于非血瘀证组,且明显高于健康人对照组,提示PLT值的升高可能是肺癌瘀血舌象形成的重要环节。结语本课题的创新点：1.本课题研究发现,肺癌患者瘀血舌象以“暗”为主要特征,主要为“暗红舌、淡暗舌”,与以往文献报道肿瘤患者瘀血舌象以“青舌、紫舌、瘀斑瘀点舌”为主的特征不同。认为“暗红舌、淡暗舌”是肺癌瘀血舌的基本舌象,而“青舌、紫舌、瘀斑瘀点舌”是肺癌瘀血舌象的典型舌象。2.本研究首次从PT、APTT、FIB、PLT角度分析了肺癌瘀血舌象的微观机理,拓宽了肺癌瘀血舌象的研究思路。更多还原

【Abstract】 Lung carcinoma, as one of the malignant tumors with highest occurrence and mortality rates in the developed countries and the large cities in our country, is a carcinoma with highest ccurrence and mortality rates over the world, with largest increasing occurrence and mortality rates among all the carcinomas. Blood stasis syndrome is one of the basic and main syndromes of the tumors, and the tongue manifestation of blood stasis is of significance in the syndrome differentiation, diagnosis and treatment of tumors. In recent years, more and more clinical practice of integrated traditional and western medicine has demonstrated the superiority and advantages in stabilizing the foci, improving the symptoms, prolonging the survival, enhancing the quality of life, etc, which has paid much attention in the medical field at home and abrord. The blood stasis tongue manifestation is one of the commonly seen manifestations of the tumors, which is of significance in the studies of tongue manifestaions. In the present dissertation, based on the research results of early phase of the project, taking the blood stasis tongue manifestations of lung carcinoma as the breakthrough point, with the literature research, clinical practise and experimental study, etc, the colorful pictures of blood stasis tongue manifestation with representatives were taken. By analyzing the clinical distribution characteristics of the blood stasis tongue of lung carcinoma and the correlations with the indexes of the modern medical tests, it provides the scientific basis for the clinical diagnosis and treatment of lung carcinoma. The present dissertation includes three parts.Part 1 Literature research In the present study, with the methods of computer-based comtbined with manual retrievals, the related ancient literatures of the blood stasis tongue, blood stasis syndrome and tumor were systematically discussed. With the methods of computer-based retrieval, the related modern literactures of blood stasis tongue and other tumor studies were systematically analyzed. The literature research indicated that there were rich records of blood stasis tongue manifestations, blood syndrome and tumors in ancient China and there was deep understanding to the close relationships among the three. However, according to these ancient literatures, there were no references of the blood stasis tongue of tumors, which needs further studies. In recent years, increasing research of the blood stasis tongue manifestation of lung carcinoma and other tumors has found that there were some certain rules of the distributions and manifestations of the tongue body, tongue coating and sublingual veins in different phases among the tumor patients. There was hypercoagulability among the patients with lung carcinoma or other tumors, which manifest as abnormal hemorheology, impediment of microcirculation, increasing coagulability of blood, increasing amounts of blood platelet, etc. There was certain relationship between the hypercoagulability of blood and the occurrence, development and metastasis of the carcinoma, and there were certain relationships and rules between the syndrome differentiation and clinical TNM, pathological categories and biolocial indexes (such as hemorheology, four items of coagulation function test, etc).Part 2 Clinical observationObjective:By diagnosing and observing the tongue manifestaions of lung carcinoma, the cases with representative blood stasis tongue manifestation were enrolled and the distribution characteristics of the tongue manifestation were analyzed.Subjects:144 patients with lung carcinoma, including 93 cases in the blood stasis tongue manifestation group and 51 cases in the non-blood stasis tongue manifestation group.Methods:Integration of observation of tongue manifestation by eye and tongue manifestation pictures taken with digital cameras.Results and conclusions2.1 Tongue body2.1.1 Among the 144 cases enrolled, the colors of the tongues manifest as dull-red, pale dark red, red, dark, pale, purple and ecchymosis, with the dull-red, pale red and pale dark the lagest ratio, accounting for 34.03%, 20.83% and 19.44% respectively. The pale red tongue manifestion is normal, but the dark red and pale dark tongue manifestations