肺癌中医证型研究概况

Progress on Lung Cancer with Syndrome Differentiation in Traditional Chinese Medicine

肺癌证型脏腑辨证发病率依次为肺阴虚、肺气虚、脾气虚、肾阴虚、肾气虚、瘀阻肺络等;也有报告为气阴两虚、阴虚内热、脾虚痰湿、气滞血瘀、气虚、痰湿蕴肺。舌苔脱落细胞MI、MV改变、肿瘤标志物表达与中医证型有关,可作为证型判断、微观辨证重要指标。肺癌多层螺旋CT表现与中医证型存在一定关系,可作为临床辨证分型客观依据。病理分型与中医证型互参,鳞癌多表现为气血瘀滞,大细胞肺癌多表现为阴虚痰热,未分化癌多表现为痰湿蕴肺,腺癌多表现为阴虚为本,兼有气虚或痰热。气虚、痰凝、血瘀是非小细胞肺癌最常见中医证候;TNM分期Ⅰ、Ⅱ期以实证居多,Ⅲ、Ⅳ期以虚实夹杂、虚证为主,Ⅳ期(M1b)期脾虚痰湿、气滞血瘀、痰热阻肺证肺癌较易出现耐药现象。血管内皮生长因子(VEGF)气血瘀滞高于气虚痰湿、阴虚热毒、气阴两虚;气虚痰湿免疫功能最好CD4+T细胞最高。化疗后1周内气虚痰湿出现最多,化疗后14~30d内气阴两虚最多。痰湿证候要素占多数,是肺癌发生发展证候基础,热毒要素出现在疾病晚期,有一定预后评价作用;对症治疗可提高患者生活质量,对预后有一定影响。目前证型评判没有统一规范标准,缺乏大样本和多中心研究,出现结果多样性和偏差性,结论不能相互得到认可。建立肺癌中医证型标准是当务之急,把舌象和脉象动态变化纳入研究范围,同时还可引入更多现代分子生物及免疫学等相关学科的微观指标和研究方法,期望能够促进肺癌微观辨证的发展。

The incidence of viscera syndrome differentiation of lung cancer syndrom types from high to low is lung Yin deficiency, lung Qi deficiency, spleen Qi deficiency,kidney Yin deficiency, kidney Qi deficiency, deficiency of blood stasis in the lung, etc; it also has reported as deficiency of both Qi and Yin, Yin deficiency inner heat, spleen hypofunction and dampness accumulation, Qi stagnation and blood stasis、Qi deficiency, phlegm-dampness accumulation in lungs. The changes of MI and MV in exfoliative cells of tongue fur and the expression of tumor markers were related to the TCM syndromes, which could be used as an important index for syndrome differentiation and microscopic differentiation. The multi-slice helical CT features of lung cancer are related to TCM syndromes, which can be used as objective basis for clinical syndrome differentiation. Pathological classification of lung cancer and TCM syndrome types are related,most squamous cell carcinoma are Qi stagnation and blood stasis, the majority of large cell lung cancer are Yin deficiency phlegm heat; the deficiency of large cell lung cancer is mainly about Yin deficiency phlegm heat; adenocarcinoma is mainly based on Yin-deficiency, combined Qi deficiency or phlegm-heat. Qi deficiency, phlegm coagulation and blood stasis are the most common TCM syndromes of non-small cell Lung Cancer.Most TNM stageⅠandⅡare excessive syndrome, stageⅢandⅣare mainly deficiency syndrome accompanied with excess syndrome and deficiency syndrome, the resistance phenomena of spleen hypofunction anddampness accumulation, Qi stagnation and blood stasis and Phlegm-Heat accumulation in lungs occurs more easily in stageⅣ（M1b） of lung cancer.Vascular endothelial growth factor（VEGF） of Qi stagnation and blood stasis is higher than that of Qi asthenia phlegmatic hygrosis, Yin deficiency with noxious heat, Qi-Yin deficiency, Qi deficiency and phlegm dampness. The immune function of Qi asthenia phlegmatic hygrosis is the best, and the value of CD4＋ T cell is the highest. Within one week after chemotherapy Qi asthenia phlegmatic hygrosis appears most, and Qi-Yin deficiency is the most in 14-30 days after chemotherapy. Phlegm-dampness syndrome elements accounted for the the majority of lung cancer, is the basis for the development of syndrome. Heat toxic elements appear in the last stage of disease, and play an important role in prognosis evaluation. Symptomatic treatment can improve the quality of life of patients, which has a certain influence on the prognosis. At present, there is no uniform standard for the evaluation of syndromes, because of the lack of large sample and multi-center study, the results of study diversity and bias. Also the conclusion can not be recognized each other. It is urgent to establish the standard of TCM syndromes of lung cancer. We should consider the dynamic changes of the tongue and pulse into the scope of study. At the same time, more microcosmic indexes and research methods of modern molecular biology and immunology can be introduced,hoping to promote the development of micro differentiation of lung cancer.