本文選題：非小細(xì)胞肺癌 + 證型　； 參考：《中國中醫(yī)科學(xué)院》2016年碩士論文

【摘要】：目的：本研究通過回顧性臨床研究,觀察痰證、血瘀證、痰瘀互結(jié)證非小細(xì)胞肺癌患者在血脂與凝血功能異常的相關(guān)性,探討非小細(xì)胞肺癌的臨床治療相關(guān)因素和血液檢查指標(biāo)的關(guān)系,總結(jié)中醫(yī)特色及優(yōu)勢,為深入研究肺癌的中醫(yī)證型和中西醫(yī)結(jié)合治療提供有效的思路及方法。方法：本研究采集中國中醫(yī)科學(xué)院廣安門醫(yī)院腫瘤科原發(fā)性非小細(xì)胞肺癌患者的住院病歷,采用“結(jié)構(gòu)化中醫(yī)住院病歷采集系統(tǒng)”,將符合納入標(biāo)準(zhǔn)的134例進(jìn)行信息整理,對全部數(shù)據(jù)表進(jìn)行總體核查和樣本例數(shù)總數(shù)的核查,完善患者在院期間的病例情況,并隨機(jī)抽取樣本進(jìn)行核查；數(shù)據(jù)處理統(tǒng)一為規(guī)范的名詞、術(shù)語及格式。運(yùn)用計(jì)算機(jī)技術(shù)對所有病例的常見癥狀、舌脈進(jìn)行證型判定,確定非小細(xì)胞肺癌的中醫(yī)證型,進(jìn)行頻數(shù)分析,并探討其演變規(guī)律。采用SPSS19.0統(tǒng)計(jì)軟件包進(jìn)行統(tǒng)計(jì)分析,化驗(yàn)指標(biāo)計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差表示描述,符合正態(tài)或近似正態(tài)分布兩組之間比較采用t檢驗(yàn),多組間比較采用方差分析,兩兩比較采用LSD檢驗(yàn)；不符合正態(tài)或近似正態(tài)分布的組間比較采用秩和檢驗(yàn)。計(jì)數(shù)(頻次)資料組間比較采用卡方檢驗(yàn)或Fisher精確檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義,探討中醫(yī)證型與臨床診療因素、理化指標(biāo)之間的關(guān)系。結(jié)果：1痰、瘀及痰瘀互結(jié)型非小細(xì)胞肺癌中醫(yī)證型的分析所研究病例樣本中中醫(yī)證型分布為：痰證33例,血瘀證36例,痰瘀互結(jié)證65例,痰證和血瘀證所占比例近似,痰瘀互結(jié)證占比重較大。痰證主要證型為痰熱和痰濕證,伴有肺脾兩虛、肺腎兩虛,以及氣血兩虛和氣陰兩虛。血瘀證主要兼證為氣虛、氣滯以及氣血兩虛、肺腎兩虛。痰瘀互結(jié)證主要兼證為氣陰兩虛。2痰、瘀及痰瘀互結(jié)型非小細(xì)胞肺癌患者中醫(yī)證型與血脂、凝血指標(biāo)相關(guān)性三組證型患者四項(xiàng)血脂指標(biāo)均出現(xiàn)不同比例的異常,其中痰證組中甘油三酯(TG)有15例偏高(占痰證組總數(shù)的45%),其構(gòu)成比多于血瘀證4例(占血瘀證組總數(shù)的11%)和痰瘀互結(jié)組21例(占痰瘀互結(jié)組總數(shù)的32%),其構(gòu)成比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。高密度脂蛋白(HDL)出現(xiàn)降低情況,其降低例數(shù)構(gòu)成比分別為痰證組19例(57.6%),血瘀證組7例(19%),痰瘀互結(jié)組34例(52.3%),痰證和痰瘀互結(jié)證組降低比例近似,均高于血瘀證組,其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。三組患者的總膽固醇(TC)偏高例數(shù)構(gòu)成比分別為痰證組7例(21%),血瘀證組3例(8.3%),痰瘀互結(jié)組12例(18.5%),但其差異無統(tǒng)計(jì)學(xué)意義(P0.05)；低密度脂蛋白(LDL)偏高例數(shù)構(gòu)成比分別為痰證組10例(30.3%),血瘀證組6例(17%),痰瘀互結(jié)組18例(27.7%),但其差異無統(tǒng)計(jì)學(xué)意義(P0.05)。三種證型的肺癌患者血脂指標(biāo)經(jīng)方差分析后,三種證型的血脂水平：痰證組甘油三酯(TG)水平為,高于血瘀證與痰瘀互結(jié)證組,但差異無統(tǒng)計(jì)學(xué)意義(P0.05)。三組證型患者在各項(xiàng)凝血指標(biāo)中,D二聚體定量(D-D)、纖維蛋白原(FIB)、活化部分凝血活酶時間(APTT)、紅細(xì)胞壓積(HCT)出現(xiàn)了不同比例的異常,其中三組患者D二聚體定量(D-D)和纖維蛋白原(FIB)升高比例近似均在40%以上,而活化部分凝血活酶時間(APTT)和紅細(xì)胞壓積(HCT)三組間存在明顯統(tǒng)計(jì)學(xué)差異�；罨糠帜蠲笗r間(APTT)痰瘀互結(jié)組有41例降低(63%),血瘀組有21例降低(58%),痰證組有12例降低(36%),經(jīng)卡方檢驗(yàn)后發(fā)現(xiàn),痰瘀互結(jié)組活化部分凝血活酶時間(APTT)降低情況明顯高于血瘀證高于痰證組(P0.05)；相較其他兩組而言,痰瘀互結(jié)組紅細(xì)胞壓積(HCT)偏高例數(shù)為46例(70%),高于血瘀組偏高例數(shù)為21例(58%),高于痰證組偏高例數(shù)為17例(51%),其差異有統(tǒng)計(jì)學(xué)意義(P0.05)。三種證型的肺癌患者凝血指標(biāo)經(jīng)方差分析后發(fā)現(xiàn),痰瘀互結(jié)證組的活化部分凝血活酶時間(APTT)明顯低于血瘀證組低于痰證組,(P0.01)。3痰、瘀及痰瘀互結(jié)型非小細(xì)胞肺癌患者臨床相關(guān)因素與中醫(yī)證型的相關(guān)性本研究臨床各期痰證、血瘀證與痰瘀互結(jié)證型的分布有差異(P0.05),其中Ⅰ期、Ⅱ期和Ⅲ期痰瘀互結(jié)證型比例較高,而Ⅳ期痰瘀互結(jié)證型比例有所下降,各證候之間比例比較接近。病理類型,原發(fā)病灶手術(shù)情況,轉(zhuǎn)移情況,化療情況與非小細(xì)胞肺癌所表現(xiàn)的痰證、血瘀證、痰瘀互結(jié)證型分布無明顯相關(guān)性(P0.05)。4痰、瘀及痰瘀互結(jié)型非小細(xì)胞肺癌患者臨床治療相關(guān)因素與血脂、凝血指標(biāo)相關(guān)性4.1 臨床分期與血脂、凝血指標(biāo)相關(guān)性：高密度脂蛋白(HDL)降低情況在各臨床分期分布不同：Ⅳ期降低情況明顯高于其他三組(P0.05)；其他血脂指標(biāo)在臨床分期之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。紅細(xì)胞壓積(HCT)在臨床各分期分布有差異：其中Ⅱ和Ⅳ期偏高例數(shù)明顯高于其他兩組(P0.05)。4.2病理類型與血脂、凝血指標(biāo)相關(guān)性：腺癌組甘油三酯(TG)偏高情況明顯高于鱗癌組(P0.05),其他血脂指標(biāo)在兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)；腺癌組甘油三酯(TG)指標(biāo)明顯高于鱗癌組(P0.05),其他三種血脂指標(biāo)在兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。