胸腔镜技术对非小细胞肺癌“证”内涵的研究
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摘要
目的：揭示非小细胞肺癌证型与患者生存质量、组织病理、肿瘤转移、耐药相关性,为该病的辨证论治及预后评估提供新的科学依据,进而证实内外合诊的科学性及可行性,进一步揭示“证”的内涵。
方法：60例非小细胞肺癌患者按照气阴两虚证、气滞痰瘀证平均分成两组,对两组患者中医症状评分、整体体力状况(KPS、ZPS)、生存质量评估(FACT-L)的基础上,运用胸腔镜技术获取肿瘤组织,对组织病理、转移(VEGF)、肿瘤耐药(P-gp)相关指标进行对照研究。
结果：
1.两证型患者中医临床症状评分比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤中医临床症状总评分相对偏高,两组差异有统计学意义,P<0.05；
2.两证型患者的体力状况比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤体力状况评分KPS评分相对偏低,而ZPS偏高,两组差异有统计学意义,P<0.05；
3.两证型患者的生活质量(FACT-L)比较,气阴两虚证组患者较气滞痰瘀证组,FACT-L各项指标及总分都显著偏高,两组差异有统计学意义,P<0.01,KPS评分与FACT-L呈负相关,而ZPS评分与FACT-L呈正相关；
4.两证型患者肺癌组织比较,气阴两虚证患者相对苍白晦暗,而气滞痰瘀证患者组织充血明显,病理切片比较,气阴两虚证患者切片显示弥漫增生,而气滞痰瘀证患者显示,局部慢性炎性改变,间质充血水肿；
5.两证型患者的VEGF比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤组织VEGF相对偏高,两组差异有统计学意义,P<0.01；
6.两证型患者的P-gp比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤组织P-gp相对偏高,两组差异有统计学意义,P<0.01。
结论：
1.非小细胞肺癌证型与患者中医临床症状、整体体力状况、生存质量、组织病理、肿瘤转移、耐药存在一定相关性；
2.气阴两虚证患者中医临床整体症状较气滞痰瘀证为差。
3.气阴两虚证患者不管是体力状况还是生存质量皆较气滞痰瘀证为差；
4气阴两虚证患者更容易发生肿瘤转移；
5.气阴两虚证患者更容易发生肿瘤耐药。
Objective:To study the relationship of the traditional Chinese medicine (TCM)"syndrome" in correlation with general body status, life quality, histopathology, metastasis, drug tolerability, and prognostic assessment in non-small cell lung cancer patients. We anticipated that these correlations of the "syndrome" differentiation will help to provide the scientificity and feasibility evidences of the internal and external inspection in lung cancer patients.
Methods:60cases of non-small cell lung cancer patients were divided into two groups,30with qiyin deficiency and30with qi stagnation. Collection of TCM symptom score, Karnofsky score (KPS、ZPS), quality of life (FACT-L) score were all recorded one day before operation in both groups. The lung tumor specimens were resected by using thoracoscopic (VATS) technique and send for histopathology, VEGF, P-gp study to investigate the variations between the two groups. The correlations of the TCM "syndrome" differentiation in both groups of patients were recorded and statistically compared.
Results:TCM symptom score in the patients is higher in qiyin deficiency compared with those with qi stagnation (P<0.05), KPS score is lower in qiyin deficiency but higher ZPS score was found as compare to group with qi stagnation (P<0.05). As for FACT-L score, qiyin deficiency group showed higher and significant than the latter,(P<0.01). Comparing between the gross appearances and histologic changes, tumour tissue in patients with qiyin deficiency seems pale and diffuse infiltrative pattern and tissue in qi stagnation seems more congested and inflammatory changes. Both the VEGF、P-gp data in qiyin deficiency is higher than the patient groups in qi stagnation (P<0.05).
Conclusion:TCM "syndromes "of non-small cell lung cancer showed some relations with patients'general body conditions; life quality, histopathology, metastasis and drug tolerability. Patients with qiyin deficiency might be one of the poor factors which will further affect the treatment and prognosis in lung cancer patients.
