痰瘀型非小细胞肺癌患者血脂与凝血功能异常相关性的临床研究

发布时间：2018-05-14 05:21

本文选题：非小细胞肺癌 + 证型　；参考：《中国中医科学院》2016年硕士论文

【摘要】：目的：本研究通过回顾性临床研究,观察痰证、血瘀证、痰瘀互结证非小细胞肺癌患者在血脂与凝血功能异常的相关性,探讨非小细胞肺癌的临床治疗相关因素和血液检查指标的关系,总结中医特色及优势,为深入研究肺癌的中医证型和中西医结合治疗提供有效的思路及方法。方法：本研究采集中国中医科学院广安门医院肿瘤科原发性非小细胞肺癌患者的住院病历,采用“结构化中医住院病历采集系统”,将符合纳入标准的134例进行信息整理,对全部数据表进行总体核查和样本例数总数的核查,完善患者在院期间的病例情况,并随机抽取样本进行核查；数据处理统一为规范的名词、术语及格式。运用计算机技术对所有病例的常见症状、舌脉进行证型判定,确定非小细胞肺癌的中医证型,进行频数分析,并探讨其演变规律。采用SPSS19.0统计软件包进行统计分析,化验指标计量资料采用均数±标准差表示描述,符合正态或近似正态分布两组之间比较采用t检验,多组间比较采用方差分析,两两比较采用LSD检验；不符合正态或近似正态分布的组间比较采用秩和检验。计数(频次)资料组间比较采用卡方检验或Fisher精确检验,以P0.05为差异有统计学意义,探讨中医证型与临床诊疗因素、理化指标之间的关系。结果：1痰、瘀及痰瘀互结型非小细胞肺癌中医证型的分析所研究病例样本中中医证型分布为：痰证33例,血瘀证36例,痰瘀互结证65例,痰证和血瘀证所占比例近似,痰瘀互结证占比重较大。痰证主要证型为痰热和痰湿证,伴有肺脾两虚、肺肾两虚,以及气血两虚和气阴两虚。血瘀证主要兼证为气虚、气滞以及气血两虚、肺肾两虚。痰瘀互结证主要兼证为气阴两虚。2痰、瘀及痰瘀互结型非小细胞肺癌患者中医证型与血脂、凝血指标相关性三组证型患者四项血脂指标均出现不同比例的异常,其中痰证组中甘油三酯(TG)有15例偏高(占痰证组总数的45%),其构成比多于血瘀证4例(占血瘀证组总数的11%)和痰瘀互结组21例(占痰瘀互结组总数的32%),其构成比差异有统计学意义(P0.05)。高密度脂蛋白(HDL)出现降低情况,其降低例数构成比分别为痰证组19例(57.6%),血瘀证组7例(19%),痰瘀互结组34例(52.3%),痰证和痰瘀互结证组降低比例近似,均高于血瘀证组,其差异有统计学意义(P0.05)。三组患者的总胆固醇(TC)偏高例数构成比分别为痰证组7例(21%),血瘀证组3例(8.3%),痰瘀互结组12例(18.5%),但其差异无统计学意义(P0.05)；低密度脂蛋白(LDL)偏高例数构成比分别为痰证组10例(30.3%),血瘀证组6例(17%),痰瘀互结组18例(27.7%),但其差异无统计学意义(P0.05)。三种证型的肺癌患者血脂指标经方差分析后,三种证型的血脂水平：痰证组甘油三酯(TG)水平为,高于血瘀证与痰瘀互结证组,但差异无统计学意义(P0.05)。三组证型患者在各项凝血指标中,D二聚体定量(D-D)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、红细胞压积(HCT)出现了不同比例的异常,其中三组患者D二聚体定量(D-D)和纤维蛋白原(FIB)升高比例近似均在40%以上,而活化部分凝血活酶时间(APTT)和红细胞压积(HCT)三组间存在明显统计学差异。活化部分凝血活酶时间(APTT)痰瘀互结组有41例降低(63%),血瘀组有21例降低(58%),痰证组有12例降低(36%),经卡方检验后发现,痰瘀互结组活化部分凝血活酶时间(APTT)降低情况明显高于血瘀证高于痰证组(P0.05)；相较其他两组而言,痰瘀互结组红细胞压积(HCT)偏高例数为46例(70%),高于血瘀组偏高例数为21例(58%),高于痰证组偏高例数为17例(51%),其差异有统计学意义(P0.05)。三种证型的肺癌患者凝血指标经方差分析后发现,痰瘀互结证组的活化部分凝血活酶时间(APTT)明显低于血瘀证组低于痰证组,(P0.01)。