舌微循环变化与肺癌的相关性研究

发布时间：2018-09-10 10:24

【摘要】：目的：探讨原发性支气管肺癌患者的舌微循环变化规律，进一步分析气虚痰湿、阴虚毒热、气血瘀滞和气阴两虚四证型的肺癌患者舌微循环变化特点，为肺癌的早期诊断、中医辨证分型及治疗提供客观依据。方法：参考第7版《内科学》中肺癌诊断标准，收集符合纳入标准的河北医科大学第四医院（河北省肿瘤医院）于2011.9-2012.10期间在呼吸科住院的140例原发性支气管肺癌患者，按统一制定的观察表询问患者情况。依据2002年版郑筱萸主编的《中药新药研究指导原则》中肺癌中医证型诊断标准，将其分为气虚痰湿证、阴虚毒热证、气血瘀滞证、气阴两虚证四个证型。采用XW-B-3型微循环显微镜检查仪观察舌微循环的变化，与30例正常人进行比较。观察项目包括：1微血管形态：①微血管数、②输入枝管径、③输出枝管径；2乳头状态：①上皮层厚度、②菌状乳头直径；3管袢形态：①管袢清晰度、②袢周异常；4血流状态：①虚线状、②断线状；5微血管状态：①出血、②渗出，并探讨四证型的变化特点。结果： 1肺癌患者存在着明显的舌微循环障碍，肺癌组患者的微血管数、上皮层厚度、管袢清晰度、袢周异常、血流状态、微血管状态与正常对照组比较均有显著性差异（P0.01）。其主要表现为微血管数明显减少；上皮层厚度变薄；管袢清晰度多见于模糊，占84.29%；袢周异常以痉挛和模糊的比例较多，分别占34.29%，22.86%；血流状态以虚线状和断线状为主，分别占45.0%，45.71%；微血管以出血和渗出为主，分别占42.14%，38.57%。 2不同证型的肺癌患者舌微循环变化有差异。其中气虚痰湿组以菌状乳头直径增粗，上皮层厚度增厚，袢周痉挛增多，占60.0%，微血管渗出增多，占73.33%，与其它三组比较均有显著性差异（P0.05）；阴虚毒热组以微血管数增多，输入枝管径和输出枝管径增粗，血流状态以断续状为主，占90.0%，与其它三组比较均有显著性差异（P0.05）；气血瘀滞组以管袢及袢周模糊，微血管出血为特点，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%，与其它三组比较均有显著性差异（P0.05）；气阴两虚组的微血管数最少，输入枝、输出枝最细及菌状乳头直径最短，上皮层厚度最薄，血流状态以虚线状最为明显，占86.84%，与其它三组比较均有显著性差异（P0.05）。结论： 1肺癌患者存在明显的微循环障碍，其机理可能是呼吸功能失常，宣降功能失调，通调水道、输布津液失职以及卫外功能不固等生理功能失调，导致末梢微循环发生障碍。主要表现为微血管数减少，上皮层厚度变薄，管袢模糊不清，袢周异常以痉挛和模糊的比例较多，血流状态以虚线状和断线状为主，微血管以出血和渗出为主。这为早期发现肺癌提供了参考指标。 2不同证型的肺癌患者舌微循环变化有差异。气虚痰湿组患者气虚推动无力，气血津液运行不畅，导致舌体中瘀血阻滞，津液停聚；气虚无法统摄血液，使其不能在脉中正常运行而溢出脉外；又痰浊水湿内聚，气机被遏，气化失常，舌上皮层细胞变化减慢；痰阻经络，经脉拘挛，故以菌状乳头直径增粗，上皮层厚度增加，袢周痉挛，微血管渗出最为明显。阴虚毒热组患者机体热毒熏蒸，气血运行加快，舌表浅血流量增加，又阴液亏虚，血液难续，故出现微血管数增多，输入枝管径、输出枝管径增粗，上皮层厚度变薄，流态以断线状为特点。气血瘀滞组患者气机阻滞，运行不畅，水谷精微物质输布失常，又瘀血阻滞，血行不畅，舌体失养；“瘀血不去，新血不生；瘀血不去，血不归经”，瘀血内阻，，血液不循常道，溢出脉外，故以管袢及袢周模糊，微血管出血为特点。气阴两虚组患者气虚推动无力，阴虚血少，舌体失养；阳气不能鼓动血行，血液流速减慢；气阴两虚，舌体失养，乳头发育不良，故以输入枝、输出枝最细及菌状乳头直径最短，上皮层厚度最薄，流态以虚线状最为明显。这可以更加深入了解肺癌的证型本质，为舌诊微观辨证研究提供参考依据。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R241.25;R273

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