鱗癌組紅細(xì)胞壓積(HCT)偏高情況均高于腺癌組(P0.05),其他凝血指標(biāo)在兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)；鱗癌組病例凝血酶原時間(PT)和活化部分凝血活酶時間(APTT)高于腺癌組(P0.05),而腺癌組紅細(xì)胞壓積(HCT)高于鱗癌組(P0.05),其他凝血指標(biāo)在兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4.3原發(fā)病灶手術(shù)情況與血脂、凝血指標(biāo)相關(guān)性對研究病例的凝血指標(biāo)與肺癌原發(fā)病灶手術(shù)情況的關(guān)系進(jìn)行對比研究,經(jīng)t檢驗(yàn)后,未手術(shù)患者組紅細(xì)胞壓積(HCT)高于手術(shù)后(P0.05),其他凝血指標(biāo)在兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)4.4肺癌轉(zhuǎn)移情況情況與血脂、凝血指標(biāo)相關(guān)性：已轉(zhuǎn)移組纖維蛋白原(FIB)偏高情況檢出率明顯高于未轉(zhuǎn)移(P0.05)；在紅細(xì)胞壓積(HCT)方面,已轉(zhuǎn)移組偏高情況明顯高于未轉(zhuǎn)移組(P0.05)；同時,已轉(zhuǎn)移紅細(xì)胞壓積(HCT)指標(biāo)高于未轉(zhuǎn)移(P0.05),其他凝血指標(biāo)在兩組之間差異無統(tǒng)計(jì)學(xué)意義(P0.05)4.5化療情況與血脂、凝血指標(biāo)相關(guān)性：化療后患者甘油三酯(TG)偏高情況低于未化療組(P0.05)�；熃M活化部分凝血活酶時間(APTT)降低情況低于未化療組(P0.05),化療組活化D二聚體(D-D)升高情況低于未化療組(P0.05),在紅細(xì)胞壓積(HCT)方面,化療組偏高情況明顯低于未化療組(P0.05);同時對比兩組凝血指標(biāo),經(jīng)t檢驗(yàn)后發(fā)現(xiàn)化療組患者的活化部分凝血活酶時間(APTT)高于未化療(P0.05)。結(jié)論：本研究結(jié)果顯示,非小細(xì)胞肺癌患者血脂水平和凝血功能異常與肺癌痰證、血瘀證、痰瘀互結(jié)證證型存在直接聯(lián)系,與患者臨床分期、病理類型、病灶手術(shù)情況、腫瘤轉(zhuǎn)移情況、化療情況存在一定的相關(guān)性。血脂水平和凝血功能可以反映肺癌患者三種基本中醫(yī)證型的存在和輕重程度,因此我們推定可以把血脂水平和凝血功能作為判定肺癌的證型理化基礎(chǔ),以豐富肺癌中醫(yī)證型的診斷標(biāo)準(zhǔn)。肺癌患者的病機(jī)具有多樣性和、復(fù)雜性的特點(diǎn),其中,瘀、痰、虛是主要的病理基礎(chǔ),痰瘀之間互相轉(zhuǎn)化,相互搏結(jié)是腫瘤發(fā)生發(fā)展的重要階段。因此對于肺癌患者的診治,應(yīng)當(dāng)抓住二者具有辨證意義的癥狀和特異性的理化檢查指標(biāo),鑒于大部分肺癌患者到中醫(yī)院就診時已屬晚期,治療時應(yīng)注意肺癌的病機(jī)特點(diǎn),注意瘀、痰、虛的關(guān)系,注意扶正、化痰、祛瘀等聯(lián)合治療,同時注意根據(jù)患者臨床情況配合降脂、抗凝治療,以期收到較好的臨床療效。
[Abstract]:Objective: To observe the correlation between blood lipid and blood coagulation dysfunction in non small cell lung cancer patients by retrospective clinical study, to investigate the relationship between blood lipid and blood coagulation dysfunction in patients with non-small cell lung cancer, explore the relationship between the clinical treatment factors and blood examination indexes of non-small cell lung cancer, summarize the characteristics and advantages of traditional Chinese medicine, and study the TCM syndrome type of lung cancer in depth. Combined with traditional Chinese and Western medicine, effective ideas and methods were provided. Methods: This study collected the hospitalization records of primary non-small cell lung cancer patients in the oncology department of the Guanganmen Hospital of Chinese Academy of Chinese medicine (Chinese Academy of Chinese Medicine), and adopted the "structured Chinese medical record collection system". The information was arranged in 134 cases which were in accordance with the standard. All the data sheets were carried out. The general verification and the total number of sample cases were checked to improve the patient's case situation during the hospital, and the sample was checked randomly. The data processing was unified as a standard noun, terminology and format. The common symptoms of all cases, the tongue vein was confirmed by computer technology, the TCM syndrome type of non small cell lung cancer was determined, and the frequency of the TCM syndrome of non small cell lung cancer was determined. A statistical analysis was made and the statistical analysis was made. The statistical analysis was carried out by the SPSS19.0 statistical software package. The measurement data of the test indexes were described by mean number of standard deviations. The two groups were compared with the normal or the approximate normal distribution, compared with the t test, the multiple groups were compared with the variance analysis, and the 22 was compared with the LSD test; it did not conform to the normal or approximate positive. The rank sum test was adopted in the comparison of the distribution of states. The chi square test or Fisher accurate test was used among the count (frequency) data groups, and the difference of P0.05 