The Exploratory Study Of Classing And Quantizing Diagnostic Criteria On Intermediate And Advanced Stage Primarily Lung Cancer Patients' Blood Stasis Syndrome

The exploratory study of classing and quantizing diagnosticcriteria on intermediate and advanced stage primarily lungcancer patients' blood stasis syndromeAt present, researches on blood stasis syndrome have shown that the category of blood stasis syndrome is so large that it can't be diagnosed by a single diagnostic criterion among different diseases. Simultaneously every disease has its distinct syndrome; patients with blood stasis syndrome have disparity at Chinese medical science's syndrome and laboratory examination index in different diseases. Therefore, in order to study and research the parenchyma of blood stasis syndrome we must combine it with certain disease. There're more and medical science scholars who begin to study blood stasis syndrome with a single disease, and they have proposed many diagnostic criteria about blood stasis syndrome. It's a developing tendency on the study of blood stasis syndrome. However, there is no systemic study of primarily lung cancer patient's blood stasis syndrome. So we don't know whether there are characteristic regularity and feature about primarily lung cancer patient's blood stasis syndrome, and if there were, what would they be? Do they mean any senses to clinical therapy and diagnosis? There are many problems need deeper researches.Moreover,some diagnostic criterias about blood stasis syndrome established before were instituted based on experts' experiences and discussions, so anthropic factors posed a great deal effect on these criterias that caused biases. This topic is an initial exploratory which in order to solve those questions. There are specific research methods and results as follow:Research Objects and MethodsThis research observed 122 patients who were in Guang an men hospital oncology endemic area during 2006．6-2007．3, rejected those whose data-entries were incomplete and defluxion during the research process, at last 105 cases were collected. Divided these cases into two groups (A and B) .Group A (processing group): 60 examples, male 41, female 19, aged from 35 to 81,averaged 67．Group B (check group): 45 examples, male 25, female 20, aged from 43 to 82,averaged 70．Set the blood stasis syndrome diagnostic criteria (《guide principle about new traditional Chinese drug's clinical research》) (on probation) as reference standard, differentiation of symptoms and signs for classification of syndrome among all patients. After differentiation of symptoms and signs, there are 27 patients with blood stasis syndrome and 33 patients without blood stasis syndrome in Group A. There are 20 patients with blood stasis syndrome and 25 patients without blood stasis syndrome in Group B. Group A is used to establish quantization standard and for retrospective check-up, Group B is used for prospective check-up.Taking all the syndromes about blood stasis syndrome and primarily lung cancer into account, adds the laboratory indexes of primarily lung cancer. In order to make the diagnostic criteria practical and easy to perform, these syndromes and laboratory indexes were sieved before be internalized epidemiological survey questionnaire. In the end, 88 indexes are involved. There are 32 Chinese medical science syndromes as follow: cough; bloody phlegm; breath lessness; chest pain; chest distress; fever; stethocatharsis; debilitation; anepithymia; dry mouth; cardiopalmus; upset and hyposomnia; spontaneous perspiration and night sweat; nausea and vomiting; diarrhea; constipation; pricking and fixed pain; stagnant blood in arteries and veins; abdominal mass; hemorrhage; algomenorrhea, black menstruation with coagulated blood,amenorrhea; violet body of the tongue,corpus linguae with ecchymosis and petechia; unsmooth pulse or acrotism; scaly skin; limbs anesthesia or hemiplegia; mania; vesania and forgetful; external injury, operation and artificial abortion history; patho-tumor; abdominal dropsy; abdomen's stagnant blood; angina pectoris. There are 66 laboratory indexes as follow: GLU,CR,BUN,CA,P,UA,HCO3,AP0A1,APOB,ALT,AST,RLPS,CK,CK-MB,LDH,ALP,γ-GT,TP,ALB,GLB,A/G,CHO,TG,HDL,LDL,VLDL,TBIL,DBIL,IBIL,WBC,RBC,HGB,HCT,MCV,MCH,MCHC,PLT,LYMPH%,MONO%,NEUT%,EOS%,BASO%,LYMPH#,MONO#,NEUT#,EOS#,BASO#,RDW-SD,RDW-CV,PDW,MPV,P-LCRAFP,AFP,CEA,CA199,CA125,CA153,PT,APTT, TT,D-dimer,FIB,CD36,CD62,CD63,TSP.All the indexes above were set as analytic data for formulate the quantify criterion. We select factors related to intermediate and advanced stage primarily lung cancer patient's blood stasis syndrome by statistics comparison method,established factors score table by conditional probability reforming method; established liminal value of quantify criterion by maximum likelihood discrimination method; carry out retrospective and prospective study by clinical epidemiology diagnostic test method; established degree-classify criterion by cluster analysis method. Statistics apply SPSS 13．0, tabulates apply Excel 2003．Result Retrospective study:Through the statistical analysis, we established the classing and quantizing diagnostic criteria on intermediate and advanced stage primarily lung cancer patient's blood stasis syndrome as follow: pricking and fixed pain (15) ; violet body of the tongue,corpus linguae with ecchymosis and petechia( 12) ;hemorrhage( 10) ;stagnant blood in arteries and veins (9) ; abdominal mass (9) ; external injury,operation and artificial abortion history (9) ;bloody phlegm (8) ; chest pain (5) .If an intermediate and advanced stage primarily lung cancer patient's blood stasis syndrome involved the syndromes above, and their numerical value adds up to 18～25,he can be diagnosed as slight blood stasis syndrome; if he got 26～32, he can be diagnosed as midrange blood stasis syndrome;if his numerical value larger than 32, he can be diagnosed as serious blood stasis syndrome.The retrospective study shown the results of test about the classing and quantizing diagnostic criteria: sensitivity 92．60%; specificity 84．85%; accuracy rating 88．33%; masculine likelihood ratio 4．42; Negative likelihood ratio 8．73%。Perspective study:The perspective study shown the results of test about the classing and quantizing diagnostic criteria: sensitivity 90．00%; specificity 88．00%; accuracy rating 88．89%; masculine likelihood ratio 4．