方法：60例非小细胞肺癌患者按照气阴两虚证、气滞痰瘀证平均分成两组,对两组患者中医症状评分、整体体力状况(KPS、ZPS)、生存质量评估(FACT-L)的基础上,运用胸腔镜技术获取肿瘤组织,对组织病理、转移(VEGF)、肿瘤耐药(P-gp)相关指标进行对照研究。
结果：
1.两证型患者中医临床症状评分比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤中医临床症状总评分相对偏高,两组差异有统计学意义,P<0.05；
2.两证型患者的体力状况比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤体力状况评分KPS评分相对偏低,而ZPS偏高,两组差异有统计学意义,P<0.05；
3.两证型患者的生活质量(FACT-L)比较,气阴两虚证组患者较气滞痰瘀证组,FACT-L各项指标及总分都显著偏高,两组差异有统计学意义,P<0.01,KPS评分与FACT-L呈负相关,而ZPS评分与FACT-L呈正相关；
4.两证型患者肺癌组织比较,气阴两虚证患者相对苍白晦暗,而气滞痰瘀证患者组织充血明显,病理切片比较,气阴两虚证患者切片显示弥漫增生,而气滞痰瘀证患者显示,局部慢性炎性改变,间质充血水肿；
5.两证型患者的VEGF比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤组织VEGF相对偏高,两组差异有统计学意义,P<0.01；
6.两证型患者的P-gp比较,气阴两虚证组患者较气滞痰瘀证组,肿瘤组织P-gp相对偏高,两组差异有统计学意义,P<0.01。
结论：
1.非小细胞肺癌证型与患者中医临床症状、整体体力状况、生存质量、组织病理、肿瘤转移、耐药存在一定相关性；
2.气阴两虚证患者中医临床整体症状较气滞痰瘀证为差。
3.气阴两虚证患者不管是体力状况还是生存质量皆较气滞痰瘀证为差；
4气阴两虚证患者更容易发生肿瘤转移；
5.气阴两虚证患者更容易发生肿瘤耐药。
Objective:To study the relationship of the traditional Chinese medicine (TCM)"syndrome" in correlation with general body status, life quality, histopathology, metastasis, drug tolerability, and prognostic assessment in non-small cell lung cancer patients. We anticipated that these correlations of the "syndrome" differentiation will help to provide the scientificity and feasibility evidences of the internal and external inspection in lung cancer patients.
Methods:60cases of non-small cell lung cancer patients were divided into two groups,30with qiyin deficiency and30with qi stagnation. Collection of TCM symptom score, Karnofsky score (KPS、ZPS), quality of life (FACT-L) score were all recorded one day before operation in both groups. The lung tumor specimens were resected by using thoracoscopic (VATS) technique and send for histopathology, VEGF, P-gp study to investigate the variations between the two groups. The correlations of the TCM "syndrome" differentiation in both groups of patients were recorded and statistically compared.
Results:TCM symptom score in the patients is higher in qiyin deficiency compared with those with qi stagnation (P<0.05), KPS score is lower in qiyin deficiency but higher ZPS score was found as compare to group with qi stagnation (P<0.05). As for FACT-L score, qiyin deficiency group showed higher and significant than the latter,(P<0.01). Comparing between the gross appearances and histologic changes, tumour tissue in patients with qiyin deficiency seems pale and diffuse infiltrative pattern and tissue in qi stagnation seems more congested and inflammatory changes. Both the VEGF、P-gp data in qiyin deficiency is higher than the patient groups in qi stagnation (P<0.05).
Conclusion:TCM "syndromes "of non-small cell lung cancer showed some relations with patients'general body conditions; life quality, histopathology, metastasis and drug tolerability. Patients with qiyin deficiency might be one of the poor factors which will further affect the treatment and prognosis in lung cancer patients.
引文
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