was statistically significant. The relationship between the TCM syndrome type and the clinical diagnosis and treatment factors and the physical and chemical indexes was discussed. Results: the analysis of the TCM syndrome type of 1 phlegm, stasis and phlegm stasis type non-small cell lung cancer The distribution of TCM Syndrome Types in the case samples: 33 cases of phlegm syndrome, 36 cases of blood stasis syndrome, 65 cases of phlegm and stasis syndrome, the proportion of phlegm and blood stasis, phlegm and stasis syndrome accounted for a large proportion. The main syndrome types of phlegm syndrome are phlegm heat and phlegm dampness syndrome, two deficiency of lung and spleen, two deficiency of lung and kidney, two deficiency of Qi and blood and two deficiency of Qi and Yin. The main syndrome of blood stasis syndrome is Qi deficiency and Qi deficiency. Stagnation and Qi and blood two deficiency, lung and kidney two deficiency. The main syndrome of phlegm and blood stasis syndrome is syndrome of Qi and yin deficiency.2 phlegm, blood stasis and phlegm and blood stasis type non-small cell lung cancer patients' TCM syndrome type and blood lipid, coagulation index related three groups of syndrome type four blood lipid indexes all have different proportions of abnormal, among which, there are 15 cases of triglyceride (TG) in the phlegm syndrome group (accounting for phlegm syndrome group) The total number of 45%) was more than 4 cases of blood stasis syndrome (11% of the total number of blood stasis syndrome group) and 21 cases of phlegm stasis group (32% of the total number of phlegm and stasis group). The composition ratio was statistically significant (P0.05). The decrease of high density lipoprotein (HDL), the ratio of the number of lower cases was 19 (57.6%) in the phlegm syndrome group, 7 cases (19%), phlegm and stasis syndrome in the blood stasis syndrome group. 34 cases (52.3%), phlegm syndrome and phlegm stasis syndrome group were lower than the blood stasis syndrome group, and the difference was statistically significant (P0.05). The ratio of total cholesterol (TC) in three groups was 7 (21%), 3 (8.3%) and 12 (18.5%) in the blood stasis syndrome group, but the difference was not statistically significant (P0.05); The ratio of density lipoprotein (LDL) was 10 (30.3%) in phlegm syndrome group, 6 cases in blood stasis syndrome (17%) and 18 cases (27.7%) in phlegm and stasis group (27.7%), but the difference was not statistically significant (P0.05). The blood lipid levels of three types of lung cancer patients were analyzed by variance, and the level of triglyceride (TG) in the phlegm syndrome group was higher than that of blood stasis syndrome. There was no significant difference in the group of phlegm and blood stasis syndrome (P0.05). Among the three groups of syndrome types, D two polymer quantitative (D-D), fibrinogen (FIB), activated partial thromboplastin time (APTT), and erythrocyte hematocrit (HCT) appeared in different proportions, of which three groups of patients were D two polymer quantitative (D-D) and fibrinogen (FIB). The proportion of the proportion of the activated partial thromboplastin time (APTT) and the red blood cell pressure product (HCT) three groups were significantly different. There were 41 cases (63%) of activated partial thromboplastin time (APTT) phlegm and blood stasis group, 21 in blood stasis group (58%) and 12 in the phlegm group (36%). After the chi square test, the phlegm and blood stasis group was found to live together. The reduction of partial