【作者】 田同德；

【导师】 陈信义；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2009， 博士

【摘要】 目的通过回顾性临床研究,探索血瘀证在中晚期非小细胞肺癌中的分布规律及其特点,并进一步分析血瘀证与病理类型、肿瘤分期、血凝指标、相兼证候等之间的相关性,从而为临床治疗提供参考。方法我们以五年内在东直门医院和北京中医医院住院的中晚期非小细胞肺癌病人为研究对象,制定调查表,收集病例。采用描述性分析,了解患者一般资料、病情信息及各凝血指标分布情况,并根据血瘀证诊断标准分为血瘀证组和非血瘀证组,①分析血瘀证患者在非小细胞肺癌患者中的构成比及证候分布特点。②分析血瘀证与一般资料、病理类型、ECOG(Ea stern CooperativeOncology group,ECOG)评分、肿瘤分期、各证型及血凝指标APTT(activatedpartial thrombopla stin time,APTT)、PT(prothrombin time,PT)、TT(thrombin time,TT)、Fbg(fibrinogen,Fbg)、D-二聚体(D-dimer,DD)之间的相关性。结果①在我们所收集的257例中晚期非小细胞肺癌患者中,气虚、阴虚、痰湿及血瘀均是其临床常见证候,其中血瘀的构成比为72.37%;②在中晚期非小细胞肺癌各证候中,阴虚与血瘀的关系更为密切,在血瘀证患者中阴虚的构成比较非血瘀证患者明显增加;③在中晚期非小细胞肺癌中,血瘀证与年龄、性别、家族史、治疗经过等一般情况以及病理类型无明显相关性,而与肿瘤患者ECOG评分、肿瘤的分期具有一定联系,随着ECOG评分及分期的增加,血瘀证有增多的趋势;④与中晚期非小细胞肺癌非血瘀证相比较,血瘀证患者D-dimer明显升高,差异显著,在多因素逻辑回归分析中也显示出与血瘀证存在明显的正相关。结论①血瘀证在中晚期非小细胞肺癌中普遍存在,相对于其他证候更为常见;②气虚、阴虚及痰湿作为肺癌的临床常见证候,被认为是影响中晚期非小细胞肺癌血瘀证的主要因素,但相对于非血瘀证,中晚期非小细胞肺癌血瘀证患者存在明显的阴虚致瘀的病理特点;③ECOG评分、肿瘤分期与中晚期非小细胞肺癌血瘀证具有一定的关联性,不仅反映了血瘀证与肿瘤的增殖与转移存在一定的联系,可作为判定中晚期非小细胞肺癌预后的重要因素,而且ECOG评分、肿瘤分期也可以在血瘀证的诊疗中为中医辨病提供参考;④D-dimer与血瘀证的强相关性,不仅反映了中晚期非小细胞肺癌血瘀证患者存在血液的高凝状态,而且还在一定程度上反映了中晚期非小细胞肺癌血瘀证在血凝功能异常方面的实质,并可成为非常实用的临床诊断血瘀证的微观指标;⑤根据中晚期非小细胞肺癌的证候特点及其与血瘀证之间的相关性,我们认为临床应以益气养阴、活血化痰作为中晚期非小细胞肺癌血瘀证的基本治疗策略,不仅体现了中医辨证论治的优势,也充分体现了与肿瘤治疗的统一性。更多还原

【Abstract】 objective Through the retrospective clinical study,to investigate distribution regularity and characteristics of blood stasis syndrome in advanced non-small cell lung cancer and further to analyze the correlation between blood stasis syndrome and pathological types,tumor stage,haemostasis markers,combination syndromes etc,and then to provide reference for clinical treatment of blood stasis syndrome. Method We took the patients of advanced non-small cell lung cancer from Dong Zhi Mei hospital and Bei Jing hospital of traditional Chinese medicine(TCM) during the recent five years as study cases,and made investigation table,collected cases.Using descriptive analysis to recognize the distribution status of general materials,information of disease and every haemostasis markers,and according to the diagnostic criteria of blood stasis syndrome,these cases were divided into blood stasis syndrome group and non-blood stasis syndrome group.①to analyze the composition ratio and combination syndromes distribution characteristics of patients with blood stasis syndrome;②to analyze the correlation between blood stasis syndrome and general materials, pathological types,tumor stages,every combination syndromes, haemostasis marker APTT(activated partial thromboplastin time),PT (prothrombin time),TT(thrombin time),Fbg(fibrinogen),D-dimer.Results①Among the collected 257 cases of advanced non-small cell lung cancer,Qi deficiency,yindeficiency,phlegm dampness and blood stasis were all common clinical syndromes,and composition ratio of blood stasis among these syndromes was 72.37%;②Among these syndromes of advanced non-small cell lung cancer,Yin deficiency had a tighter correlation with blood stasis than other syndromes,comparing with non-blood stasis syndrome composition ratio of Yin deficiency was significantly increased in blood stasis syndrome;③In advanced non-small cell lung cancer,blood stasis syndrome had no correlation with general materials of age,sex,family disease history,treatment experience etc and pathological types,but had some correlation with ECOG performance score and the staging of the tumor,with the increase of staging and ECOG score,blood stasis syndrome were with increasing trend;④Comparing with non-blood stasis syndrome of advanced non-small cell lung cancer,D-dimer level of patients with blood stasis syndrome was obviously increased with a significant difference,and also had a significant positive correlation with blood stasis syndrome in multifactor Logistic regression analysis.Conclusion①In advanced non-small cell lung cancer,blood stasis syndrome was prevalent and more common than other syndromes;②Qi deficiency,yin deficiency and phlegm dampness,which were common syndromes of lung cancer in clinic,all were recognized as primary influencing factors of blood stasis syndrome,but comparing with non-blood stasis syndrome,there was an obvious pathological characteristic of yin deficiency causing blood stasis in blood stasis syndrome of advanced non-small cell lung cancer;③The correlation between ECOG score,tumor staging and blood stasis syndrome,not only reflected some links between blood stasis syndrome and tumor proliferation,matastasis,and thereby ECOG score and tumor staging may were taken to be as important factors for prognosis,but also ECOG score and tumor stage may also provide the basic foundation for disease differentiation of TCM in blood stasis syndrome diagnosis and treatment;④The significant correlation between D-dimer and blood stasis syndrome not only reflected tumor hypercoagulative status in the patients of blood stasis syndrome,but also,to some extent,reflected the blood stasis syndrome essentials of advanced non-small cell lung cancer in terms of blood coagulation disfunction,and then it may was very useful to be taken as a micro-index for clinical diagnosis of blood stasis syndrome;⑤According to the characteristics of blood stasis syndrome combination syndromes and its correlation with blood stasis syndrome, we consider that strengthening qi and nurishing yin,activating blood and removing phlegm should be the basic strategy for the treatment of blood stasis syndrome of advanced non-small cell lung cancer,it not only embodieded the advantage of treatment based on syndrome differentiation of TCM,but also embodied the unity with tumor therapy.更多还原