【作者】 黄国品；

【导师】 章永红；

【作者基本信息】 南京中医药大学 ， 中医内科学（专业学位）， 2013， 博士

【摘要】 目的：一.探讨肺癌和中医体质的相关性；二.探讨肺癌中医证候(证型)的分布特点；三.探究肺癌中医体质和证候(证型)与肺癌临床分期(TNM)的相互关系,为今后中医临床建立起肺癌中医体质和证型整体结构的基本框架。方法：将符合纳入标准的113例肺癌患者,对其进行中医体质分型,中医辨证分型及国际肺癌临床分期(TNM),用SPSS统计软件对数据进行统计,并进行交叉比较,以探明其内在的相关性结果：1.TNM分期分布情况Ⅰ期3例(2%),Ⅱ期12例(11%),Ⅲ期43例(38%),Ⅳ期55例(49%)。2.中医体质分布情况气虚质36例(32%)>阴虚质19例(17%)>阳虚质16例(13%)>气郁质12例(11%)>痰湿质10例(9%)>平和质8例(7%)>血瘀质7例(6%)>湿热质3例(3%)>特禀质2例(2%)。3.中医证型分布情况气虚痰湿证16例(14%)；阴虚热毒证28例(25%)；气血瘀滞证22例(19%)气阴两虚证47例(42%)。4肺癌中医体质与临床分期(TNM)的相互关系Ⅰ期偏颇体质主要是阴虚质(33.3%)和痰湿质(33.3%)；Ⅱ期偏颇体质主要是气虚质(25%),其次是痰湿质(15.4%)、血瘀质(15.4%)、气郁质(15.4%)；Ⅲ期偏颇体质主要是气虚质(25.6%),其次是阴虚质(18.6%)、阳虚质(14%)、气郁质(11.6%)；Ⅳ期偏颇体质主要是气虚质(40%),其次是阳虚质(18.2%)、阴虚质(16.4%)、气郁质(9.1%)。5.肺癌中医证型(证候)与临床分期(TNM)的相互关系Ⅰ期Ⅱ期均以气虚痰湿证为主要证型,其次为气血瘀滞证；Ⅲ期以气阴两虚证及阴虚热毒证为主,其次为气血瘀滞证；Ⅳ期以气阴两虚证为主,其次为阴虚热毒证及气血瘀滞证。6.肺癌中医体质与中医证型(证候)之间的相互关系平和质、湿热质、特禀质与证型无相关,其余体质皆和证型有相关性。结论：1.肺癌患者TNM分期以晚期为多,Ⅲ、Ⅳ期患者共98例(87%)。2.肺癌患者主要偏颇体质类型为气虚质,约占1/3(32%)；气虚质、阴虚质、阳虚质等虚性偏颇体质,约占2/3；气郁质、痰湿质、血瘀质、湿热质等实性偏颇体质占29%。3.肺癌患者最常见的证型依次是：气阴两虚证(42%)>阴虚热毒证(25%)>气血瘀滞证(19%)>气虚痰湿证(14%)。4.体质与分期(1)ⅠⅡ期以阴虚质及气虚质等正虚体质为主,兼见邪实体质。(2)ⅢⅣ期以气虚质、阳虚质、阴虚质等正虚体质为主且比重随病期逐渐上升,而邪实体质比例渐趋减少。(3)气郁质在Ⅱ期Ⅲ期Ⅳ期是邪实体质的最主要类型5.证型与分期(1)ⅠⅡ期均以气虚痰湿证为主要证型。(2)ⅢⅣ期均以气阴两虚证为主要证型。(3)气血瘀滞证贯穿各期,在Ⅱ期Ⅲ期Ⅳ期均有一定比例。6.体质与证型平和质、湿热质及特禀质与肺癌临床证型无关；气虚质和气阴两虚证、阳虚质和气阴两虚证、阴虚质和阴虚热毒证、痰湿质和气虚痰湿证、血瘀质和气血瘀滞证、气郁质和气血瘀滞证相关。更多还原