thromboplastin time (APTT) was significantly higher than that of blood stasis syndrome (P0.05). Compared with the other two groups, the number of red blood cell pressure accumulation (HCT) in the group of phlegm and stasis group was 46 (70%), higher than that in blood stasis group 21 cases (58%), higher than that in the sputum syndrome group, 17 cases (51%), and the difference was statistically significant (P0.05). Three After the analysis of variance analysis of the blood coagulation indexes of the patients with lung cancer, the activated partial thromboplastin time (APTT) in the syndrome group of phlegm and blood stasis syndrome was significantly lower than that of the blood stasis syndrome group, and the correlation between the clinical related factors and the TCM syndrome type of non small cell lung cancer patients (P0.01).3 phlegm, blood stasis and phlegm and stasis type There was a difference in the distribution of syndrome types with phlegm and stasis syndrome (P0.05), of which stage I, II and III phase of phlegm and stasis syndrome type were higher, but the proportion of syndrome type of phlegm and stasis syndrome in stage IV was decreased, and the proportion of each syndrome was close. The pathological type, primary focus operation, metastasis, phlegm syndrome and blood stasis syndrome of non-small cell lung cancer were treated with chemotherapy. The distribution of phlegm and blood stasis syndrome has no significant correlation (P0.05).4 phlegm, blood stasis and phlegm and blood stasis type non-small cell lung cancer patients' clinical treatment related factors and blood lipid, blood clotting index correlation 4.1 clinical stages and blood lipids, blood coagulation indexes: high density lipoprotein (HDL) reduction in the clinical stages of the different distribution: stage IV reduction is obvious The difference between the other three groups (P0.05) was not significant (P0.05). The distribution of red blood cell pressure (HCT) in clinical stages was different: the number of high cases in stage II and IV was significantly higher than that of the other two groups (P0.05), the pathological type of.4.2 was related to blood fat and blood coagulation index: the high triglyceride (TG) in the adenocarcinoma group was higher. The situation was significantly higher than that of the squamous cell carcinoma group (P0.05). There was no significant difference in other blood lipid indexes between the two groups (P0.05), and the triglyceride (TG) index of the adenocarcinoma group was significantly higher than that of the squamous cell carcinoma group (P0.05), and the other three blood lipid indexes were not statistically significant between the two groups (P0.05). The high degree of erythrocyte pressure accumulation (HCT) in the squamous cell carcinoma group was higher than that of the adenocarcinoma group (P0.05). There was no significant difference in other coagulation indexes between the two groups (P0.05). The prothrombin time (PT) and activated partial thromboplastin time (APTT) in the squamous cell carcinoma group were higher than that in the adenocarcinoma group (P0.05), while the erythrocyte pressure product (HCT) in the adenocarcinoma group was higher than that of the squamous cell carcinoma group (P0.05), and the difference of the coagulation index between the two groups was not statistically significant (P0.05).4.3. The correlation between blood lipid and blood coagulation index was related to the relationship between the blood coagulation index and the primary lung cancer. After t test, the