80; negative likelihood ratio 11．36%。 Observation and statistics analysis about laboratory index:The statistics analysis shown that there weren't significant difference between patients who with blood stasis syndrome and patients who without blood stasis syndrome.Conclusion and Discussion1,This topic tight associate with clinical practice, apply statistical method severity, formulate the classing and quantizing diagnostic criteria on. It brings new ideas and possesses practicality.2,The statistical method design is very rigorous in this research. Firstly, the factor were given its numerical value only after it passed the statistics comparison and analysis, which ensure it was statistics relative to intermediate and advanced stage primarily lung cancer patient's blood stasis syndrome; secondly, this topic carry out retrospective and prospective study by clinical epidemiology diagnostic test method, which confirm the sensitivity,specificity,accuracy rating,masculine likelihood ratio of the degree-classify criterion were large than 80%.At the same time, the Negative likelihood ratio was very low. Therefore, it is a fine criterion by statistics.3,Compared with some diagnostic criteria about blood stasis syndrome established before, the classing and quantizing diagnostic criteria on intermediate and advanced stage primarily lung cancer patients' blood stasis syndrome has its own characteristics: (1) This criteria based on clinical epidemiology investigation, reflects clinical practical better than others. (2) The statistics method of this topic is scientific which refining the places cause arguments in the past. (3) the numerical value given to correlation factors can reflect the factor's contribution better. (4) This research obey the clinical epidemiology tentative diagnosis evaluation principle severity,run retrospective and prospective test which take the sensitivity,specificity,accuracy rating,masculine likelihood ratio,the Negative likelihood ratio into account. So this topic is rigorous on statistics. (5) The criteria contain classing diagnostic criteria so it can be compared between different syndromes.And it is consistent with clinical practical of Chinese medical science. 4,This topic is an exploratory study on formulate the classing and quantizing diagnostic criteria on intermediate and advanced stage primarily lung cancer patients' blood stasis syndrome. Primarily lung cancer serious endangers people's life and health. Blood stasis syndrome is always a hot investigative spot for Chinese medical science and combination of TCM with Western medicine. Research on Combine primarily lung cancer and blood stasis syndrome together has more great significance.5,This criteria has certain similarity with the former criterias about blood stasis syndrome. It verificated that the former criterias about blood stasis syndrome's correctness and practicality to some degree, and verificated that Chinese medical science rational and expertise are scientific.6,The statistics analysis in this topic shown that there were not significant difference between patients with blood stasis syndrome and patients without blood stasis syndrome, which is different with some former research to some degree. For intermediate and advanced stage primarily lung cancer patients, do there really exist necessary and essentially relationships between laboratory indexes and Chinese medical science dialectical? It needs more and deep research.7,Intermediate and advanced stage primarily lung cancer patients' syndromes not only including blood stasis syndrome, but also including syndromes of deficiency of QI,blood stasis,phlegmatic hygrosis and yin asthenia and so on. Whether or not it is because intermediate and advanced stage primarily lung cancer patients have longer stage and heavier pathogenetic condition, so these syndromes are confounding together. If things like this, it is consistent with clinic-practical conditions of traditional Chinese medicine.8,Is the blood stasis syndrome in macroscopy unified with the blood stasis syndrome in microcosmic? In addition, if it was, how could it be? Alternatively, they cannot unified because the different of theories and diagnostic methods of traditional Chinese medicine and west medicine. Are there some changes in nerve system,body fluid system,feeling system and internal hormone system besides blood circulation system? Do they cause the blood stasis syndrome? In order to solve these problems, more and more research works need to do. 9,From the results we can see that in the classing and quantizing diagnostic criteria only bloody phlegm and chest pain are the features of the primarily lung cancer, other syndromes can be found in almost all the blood stasis syndrome of other diseases.Whether bloody phlegm and chest pain are the common part in all chest diseases, it needs to be studied.If it is so, then whether those diseases which occur in the same part of the body have same syndromes of blood stasis syndrome.Is the blood stasis syndrome more relevant with the location than the character of the disease? Whether different etiopathogenisis affect the same part of the body, cause the same patho-change, result in same syndromes.Is it true for the blood stasis syndrome?10,In this topic, the observed indexes were limited in the rage of these which have been researched. We should observer more indexes than previous researches, and maybe we can get new results.11,The same symptom got different score in different disease, why? Is it because the characters of diseases are different? Does it suggest that there are real different between different diseases' blood stasis syndrome?12,How to connect the research on diagnostic criteria with clinical therapy so that we can get more effective result of therapy? We must think about what to do next step. When and how to use the drugs for invigorating blood circulation and eliminating stasis is a big and complicated question before us.This topic is the exploratory study of classing and quantizing diagnostic criteria on intermediate and advanced stage primarily lung cancer patient's blood stasis syndrome. Although classing and quantizing diagnostic criteria has been established, there are also some problems exist, large sample and multicentre clinical research should keep going, at the same time, accompanied symptoms and signs should be investigate in the future.