account for 53.47%, indicating that there were mostly blood stasis signs among the lung carcinoma patients, which was accordance with the TCM understanding to the tumors and the clinical results of syndrome differentiation.2.1.2 With the comparison of the tongue body distribution between the blood stasis tongue group and the non-blood stasis tongue group, there were apparently more blood stasis tongue manifestation in the former group than that in the latter group, with significant difference between the two (P<0.05). In the former group, the tongue manifestations from large to small ratio successively were dull-red, pale dark, pale red, dark, pale, purple and ecchymosis, with the dark red the largest, accounting for 44.09%; pale dark secondly, accounting for 18.28%. In the latter group, the tongue manifestations from large to small ratio successively were pale red, pale dark, dull-red, red, purple, dark, pale and ecchymosis, mainly as the pale red and pale dark, accounting for 31.37% and 21.57% respectively. In the former group, the tongue manifestations were manily characteristic as dark, which was accordance with the syndrome differentiation as blood stasis syndrome due to lung depression, phlegm and blood stasis; in the latter group, the tongue manifestations were manily characteristic as pale, which was accordance with the syndrome differentiation as deficiency syndrome due to spleen deficiency and phlegm-dampness, yin-deficiency and phlegm-heat and dual deficiency of qi and yin.2.1.3 The tongue colors changed with the difference of ages, sexes, metastasis, phases and pathological categories. The distribution characteristics were also different. In the early and middle phases, the cases of blood stasis syndrome of lung carcinoma manifest mainly as dull-red, pale dark and pale red tongue manifestations. However, in the middle and late phases, the ratios of purple and ecchymosis tongue manifestations and sublinguial varicose veins have the tendency of increasing, which maybe was closely related with the serious situation of the patients and the serious blood stasis situation.2.2 Tongue coating2.2.1 Among the 144 cases enrolled, most of the manifestations of the tongue coating were white, thin-white, white-greasy and thin-yellowish, particularly the white, accounting the largest ratio.2.2.2 According to the occurrence frequency of all kinds of the tongue coating, the tongue coating manifestations from large to small ratio in the blood stasis tongue group successively were white, thin-white, thin-yellowish, white-greasy, yellowish, white-thick, yellowish-greasy, yellowish-thick, little coating, yellowish-thick-greasy and peeling coatings. The tongue coating manifestations from large to small ratio in the non-blood stasis tongue group successively were white, white-greasy, little coatings, thin-yellowish, yellowish, peeling coatings, white-thick, white-thick-greasy, yellowish-thick and little coatings. With the statistical management, there was significant difference of the distribution of the tongue coating between the two groups.2.2.3 The distribution characteristics of the tongue coating among the lung carcinoma patients were different with the difference of the ages, sexes, metastasis, phases and the pathological categories.2.3 Sublinguial veinsThe signs of sublinguial veins accounted for 24.73% in the blood stasis tongue group and 5.88% in the non-blood stasis tongue group, with the signs in the former group obviously higher than that in the latter group, which was accordance with the results of the TCM clinical syndrome differentiation. Part 3 Clinical experimental research3.1 Objective:To explore the pathological mechanism of the formation of the blood stasis tongue manifestation of tumors from the experimental aspects.3.2 Subjects:144 lung carcinoma patients (including 93 cases in the blood stasis tongue group and 51 cases in the non-blood stasis tongue group) and 32 healthy people.3.3 Methods:Venous blood before breakfast was collected. The following indexes such as prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), platelet count (PLT) were tested with the Sysmex CA1500 and Sysmex XE2100 Auto-blood analyzer.3.4 Results and conclusions3.4.1 Comparison of the prothrombin time (PT)3.4.1.1 The PT of the blood stasis tongue group and the non-blood stasis tongue group were lower than the healthy group, with no significant difference (P>0.05); the PT of the blood stasis tongue group was lower than the non-blood stasis