【摘要】：目的：探討原發(fā)性支氣管肺癌患者的舌微循環(huán)變化規(guī)律，進(jìn)一步分析氣虛痰濕、陰虛毒熱、氣血瘀滯和氣陰兩虛四證型的肺癌患者舌微循環(huán)變化特點(diǎn)，為肺癌的早期診斷、中醫(yī)辨證分型及治療提供客觀依據(jù)。 方法：參考第7版《內(nèi)科學(xué)》中肺癌診斷標(biāo)準(zhǔn)，收集符合納入標(biāo)準(zhǔn)的河北醫(yī)科大學(xué)第四醫(yī)院（河北省腫瘤醫(yī)院）于2011.9-2012.10期間在呼吸科住院的140例原發(fā)性支氣管肺癌患者，按統(tǒng)一制定的觀察表詢問(wèn)患者情況。依據(jù)2002年版鄭筱萸主編的《中藥新藥研究指導(dǎo)原則》中肺癌中醫(yī)證型診斷標(biāo)準(zhǔn)，將其分為氣虛痰濕證、陰虛毒熱證、氣血瘀滯證、氣陰兩虛證四個(gè)證型。采用XW-B-3型微循環(huán)顯微鏡檢查儀觀察舌微循環(huán)的變化，與30例正常人進(jìn)行比較。觀察項(xiàng)目包括：1微血管形態(tài)：①微血管數(shù)、②輸入枝管徑、③輸出枝管徑；2乳頭狀態(tài)：①上皮層厚度、②菌狀乳頭直徑；3管袢形態(tài)：①管袢清晰度、②袢周異常；4血流狀態(tài)：①虛線狀、②斷線狀；5微血管狀態(tài)：①出血、②滲出，并探討四證型的變化特點(diǎn)。 結(jié)果： 1肺癌患者存在著明顯的舌微循環(huán)障礙，肺癌組患者的微血管數(shù)、上皮層厚度、管袢清晰度、袢周異常、血流狀態(tài)、微血管狀態(tài)與正常對(duì)照組比較均有顯著性差異（P0.01）。其主要表現(xiàn)為微血管數(shù)明顯減少；上皮層厚度變��；管袢清晰度多見(jiàn)于模糊，占84.29%；袢周異常以痙攣和模糊的比例較多，分別占34.29%，22.86%；血流狀態(tài)以虛線狀和斷線狀為主，分別占45.0%，45.71%；微血管以出血和滲出為主，分別占42.14%，38.57%。 2不同證型的肺癌患者舌微循環(huán)變化有差異。其中氣虛痰濕組以菌狀乳頭直徑增粗，上皮層厚度增厚，袢周痙攣增多，占60.0%，微血管滲出增多，占73.33%，與其它三組比較均有顯著性差異（P0.05）；陰虛毒熱組以微血管數(shù)增多，輸入枝管徑和輸出枝管徑增粗，血流狀態(tài)以斷續(xù)狀為主，占90.0%，與其它三組比較均有顯著性差異（P0.05）；氣血瘀滯組以管袢及袢周模糊，微血管出血為特點(diǎn)，管袢模糊增多，占96.87%，袢周模糊增多，占78.13%，微血管出血增多，占75.0%，與其它三組比較均有顯著性差異（P0.05）；氣陰兩虛組的微血管數(shù)最少，輸入枝、輸出枝最細(xì)及菌狀乳頭直徑最短，上皮層厚度最薄，血流狀態(tài)以虛線狀最為明顯，占86.84%，與其它三組比較均有顯著性差異（P0.05）。 結(jié)論： 1肺癌患者存在明顯的微循環(huán)障礙，其機(jī)理可能是呼吸功能失常，宣降功能失調(diào)，通調(diào)水道、輸布津液失職以及衛(wèi)外功能不固等生理功能失調(diào)，導(dǎo)致末梢微循環(huán)發(fā)生障礙。主要表現(xiàn)為微血管數(shù)減少，上皮層厚度變薄，管袢模糊不清，袢周異常以痙攣和模糊的比例較多，血流狀態(tài)以虛線狀和斷線狀為主，微血管以出血和滲出為主。這為早期發(fā)現(xiàn)肺癌提供了參考指標(biāo)。 2不同證型的肺癌患者舌微循環(huán)變化有差異。氣虛痰濕組患者氣虛推動(dòng)無(wú)力，氣血津液運(yùn)行不暢，導(dǎo)致舌體中瘀血阻滯，津液停聚；氣虛無(wú)法統(tǒng)攝血液，使其不能在脈中正常運(yùn)行而溢出脈外；又痰濁水濕內(nèi)聚，氣機(jī)被遏，氣化失常，舌上皮層細(xì)胞變化減慢；痰阻經(jīng)絡(luò)，經(jīng)脈拘攣，故以菌狀乳頭直徑增粗，上皮層厚度增加，袢周痙攣，微血管滲出最為明顯。陰虛毒熱組患者機(jī)體熱毒熏蒸，氣血運(yùn)行加快，舌表淺血流量增加，又陰液虧虛，血液難續(xù)，故出現(xiàn)微血管數(shù)增多，輸入枝管徑、輸出枝管徑增粗，上皮層厚度變薄，流態(tài)以斷線狀為特點(diǎn)。氣血瘀滯組患者氣機(jī)阻滯，運(yùn)行不暢，水谷精微物質(zhì)輸布失常，又瘀血阻滯，血行不暢，舌體失養(yǎng)；“瘀血不去，新血不生；瘀血不去，血不歸經(jīng)”，瘀血內(nèi)阻，，血液不循常道，溢出脈外，故以管袢及袢周模糊，微血管出血為特點(diǎn)。氣陰兩虛組患者氣虛推動(dòng)無(wú)力，陰虛血少，舌體失養(yǎng)；陽(yáng)氣不能鼓動(dòng)血行，血液流速減慢；氣陰兩虛，舌體失養(yǎng)，乳頭發(fā)育不良，故以輸入枝、輸出枝最細(xì)及菌狀乳頭直徑最短，上皮層厚度最薄，流態(tài)以虛線狀最為明顯。這可以更加深入了解肺癌的證型本質(zhì)，為舌診微觀辨證研究提供參考依據(jù)。
[Abstract]:Objective: To explore the changes of tongue microcirculation in patients with primary bronchogenic carcinoma, and further analyze the characteristics of tongue microcirculation in lung cancer patients with Qi deficiency and phlegm dampness, Yin deficiency and toxic heat, Qi and blood stasis and deficiency of both qi and yin.
