D-二聚体水平与晚期非小细胞肺癌血瘀证及其亚型分布的相关性研究

Correlation between D-dimer Level and Distribution Patterns of Blood Stasis Syndrome and Its Subtypes in Patients with Advanced Non-Small Cell Lung Cancer

目的:初步探寻晚期肺癌患者D-二聚体水平与中医血瘀证及其亚型的分布规律。方法:收集杭州市中医院、杭州市丁桥医院肿瘤科及胸外科2020年9月—2022年8月住院治疗的晚期非小细胞肺癌患者的中医四诊、血浆D-二聚体等资料,初步探寻此类患者D-二聚体水平与中医血瘀证及其亚型的分布规律。结果:化疗、靶向治疗前后,D-二聚体正常者血瘀证出现频率分别仅为24.5%、28.6%,D-二聚体升高患者血瘀证出现频率高达87.2%、88.3%;治疗前D-二聚体轻度升高与显著升高两者血瘀证亚型分布相同,出现频率高低依次皆为气虚证、阴虚证、痰浊证、气滞证、血热证,但随着D-二聚体水平升高,痰浊证、气滞证频率则显著增加;化疗后D-二聚体轻度升高与显著升高两者血瘀证亚型分布皆以阴虚证、气滞证、气虚证为主;靶向治疗后D-二聚体轻度升高与显著升高两者血瘀证亚型分布则以阴虚证、血热证、气虚证为主。结论:血瘀证是晚期非小细胞肺癌常见的证候,D-二聚体水平与中医血瘀证密切相关,D-二聚体水平越高,中医血瘀证出现频率亦越高。化疗、靶向治疗不影响患者血瘀证总体证型分布,但影响血瘀证的亚型分布。血瘀证亚型总体分布虚证以气虚证、阴虚证为主,实证以痰浊证、气滞证为主。气虚血瘀证、阴虚血瘀证是贯穿晚期非小细胞肺癌综合治疗的主导证型,但靶向治疗后需重视血热血瘀证;对此开展针对性有效干预,灵活、精准运用活血化瘀疗法。

Objective:To explore the correlation between the plasma D-dimer level and the distribution patterns of blood stasis syndrome and its subtypes in patients with advanced lung cancer.Methods:Data on traditional Chinese medicine(TCM)syndrome differentiation and plasma D-dimer levels were collected from patients with advanced non-small cell lung cancer who were admitted to the Departments of Oncology and Thoracic Surgery at Hangzhou Hospital of Chinese Medicine and Dingqiao Hospital of Hangzhou City from September 2020 to August 2022.A retrospective case study method was used to preliminarily explore the correlation between D-dimer levels and blood stasis syndrome and its subtypes in these patients.Results:Before and after chemotherapy and targeted therapy,the frequency of blood stasis syndrome in patients with normal D-dimer levels was only 24.5%and 28.6%,respectively,while the frequency in patients with elevated D-dimer levels were as high as 87.2%and 88.3%.The distribution of blood stasis syndrome subtypes in patients with mild and significant elevation of D-dimer levels before treatment was the same,with the high frequencies being qi deficiency syndrome,yin deficiency syndrome,phlegm turbidity syndrome,qi stagnation syndrome,and blood heat syndrome.However,as the D-dimer levels raised,the frequencies of phlegm turbidity syndrome and qi stagnation syndrome were significantly increased.After chemotherapy,the distribution of blood stasis syndrome subtypes in patients with mild and significant elevation of D-dimer levels was mainly yin deficiency syndrome,qi stagnation syndrome,and qi deficiency syndrome.After targeted therapy,the distribution of blood stasis syndrome subtypes in patients with mild and significant elevation of D-dimer le-vels was mainly yin deficiency syndrome,blood heat syndrome,and qi deficiency syndrome.Conclusion:Blood stasis syndrome is the most common syndrome in patients with advanced non-small cell lung cancer,and it is closely related to the level of D-dimer.The higher the D-dimer level,the higher the frequency of blood stasis syndrome.Chemotherapy and targeted therapy do not affect the overall distribution of blood stasis syndrome pa-tterns,but they affect the distribution of its subtypes.The overall distribution of blood stasis syndrome subtypes is dominated by deficiency patterns,with qi deficiency syndrome and yin deficiency syndrome being the main patterns,while phlegm turbidity syndrome and qi stagnation syndrome are the main patterns in excess patterns.Qi deficiency and blood stasis syndrome and yin deficiency and blood stasis syndrome are the dominant patterns in the comprehensive treatment of advanced non-small cell lung cancer,but attention should be paid to blood heat and blood stasis syndrome after targeted therapy.It is necessary to carry out targeted and effective interventions and flexibly and accurately use blood-activating and stasis-resolving therapy.