3痰、瘀及痰瘀互结型非小细胞肺癌患者临床相关因素与中医证型的相关性本研究临床各期痰证、血瘀证与痰瘀互结证型的分布有差异(P0.05),其中Ⅰ期、Ⅱ期和Ⅲ期痰瘀互结证型比例较高,而Ⅳ期痰瘀互结证型比例有所下降,各证候之间比例比较接近。病理类型,原发病灶手术情况,转移情况,化疗情况与非小细胞肺癌所表现的痰证、血瘀证、痰瘀互结证型分布无明显相关性(P0.05)。4痰、瘀及痰瘀互结型非小细胞肺癌患者临床治疗相关因素与血脂、凝血指标相关性4.1 临床分期与血脂、凝血指标相关性：高密度脂蛋白(HDL)降低情况在各临床分期分布不同：Ⅳ期降低情况明显高于其他三组(P0.05)；其他血脂指标在临床分期之间差异无统计学意义(P0.05)。红细胞压积(HCT)在临床各分期分布有差异：其中Ⅱ和Ⅳ期偏高例数明显高于其他两组(P0.05)。4.2病理类型与血脂、凝血指标相关性：腺癌组甘油三酯(TG)偏高情况明显高于鳞癌组(P0.05),其他血脂指标在两组之间差异无统计学意义(P0.05)；腺癌组甘油三酯(TG)指标明显高于鳞癌组(P0.05),其他三种血脂指标在两组之间差异无统计学意义(P0.05)。鳞癌组红细胞压积(HCT)偏高情况均高于腺癌组(P0.05),其他凝血指标在两组之间差异无统计学意义(P0.05)；鳞癌组病例凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)高于腺癌组(P0.05),而腺癌组红细胞压积(HCT)高于鳞癌组(P0.05),其他凝血指标在两组之间差异无统计学意义(P0.05)。4.3原发病灶手术情况与血脂、凝血指标相关性对研究病例的凝血指标与肺癌原发病灶手术情况的关系进行对比研究,经t检验后,未手术患者组红细胞压积(HCT)高于手术后(P0.05),其他凝血指标在两组之间差异无统计学意义(P0.05)4.4肺癌转移情况情况与血脂、凝血指标相关性：已转移组纤维蛋白原(FIB)偏高情况检出率明显高于未转移(P0.05)；在红细胞压积(HCT)方面,已转移组偏高情况明显高于未转移组(P0.05)；同时,已转移红细胞压积(HCT)指标高于未转移(P0.05),其他凝血指标在两组之间差异无统计学意义(P0.05)4.5化疗情况与血脂、凝血指标相关性：化疗后患者甘油三酯(TG)偏高情况低于未化疗组(P0.05)。化疗组活化部分凝血活酶时间(APTT)降低情况低于未化疗组(P0.05),化疗组活化D二聚体(D-D)升高情况低于未化疗组(P0.05),在红细胞压积(HCT)方面,化疗组偏高情况明显低于未化疗组(P0.05);同时对比两组凝血指标,经t检验后发现化疗组患者的活化部分凝血活酶时间(APTT)高于未化疗(P0.05)。结论：本研究结果显示,非小细胞肺癌患者血脂水平和凝血功能异常与肺癌痰证、血瘀证、痰瘀互结证证型存在直接联系,与患者临床分期、病理类型、病灶手术情况、肿瘤转移情况、化疗情况存在一定的相关性。血脂水平和凝血功能可以反映肺癌患者三种基本中医证型的存在和轻重程度,因此我们推定可以把血脂水平和凝血功能作为判定肺癌的证型理化基础,以丰富肺癌中医证型的诊断标准。肺癌患者的病机具有多样性和、复杂性的特点,其中,瘀、痰、虚是主要的病理基础,痰瘀之间互相转化,相互搏结是肿瘤发生发展的重要阶段。因此对于肺癌患者的诊治,应当抓住二者具有辨证意义的症状和特异性的理化检查指标,鉴于大部分肺癌患者到中医院就诊时已属晚期,治疗时应注意肺癌的病机特点,注意瘀、痰、虚的关系,注意扶正、化痰、祛瘀等联合治疗,同时注意根据患者临床情况配合降脂、抗凝治疗,以期收到较好的临床疗效。
[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.

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R273

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