Methods: Referring to the diagnostic criteria of lung cancer in the 7th edition of Internal Medicine, 140 patients with primary bronchogenic carcinoma hospitalized in the Department of Respiratory Medicine in the Fourth Hospital of Hebei Medical University (Hebei Cancer Hospital) from September 2011 to October 2012 were enquired about according to the unified observation table. The diagnostic criteria of TCM syndromes of lung cancer were divided into four syndromes: deficiency of Qi and phlegm-dampness, deficiency of yin and toxin-heat, stagnation of Qi and blood, deficiency of both qi and yin. Number of vessel, diameter of input branch, diameter of output branch; 2 papillary state: 1 epithelial layer thickness, diameter of bacterial papilla; 3 loop shape: 1 loop clarity, 2 loop abnormality; 4 blood flow state: 1 dashed line, 2 broken line; 5 microvascular state: 1 hemorrhage, 2 exudation, and explore the changing characteristics of four syndrome types.
Result:
There were significant differences in the number of microvessels, epithelial layer thickness, loop clarity, abnormal periloop, blood flow status, and microvascular status between lung cancer patients and normal control group (P 0.01). The main manifestations were the decrease of the number of microvessels, the thinning of epithelial layer, and the loops clarity. The percentage of periloop abnormalities was 34.29% and 22.86% respectively; the blood flow was mainly dotted line and broken line, accounting for 45.0% and 45.71% respectively; the microvasculature was mainly hemorrhage and exudation, accounting for 42.14% and 38.57% respectively.
The changes of microcirculation of tongue in lung cancer patients with different syndromes were different. In Qi-deficiency and phlegm-dampness group, the diameter of papillae was enlarged, the thickness of epithelium was thickened, the spasm around the loop was increased, accounting for 60.0%, the microvascular exudation was increased, accounting for 73.33%, and there was significant difference compared with other three groups (P 0.05). The diameter of the outgoing branch was enlarged, and the blood flow was mainly intermittent, accounting for 90.0%, which was significantly different from the other three groups (P 0.05); in the Qi-blood stasis group, the loops and periloops were blurred, and the microvascular bleeding was characterized by 96.87%, 78.13% and 75.0% of the other three groups, respectively. Sex difference (P 0.05); Qi-Yin deficiency group had the least number of microvessels, input branches, output branches and the shortest diameter of bacterial papilla, the thinnest thickness of epithelial layer, the most obvious blood flow state was dotted line, accounting for 86.84%, compared with the other three groups had significant differences (P 0.05).
Conclusion:
1. There are obvious microcirculation disorders in lung cancer patients, which may be caused by respiratory dysfunction, dysfunction of propagating and lowering, dysfunction of regulating channels, dereliction of transfusion and distribution of fluid, and unstable external defense functions, leading to peripheral microcirculation disorders. There were more spasms and blurs, the blood flow was mainly dotted line and broken line, and the microvasculature was mainly bleeding and exudation.
The changes of tongue microcirculation in lung cancer patients with different syndromes were different.Qi deficiency and phlegm-dampness group had weak promotion of Qi deficiency,and the movement of Qi-blood and fluid was not smooth,which led to blood stasis in the tongue and the accumulation of body fluid.Qi deficiency could not control the blood and make it overflow the pulse. The changes of layer cells were slowed down; phlegm obstructed the channels and collaterals, and the channels were constrained, so the diameter of bacterial papillae was enlarged, the thickness of epithelial layer was increased, the spasm around the loop and the microvascular exudation was most obvious. In the Qi-blood stasis group, Qi-qi was blocked, the movement was not smooth, the blood transfusion was abnormal, and blood stasis was blocked, the blood flow was not smooth, and the tongue was dystrophic; "blood stasis did not go away, new blood did not grow; blood stasis did not go away, blood did not return to the meridian," blood stasis internal obstruction, blood stasis did not follow the normal path, overflow veins. The deficiency of both Qi and Yin group can not stimulate blood flow, blood flow rate is slowed down; deficiency of both Qi and Yin, tongue dystrophy, dysplasia of the nipple, so the input branch, output branch and the smallest diameter of bacterial papilla, epithelial layer thickness is the thinnest. The most obvious flow pattern is dotted line, which can help us to understand the nature of lung cancer and provide a reference for the study of microcosmic syndrome differentiation of tongue diagnosis.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R241.25;R273

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