erythrocyte hematocrit (HCT) in the group of non operated patients was higher than that of the operation (P0.05), and there was no significant difference between the two groups (P0.05) 4.4 of the metastasis of lung cancer. The relationship with blood lipid and blood coagulation indexes: the high detection rate of FIB in the transferred group was significantly higher than that in the non metastasis (P0.05), and the high level of the transferred group was significantly higher than that of the non metastasis group (P0.05) in the red blood cell pressure product (HCT); at the same time, the index of the transferred erythrocyte hematocrit (HCT) was higher than that of the non metastasis (P0.05), and the other coagulation indexes were in the red blood cell. The difference between the two groups was not statistically significant (P0.05) 4.5 chemotherapy and blood lipid, blood coagulation index: after chemotherapy, the high level of triglyceride (TG) was lower than that of the non chemotherapy group (P0.05). The reduction of the activated partial thromboplastin time (APTT) in the chemotherapy group was lower than that in the non chemotherapy group (P0.05), and the increase of the activated D two polymer (D-D) in the chemotherapy group was lower than that in the chemotherapy group. The treatment group (P0.05), in the red blood cell pressure product (HCT), the chemotherapy group was significantly lower than the non chemotherapy group (P0.05); at the same time compared the two groups of coagulation indexes, after t test, the activated partial thromboplastin time (APTT) in the chemotherapy group was higher than that of the non chemotherapy (P0.05). Conclusion: the results of this study showed that the blood lipid level and coagulation of patients with non small cell lung cancer There is a direct relationship between the abnormal blood function and the syndrome type of lung cancer phlegm syndrome, blood stasis syndrome and phlegm stasis syndrome. There is a certain correlation with the clinical stage, pathological type, tumor operation, tumor metastasis and chemotherapy. Blood lipid level and coagulation function can reflect the existence and degree of three basic TCM Syndromes of lung cancer patients. It is presumed that the level of blood lipid and the function of blood coagulation can be used as a basis for determining the syndrome type of lung cancer to enrich the diagnostic standard of TCM syndrome type of lung cancer. The pathogenesis of lung cancer patients has diversity and complexity, among which the main pathological basis is stasis, phlegm and deficiency, and the mutual transformation between phlegm and blood stasis is the serious development of cancer. Therefore, for the diagnosis and treatment of lung cancer patients, we should seize the symptoms and specific physical and chemical examination indexes of the two patients with dialectical significance. In view of the fact that most of the lung cancer patients come to the hospital in Chinese medicine hospital, they should be late, and should pay attention to the characteristics of lung cancer, pay attention to the relationship between blood stasis, phlegm, deficiency, and pay attention to the combined treatment of centralizing, eliminating phlegm and removing stasis. Attention should be paid to the combination of lipid-lowering and anticoagulation according to the clinical conditions of patients, so as to achieve better clinical efficacy.

【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R273

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