| BackgroudThe saying of "fighting of body fluid and blood" proposed in Inner Canon of Huangdi is the earliest discourse of theories related to phlegm and blood stasis;Zhang Zhongjing creates Didang decoction to treat the syndrome of intermin-gled phlegm and blood stasis and proposes "phlegm and fluid retention" and "blood stasis",significantly promoting the development of theories related to phlegm and blood stasis.In the Yuan dynasty,Zhu Danxi proposed the saying of "phlegm carries blood stasis" and that phlegm and blood stasis are inseparable and he firstly proposed the theory related to phlegm and blood stasis.In traditional Chinese medicine,the pathogenesis of lung cancer is attributable to imbalance of Yin and Yang,seven modes of emotions stagnation,damage to viscera,thus causing Qi deficiency,phlegm stagnation and blood stasis which become accumulation for a long time;hence,it is named "lung accumulation".As it is put in General Medical Collection of Royal Benevolence that "the meaning of tumor is retention".However,the change of hemorheology index is the manifestation of pathological change.In clinical observation,patients with lung cancer often have high viscosity and stagnation and high-coagulation condition which are influenced by substances for blood coagulation released by lung cancer cells and also related to the combined action of body immunity and circulatory system.The final result caused by these complex mechanisms is the change of hemorheology parameter of patients:the change of blood lipid level and blood coagulation indexes.In the Topic,patients with middle and advanced non-small lung cancer are taken as research objects to analyze the data related to the blood lipid level and blood coagulation function of patients with lung cancer and discuss the clinical correlation between the two pathological factors "phlegm"and "blood stasis" in traditional Chinese medicine to make syndrome elements of"phlegm" and "blood stasis" microcosmic and precise,so as to better guide clinical diagnosis,treatment,curative effect evaluation and prognosis.Hope to achieve innovation and breakthrough in theory and knowledge through the basic-clinical combination of traditional Chinese medicine and western medicine.Research purposeObserve the blood lipid level and blood coagulation function of patients with middle-advanced lung cancer and analyze the relation between the blood lipid abnormality and blood coagulation function abnormality and reliminarily discuss the relation between the two to verify the scientificity of theories related to phlegm and stasis.Analyze the information of four diagnostic methods of TCM and symptom type distribution of middle-advanced lung cancer.Enrich the diagnosis and treatment mode of differentiation of disease,differentiation of syndrome and differentiation of symptoms of lung cancer.Search for the micro index of TCM syndrome differentiation.3 Research object and method3.1 Research objectRetrospectively collect 3298 cases of patients confirmed to have primary lung cancer after pathological examination under treatment in Area 11,15 and 19 of Oncology Department of Guang'anmen Hospital,China Academy of Chinese Medical Science from January 2000 to December 2016.After screening in accordance with the incorporating exclusion standard,there are 281 cases of patients with complete final clinical data and examination results in which 192 cases of patients are males and 89 cases of patients are females;their age is between 31?87 years old and the staging and pathological pattern are clear and definite.They have such examination and detection results as blood lipid level,blood coagulation function and blood routine within 2 days after hospital admission.3.2 Research method3.2.1 Standard of diagnosis:the standard of western medicine diagnosis is the standard of diagnosis for patients with primary non-small cell lung cancer-Specifications for Diagnosis and Treatment of Primary Lung Cancer(Version 2011)written by Ministry of Health;for the reference range of blood lipid index,refer to Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults(Version 2007);for the reference range of blood coagulation index,refer to of Laboratory Routine Examination Guang'anmen Hospital;for the syndrome differentiation standard of TCM syndrome,refer to the 6th Edition of the Textbooks-TCM Syndrome Diagnostics and Therapeutics and Diagnostics of Traditional Chinese Medicine and combine clinical practice to conduct the syndrome differentiation and classification.3.2.2 Fill in and record the data and information of cases of 281 patients with lung cancer in accordance with the self-designed Registration Form for Clinical Observation of the Flood Function and Blood Lipid Level of Patients with Primary Bronchogenic Carcinoma.Collect the gender,age,pathological pattern,course of disease,clinical symptoms and information of four diagnostic methods to conduct the statistical analysis.3.2.3 Groups with single item of blood lipid level:group with increase in total cholesterol(TC),group with increase in triglyceride(TG),group with increase in high-density lipoprotein cholesterol(HLD-C),low-density lipoprotein cholesterol(LDL-C),group with decrease in total cholesterol,group with decrease in triglyceride,group with decrease in high-density lipoprotein cholesterol,group with increase in lipoprotein A[LP(a)];groups with composite items of blood lipid level:group with increase in blood lipid,group with decrease in blood lipid,group with