tongue group, with no significant difference (P>0.05).3.4.1.2 The PT of the non-metastasis group and the metastasis group were lower than the healthy group, with no significant difference (P>0.05); the PT of the non-metastasis group was lower than the metastasis group, with no significant difference (P>0.05).3.4.1.3 The PT of the early phase group and the middle-late phase group were lower than the healthy group, with no significant difference (P>0.05); the PT of the early phase group was lower than the middle-late phase group, with no significant difference (P>0.05).3.4.1.4 Among different Chinese medicine syndrome group, the PT of the lung depression, phlegm and blood stasis group, the spleen deficiency, phlegm and dampness group and the Yin deficiency, phlegm and heat group were lower than the healthy group, with no significant difference (P>0.05); the PT of the Qi and Yin deficiency group was higher than the healthy group, with significant difference (P<0.01);the PT among different Chinese medicine groups were not statistically significant (P>0.05).PT is an important reference index for blood stasis tongue syndrome. The shortening of PT of cancer patients prompted hypercoagulative state of blood. Among the comparison of the PT of the blood stasis tongue group, the non-blood stasis tongue group and the healthy group, the statistical result showed no significant difference.But the result showed as follow:the healthy group > the non-blood stasis tongue group> the blood stasis tongue group.That meaned hypercoagulative state of the blood stasis tongue group was higher than that of the non-blood stasis tongue group, and hypercoagulative state of the non-blood stasis tongue group was higher than that of the healthy group. They are coincide with the understanding of TCM clinical syndrome differentiation for blood stasis tongue syndrome (the lung depression, phlegm and blood stasis syndrome) and non-blood stasis tongue syndrome(the spleen deficiency, phlegm and dampness syndrome, the Yin deficiency, phlegm and heat syndrome and the Qi and Yin deficiency syndrome).3.4.2 Comparision of the activated partial thromboplastin time (APTT)3.4.2.1 The APTT among the blood stasis tongue group, the non-blood stasis tongue group and the healthy group were not statistically significant (P>0.05); The APTT between the blood stasis tongue group and the non-blood stasis tongue group was not statistically significant (P>0.05).3.4.2.2 The APTT between the non-metastasis group, the metastasis group and the healthy group were not statistically significant (P>0.05); The APTT between the non-metastasis group and the metastasis group was not statistically significant (P>0.05).3.4.2.3 The APTT among the early phase group, the middle-late phase group and the healthy group were not statistically significant (P>0.05); The APTT between the early phase group and the middle-late group was not statistically significant (P>0.05).3.4.2.4 The APTT between different TCM syndrome group and the healthy group were not statistically significant(P>0.05); The APTT between different TCM syndrome group were not statistically significant (P>0.05).APTT is an important reference index for blood stasis tongue syndrome. The shortening of APTT often prompted hypercoagulative state of blood. This research showed that the APTT of the blood stasis tongue group was the same as that of the non-blood stasis tongue group. That pointed out APTT was just an important reference index, but not a specificity experimental index.3.4.3 Comparision of the Fibrinogen (FIB)3.4.3.1 The FIB of the blood stasis tongue group was higher than the healthy group, with significant difference(P<0.01); the FIB of the non-blood stasis tongue group was higher than the healthy group, with no significant difference(P>0.05); The FIB of the blood stasis tongue group was higher than the non-blood stasis tongue group, with no significant difference (P>0.05).3.4.3.2 The FIB of the early phase group was higher than the healthy group, with significant difference(P<0.05); the FIB of the middle-late phase group was higher than the healthy group, with significant difference(P<0.05); The FIB of the middle-late phase group was higher than the early phase group, with no significant difference (P>0.05).3.4.3.3 The FIB of the non-metastasis group was higher than the healthy group, with significant difference(P<0.05); the FIB of the metastasis group was higher than the healthy group, with significant difference(P<0.05); the FIB