肺癌患者舌苔脱落细胞化学指标与证型的相关性

Study on Relationship between TCM Syndrome Type in Patients with Middle-Advanced Stage of Pulmonary Cancer and Chemical Index of Tongue Coating

目的:通过检测中晚期原发性支气管肺癌患者舌苔脱落细胞化学指标的含量,探讨中晚期原发性支气管肺癌四证型(气虚痰湿证、阴虚热毒证、气阴两虚证、气血瘀滞证)与其之间的关系,为中医辨证提供客观依据。方法:将140例中晚期肺癌患者分为气虚痰湿、气血瘀滞、阴虚热毒、气阴两虚4个证型,检测各证型患者舌苔脱落细胞的化学指标乳酸脱氢酶(LDH)、琥珀酸脱氢酶(SDH)、酸性磷酸酶(ACP)的活性及巯基(-SH)的含量,将结果进行比较,并与30例正常人相对照。结果:中晚期原发性肺癌不同TNM分期的中医证型分布有显著性差异(P<0.01),ⅡB期患者多见气虚痰湿型,占72.42%,ⅢA期则以气血瘀滞证为主,占52.17%,ⅢB期多表现为阴虚热毒证型,占66.67%,IV期多集中在气阴两虚,占90.00%。中晚期肺癌阴虚热毒证组LDH、SDH、ACP活性较正常组活性较高,-SH含量也高(P<0.01),气虚痰湿、气阴两虚、气血瘀滞组较正常组LDH、SDH、ACP活性下降,-SH含量降低,其中气阴两虚和气虚痰湿组SDH的活性、-SH含量下降的最为明显(P<0.01),气虚痰湿组ACP含量降低的最为明显(P<0.01)。不同TNM期的肺癌患者中医证型分布有差别,舌苔脱落细胞化学指标乳酸脱氢酶(LDH)、琥珀酸脱氢酶(SDH)、酸性磷酸酶(ACP)的活性及巯基(-SH)的含量与肺癌所表现的中医证型有关。

Objective：To explore and discuss the relationship between TCM syndrome differentiation of middle-advanced stage of primary bronehogenic carcinoma by detecting chemical indexes（ LDH ,SDH ,-SH and ACP） of tongue coating exfoliated cells, so that we can provide an objective basis for TCM syndrome differentiation of clinical middle-advanced stage of primary bronchogenie carcinoma. Methods ： 140 examples patients who were in middle-advanced stage of primary bronchogenie carcinoma were divided into different standard types according to TCM syndrome. Chemical indexes（ LDH ,SDH ,-SH and ACP） of tongue coating extbliated cells that were from patients of each syndrome type and 30 eases of normal people were detected via experimental techniquesof tongue printing slides and modern cytochemistry. Results ： The distribution difference in the TCM syndrome of middle-advanced stage of primary bronchogenic carcinoma had a high statistical significant meaning. Patients in ⅡB period mostly belonged to Qideficiency and phlegm-damp, accounting for 72.42%. Patients in Ⅲ A period mostly belonged to Qi-blood stagnation, accounting for 52.17%. Patients in m B period mostly belonged to Yin-deficiency and toxic heat, taking up for 66.67%. Patients in IV period mostly belonged to Qi-Yin deficiency, holding 90.0%. The activity of LDH, SDH and ACP was higher in Yin-deficiency and toxic heat group while lower in other groups than that in normal group, with a high level of SH in the former and a low level in the latter groups. There was most obvious decrease of LDH, SDH and -SH in Qi-Yin deficiency group and Qi-deficiency and phlegm-damp group and ACP in Qi-deficiency and phlegm-damp group （ P 〈 0. 01 ）. Conclusion ： The distribution difference in the TCM syn- drome of middle-advanced stage of primary bronchogenic carcinoma in different TNM stages had a high statistical significant meaning. Chemical indices（ LDH ,SDH,SH and ACP） of tongue coating exfoliated cells have relationships with the TCM syndrome types of lung cancer.