abnormal blood lipid,group with normal blood lipid;groups with single item of blood coagulation indexes:group with increase in prothrombin time(PT),group with decrease in prothrombin time,group with normal prothrombin time;group with normal activity of prothrombin time(PT%),group with decrease in activity of prothrombin time;group with increase in activated partial thromboplastin time(APTT),group with decrease in activated partial thromboplastin time,group with normal activated partial thromboplastin time;group with increase in thrombin time(TT),group with decrease in thrombin time;group with normal thrombin time;group with increase in fibrinogen(FIB),group with decrease in fibrinogen,group with normal fibrinogen;group with increase in fibrin degradation products(FDP),group with normal fibrin degradation products;group with increase in D-Dimer,group with normal D-Dimer;group with increase in platelet(PLT),group with decrease in platelet,group with normal platelet;conduct the analysis on the difference between groups from the gender,age,pathological pattern,clinical stages and KPS scores;conduct the correlation analysis for every two variables of the blood lipid indexes and blood coagulation function indexes of research objects.Conduct the frequency statistics for the information of four diagnostic methods and syndrome differentiation and classification.4 Research results4.1 Analysis on single index of blood lipidManifestation of the single index abnormality of blood lipid is as follows:116 cases(41.30%)with decrease in HDL-C,20 cases(7.10%)with increase in HDL-C,84 cases(29.90%)with increase in LDL-C,66 cases(23.50%)with increase in LP(a),61 cases(21.70%)with increase in TG,9 cases(3.20%)with decrease in TG,54 cases(19.20%)with increase in TC,3 cases(1.10%)with decrease in TC;in the analysis of relevant factors:there is a negative correlation between age and TG(R=-0.2304,P<0.0001)and there is a positive correlation between age and HDL-C(R=0.1282,P<0.05)and there is no statistical significance for the difference between age and the remaining indexes;in male group and female group,there is statistical significance for the difference between age and LP(a)index(P<0.05)and there is no statistical significance for the difference between age and such indexes as TC,TG,HDL-C,LDL-C,APOA1 and APOB(P>0.05);the LP(a)index of male is higher than that of female.There is no statistical difference in the analysis of correlation between different pathological patterns,clinical stages,KPS scores and single index of blood lipid.4.2 Analysis on composite index of blood lipidIn composite groups of research objects,the proportion of groups with increase in blood lipid is large.There are 100 people(35.50%)in groups with increase in blood lipid,64 people(22.70%)in groups with blood lipid disorders,60 people(21.30%)with decrease in blood lipid and 57 people(20.20%)with normal blood lipid.Analyze the difference between groups from gender,age,KPS scores,pathological pattern and clinical stages and there is no statistical significance for the results(P>0.05).4.3 Distribution of coagulation index abnormalityMain manifestation of blood coagulation index abnormality is as follows:the probability for increase of D-Dimer is 63.70%;the probability for increase of FIB is 49.10%and the probability for decrease is 3.20%;the probability for increase of FDP is 28.10%;the probability for increase of PLT is 25.60%and the probability for decrease is 0.4%;the probability for increase of TT is 22.40%and probability for decrease is 12.50%;the probability for increase of APTT is 12.10%and probability for decrease is 8.90%;the probability for increase of PT is 8.50%and probability for decrease isl.8%;there is no patient with increase of PT%and the probability for decrease is 8.20%.In the analysis of relevant factors of blood coagulation indexes:there is no statistical significance for the analysis on the correlation between age and single index of blood coagulation(P>0.05);there is a negative correlation between KPS scores and FDP and there is no statistical significance for the analysis on the correlation between KPS scores and the remaining indexes(P>0.05);in male groups and female groups,there is statistical significance for difference between the single blood coagulation index PT and APTT(P<0.05)and there is no statistical significance for the difference between groups of the remaining blood coagulation indexes(P>0.05)and the PT and APTT indexes of female are higher than that of male,indicating that the high-coagulation condition of female patients with lung cancer is slightly lower than that of male;there is statistical significance for the difference between PLT groups of pathological pattern and blood coagulation index(P<0.05)and there is no statistical significance for the difference between groups of the remaining items;there is statistical significance for the difference between FDP and D-Dimer groups of clinical stages and blood coagulation index(P<0.05);there is a positive correlation between FDP and D-Dimer and degree of staging;there is no statistical significance for the difference between groups of the remaining items.4.4 Analysis on the correlation between blood lipid level and blood coagulation functionConduct the correlation analysis for every two variables of blood lipid indexes and blood coagulation indexes.In the correlation analysis of 56 groups:33 groups have statistical significance and the correlation ratio is up to 59%.There is a positive