of the metastasis group was higher than the non-metastasis group, with no significant difference(P>0.05).3.4.3.4 The FIB of different TCM syndrome group was higher than the healthy group, with siginificant difference(P<0.05); the comparison of different TCM syndrome group on FIB showed that as follow:the lung depression, phlegm and blood stasis group>the Qi and Yin deficiency group>the Yin deficiency, phlegm and heat group>the spleen deficiency, phlegm and dampness group, with no significant difference (P>0.05).The increasing of the FIB was the important pathologic basis of the formation of blood stasis tongue. The increasing of FIB was related to the occurrence, evolution and metastasis of lung carcinoma. It keeped the blood of lung carcinoma patient in a "thick, sticky, concretionary, congregative" hypercoagulative state. The FIB of blood stasis tongue group was higher than the non-blood stasis group, and was significantly higher than the healthy group. That pointed out the increasing of FIB was the important pathologic basis of the formation of blood stasis tongue.3.4.4 Comparison of Platelet count (PLT)3.4.4.1 The PLT of blood stasis tongue group was higher than the healthy group, with significant difference(P<0.01); The PLT of blood stasis tongue group was higher than the non-blood stasis tongue group, with no significant difference(P>0.05); The PLT of non-blood stasis tongue group was higher than the healthy group, with no significant difference (P>0.05).3.4.4.2 The PLT among the early phase group, the middle-late phase group and the healthy group were statistically significant (P<0.05); the PLT of the early phase group was higher than the healthy group, with significant difference (P<0.05); the PLT of the middle-late phase group was higher than the healthy group, with no significant difference (P>0.05).3.4.4.3 The PLT among the non-metastasis group,the metastasis group and the healthy group were statistically significant (P<0.05); the PLT of the non-metastasis group was higher than the healthy group, with significant difference (P<0.01); the PLT of the metastasis group was higher than the healthy group, with significant difference(P<0.05); the PLT of the non-metastasis group was higher than the metastasis group, with no significant difference(P>0.05). 3.4.4.4 Among different TCM syndrome group, the PLT of the lung depression, phlegm and blood stasis group was higher than the other syndrome group, with no significant difference (P>0.05); the PLT of the lung depression, phlegm and blood stasis group was higher than the healthy group, with significant difference(P<0.01).The increasing of the PLT was an important part of the formation of lung carcinoma blood stasis tongue. The number of PLT increased, the number of PLT in body increased, lots of PLT accumulated, all of that formed the PLT thrombosis. The protein complexes which adhered on the surface of the PLT activated thrombin. That increased the blood coagulability, slowed the blood flow, and the tissue were hypoxia. All of that reflectd in the blood stasis tongue. The PLT of the blood stasis tongue group was higher than the non-blood stasis tongue group, and was significantly higher than the healthy group. That pointed out the increasing of the number of PLT maybe an important part of the formation of lung carcinoma blood stasis tongue.ConclusionInnovation of the present study 4.1 Taking the blood stasis tongue manifestation as the breakthrough point, in the present research, the characteristics, the rules of the clinical distribution and the mechanism of the formation of the tongue manifestation were systematically analyzed. It indicated that the blood stasis tongue manifestations of lung carcinoma were mainly characteristic with dark, mostly were dull-red, pale dark, which were different from the previous literacture reports on the blood stasis manifestations of tumors as green, purple or ecchymosis. It was thought that the dark red tongue and the dark pale tongue was the basic tongue manifestations of the blood stasis syndrome of lung carcinoma, and the blue, purple and ecchymosis petechia tongues were the typtical tongue manifestations of the blood stasis syndrome of lung carcinoma.4.2 In the present study, it was firstly analyzed the micro-mechanism of the blood stasis tongue manifestations of lung carcinoma from the perspective of PT, APTT, FIB and PLT, which consequently broadens the study strategies for the blood stasis tongue manifestations of lung carcinoma.更多还原