【Abstract】 Objective:1. To explore the correlation between the lung cancer and TCM constitution;2. To explore the factors influencing the distribution of TCM symptoms; To investigate the correlation between TCM constitutions/symptoms and the TNM stages for lung cancer. This thesis is aimed to establish a theoretical frame for clinical analysis of TCM constitutions/symptoms in patients with lung cancer.Methodology:113eligible patients with lung cancer were stratified according to TCM constitutions, TCM symptoms, and the TNM stages for lung cancer. The statistical data derived from SPSS software were also cross-compared to identify the internal correlation.Result:1. Distribution of TNM stagesStage I:3patients (2%); Stage II:12patients (11%); Stage Ⅲ:43patients (38%); Stage IV:55patients (49%)2. Distribution of TCM constitutionsQi Deficiency constitution:36patients (32%)> Yin Deficiency constitution:19patients (17%)> Yang Deficiency constitution:16patients (13%)> Qi depression constitution:12patients (11%)> Phlegm-dampness constitution:10patients (9%)> yin-yang harmony constitution:8patients (7%)> Blood stasis constitution:7patients (6%)> Dampness-heat constitution:3patients (3%)> allergic constitution:2patients (2%).3. Distribution of TCM symptomsDeficiency of qi and phlegm and dampness syndrome:16patients (14%); deficiency of yin and excessive heat syndrome:28patients (25%); Qi stagnation and blood stasis syndrome:22patients (19%); Qi-Yin deficiency syndrome:47patients (42%).4. Correlation between TCM constitutions and TNM stages in patients with lung cancerStage Ⅰ:Yin Deficiency constitution (33.3%) and Phlegm-dampness constitution (33.3%); Stage Ⅱ:Qi Deficiency constitution (25%), followed by Phlegm-dampness constitution (15.4%), Blood stasis constitution (15.4%), and Qi depression constitution (15.4%); Stage III:Qi Deficiency constitution (25.6%), followed by Yin Deficiency constitution (18.6%), Yang Deficiency constitution (14%), and Qi depression constitution (11.6%); Stage IV:Qi Deficiency constitution (40%), followed by Yang Deficiency constitution (18.2%), Yin Deficiency constitution (16.4%), and Qi depression constitution (9.1%).5. Correlation between TCM symptoms and TNM stages in patients with lung cancer Stages I and II:Deficiency of qi and phlegm and dampness syndrome, followed by Qi stagnation and blood stasis syndrome; Stage III:Qi-Yin deficiency syndrome and deficiency of yin and excessive heat syndrome, followed by Qi stagnation and blood stasis syndrome; Stage IV: Qi-Yin deficiency syndrome, followed by deficiency of yin and excessive heat syndrome and Qi stagnation and blood stasis syndrome.6. Correlation between TCM constitutions and TCM symptoms in patients with lung cancerTCM constitutions and TCM symptoms are correlated in all parameters other than yin-yang harmony constitution, Dampness-heat constitution, and allergic constitution.Conclusion:1. A majority of patients with lung cancer presented with advanced stages, i.e. a total of98patients in Stages Ⅲ and Ⅳ (87%).2. A majority of patients with lung cancer presented with Qi Deficiency constitution (1/3,32%); Qi Deficiency constitution, Yin Deficiency constitution, and Yang Deficiency constitution (2/3); Qi Deficiency constitution, Phlegm-dampness constitution, Blood stasis constitution, and Dampness-heat constitution (29%).3. Most common TCM symptoms in patients with lung cancer include (in the descending order):Qi-Yin deficiency syndrome (42%)> deficiency of yin and excessive heat syndrome (25%)> Qi stagnation and blood stasis syndrome (19%)>(Deficiency of qi and phlegm and dampness syndrome)(14%).4. Stages and TCM constitutions(1) Stages Ⅰ and Ⅱ:Dominant in Yin Deficiency constitution, and Qi Deficiency constitution, followed by excessive pathogen constitution.(2) Stages Ⅲ and Ⅳ:Dominant in Qi Deficiency constitution, Yang Deficiency constitution, and Yin Deficiency constitution, the proportion of which increased with disease severity (stages) while the proportion of excessive pathogen constitutions decreased.(3) Stages Ⅱ, Ⅲ, and Ⅳ:Qi depression constitution constituted a majority of excessive pathogen constitution.5. Stages and TCM symptoms(1) Stages Ⅰ and Ⅱ:Dominant in Deficiency of qi and phlegm and dampness syndrome(2) Stages Ⅲ and Ⅳ:Dominant in Qi-Yin deficiency syndrome(3) Qi stagnation and blood stasis syndrome was observed across all the stages, with a higher proportion in Stages Ⅱ, Ⅲ, and Ⅳ.6. TCM constitutions and TCM symptomsYin-yang harmony constitution, Dampness-heat constitution and allergic constitution was not correlated to TCM symptoms while Qi Deficiency constitution and Qi-Yin deficiency syndrome, Yang Deficiency constitution and Qi-Yin deficiency syndrome, Yin Deficiency constitution and deficiency of yin and excessive heat syndrome, Phlegm-dampness constitution and Deficiency of qi and phlegm and dampness syndrome, Blood stasis constitution and Qi stagnation and blood stasis syndrome, Qi depression constitution and Qi stagnation and blood stasis syndrome were correlated.更多还原