correlation between TC and PT%and a negative correlation between TC and PT,APTT(P value<0.01);there is a positive correlation between TG and FIB,FDP,PT%and a negative correlation between TG and PT,APTT(P value<0.01);there is a positive correlation between HDL-C and PT%and a negative correlation between HDL-C and PT,APTT,FIB,PLT(P value<0.01)and a negative correlation between HDL-C and FDP(P value=0.0199<0.05);there is a negative correlation between LDL-C and PT,APTT(P value<0.01);there is a positive correlation between APOA1 and PT%and a negative correlation between APOA1 and PT,APTT,FIB,PLT,FDP,D-Dimer(P value<0.01);there is a positive correlation between APOB and TT(P value<0.01)and a negative correlation between APOB and PT%,PT,APTT,FIB(P value<0.01);there is a positive correlation between LP(a)and PT,APTT,FIB,PLT,FDP and a negative correlation between LP(a)and PT%(P value<0.01).It can be concluded that the correlation between blood coagulation function and blood lipid level is expressed as follows:there is a positive correlation between high-coagulation condition indexes and such indexes as TC,TG,LDL-C,APOA1,APOB and LP(a);there is a negative correlation between high-coagulation condition indexes and HDL-C index.4.5 Syndrome analysis of traditional Chinese medicine4.5.1 Symptoms distributionConduct frequency analysis for clinical symptoms of 281 cases of research objects and the common symptoms in the questionnaire shall be designed with reference to Guidelines on TCM Diagnosis and Treatment of Malignant Tumor(Version 2014)and those not listed shall be supplemented and filled in.The frequency of symptoms is as follows from high to low:spirit fatigue and weakness,pain,inappetence,chest distress and shortness of breath,insomnia,expectoration,constipation,cough,blood-stained sputum,dry mouth and throat,spontaneous sweating and night sweat,skin itch,palpitation,sour regurgitation and heartburn,extreme chilliness,fever,abdominal distension,frequent urination and copious urine at night,hoarseness,diarrhea,haziness of spirit-mind,dizziness and dysphoria in chestpalms-soles.4.5.2 Tongue pictureConduct statistical analysis for the tongue picture(tongue color,tongue shape,coating nature and coating color)of all research objects and the 10 types of the most frequent tongue picture are sorted out and frequency from high to low is as follows:white coating,red tongue,greasy coating,dark tongue,pale tongue,thin coating,tooth-marked margin of tongue,few coating,thick coating and yellow coating.The comprehensive tongue picture mainly includes dark tongue,white coating and greasy coating.4.5.3 Pulse manifestationConduct the statistical analysis for the pulse manifestation of all research objects.The frequency from high to low is as follows:small pulse,wiry pulse,slippery pulse,rapid pulse,weak pulse,unsmooth pulse,deep pulse and slow pulse.4.5.4 Distribution of TCM syndromes16 syndrome types are as follows from high to low of proportion and frequency:the type of deficiency of both Qi and Yin;phlegm-dampness stagnation type;Qi deficiency and blood stasis type;Yin deficiency and heat-toxin type;phlegm-dampness type;the type of deficiency of both Qi and Yin and phlegm stagnation;Qi deficiency and phlegm-dampness stagnation type;the type of Qi stagnation and blood stasis;Qi deficiency and phlegm-dampness type;the type of Yin deficiency,phlegm-heat and blood stasis;blood stasis type;Yin deficiency type;the type of deficiency of both Qi and Yin,drinking-stop and chest and hypochondrium;Yin deficiency and phlegm-heat type;phlegm-heat type;Qi deficiency type.In the analysis on the correlation between syndrome differentiation and blood lipid index and blood coagulation index:for the analysis on correlation between different syndrome types and blood lipid index,P>0.05 and there is no statistical significance for difference between groups;there is statistical difference between different syndrome types and such blood coagulation indexes as FDP and D-Dimer and P<0.05 and the FDP and D-Dimer indexes of phlegm-dampness stagnation type are higher than that of other syndrome types.5 Conclusion5.1 Patients with middle and advanced lung cancer generally have blood lipid level abnormality and blood coagulation function abnormality;5.2 With regard to clinical data and the correlation between single indexes of blood lipid and blood coagulation:the high-coagulation condition is easier to occur on male patients than female patients;the blood lipid status of aged patients tends to be normal(there is a negative correlation between age and TG and there is a positive correlation between age and HDL-C);the degree of correlation between PLT index and squamous carcinoma.is higher than that of other pathological patterns;the increase of FDP and D-Dimer can serve as the microcosmic syndrome differentiation factor of phlegm-dampness stagnation and indicates the relatively high recurrence and metastasis risks;5.3 There is a clear correlation between the blood lipid level and blood coagulation function of patients with middle and advanced lung cancer and there is a positive correlation between the high-coagulation condition and TC,TG,LDL-C,APOA1,LP(a);there is a negative correlation between the high-coagulation condition and HDL-C;the reasonability for discussion on the treatment strategy combining traditional Chinese medicine and western medicine based on theories related to phlegm and stasis is determined. |
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