【作者】 何蓉；

【导师】 周伟生；

【作者基本信息】 广州中医药大学 ， 中西医结合临床， 2006， 硕士

【摘要】 目的:探讨中晚期原发性周围型肺癌（以下部分简称肺癌）的螺旋CT征象与中医辨证分型之间的关系,为中医辨证分型提供客观诊断依据。 方法:选取广州中医药大学第一附属医院肿瘤中心在2004年3月至2006年4月期间诊治的符合本研究纳入诊断标准的中晚期原发性周围型肺癌患者94例,所有病例均经均在CT导向下经皮肺穿刺活检取得病理组织并经本院病理室确诊为肺癌后,再按照周岱翰教授关于肺癌临床分型将所有病例分为肺郁痰瘀、脾虚痰湿、阴虚痰热、气阴两虚四型,对所有病例行胸部和全身重要脏器的CT增强扫描,获得病灶形态、灶状坏死、钙化、空洞征、空泡征、分叶征、毛刺征、胸膜凹陷征、胸膜增厚、胸膜外脂肪线不完整、血管集束征、胸腔积液、胸膜结节等CT征象。运用统计学方法对数据进行处理,先用单因素分析对自变量进行筛选,组间计量资料的对比,服从正态分布的资料采用方差分析及多样本间的多重比较,计数资料的对比采用卡方检验。然后对具有显著性意义的自变量用向后删除法作logistic回归分析。 结果:1、性别、T与M分期与气阴两虚型有联系,其OR值分别为8.572、2.633、11.993。 最终得Logistic回归预测方程为:P=1/[1+e^{-（-6.310+2.148性别+0.968T+2.484M）}]。 方程对气阴两虚型的敏感度为39.13%,特异度为83.10%。 2、深分叶征与阴虚痰热型有一定的联系,OR值为3.315。 最终得Logistic回归预测方程为:P=1/[1+e^{-（-1.629+1.198深分叶）}]。 方程对阴虚痰热型的敏感度较低,特异度为44.64%。 3、T、N分期与脾虚痰湿型有一定的联系,其OR值分别为2.187、2.901,但并未提示T₂、T₃、T₄比T₁与脾虚痰湿型关联更强;空泡征、胸腔积液与脾虚痰湿型有联系,其OR值分别为6.315、8.149。 最终得Logistic回归预测方程为:P=1/[1+e^{-（-6.658+1.843空泡征+2.098胸腔积液+0.782T+1.605N）}]。 方程对脾虚痰湿型的敏感度为74.07%,特异度为74.63%。 4、胸膜凹陷和血管集束征与肺郁痰瘀型有一定的联系,OR值分别为3.920、3.255;如胸膜凹陷与血管集束征同时出现,OR值为10.133;但这两种征象不是诊断为阴虚痰热型的唯一征象。 最终得Logistic回归预测方程为:P（1）=1/[1+e⁽-(-1.999+1.366胸膜凹陷+1.180血管更多还原

【Abstract】 PURPOSE: To observe the accordance between the CT appearance and Traditional Chinese Medicine （TCM） syndrome types for advanced stage Peripheral Pulmonary Carcinoma （PPC）, and provide the objective diagnostic evidence of peripheral lung cancer for Traditional Chinese Medicine syndrome types.MATERIALS AND METHODS: From Mar. 2004 to Jan. 2006, 94 cases with PPC determined by pathology and imaging examination in the first affiliated Hospital of Guangzhou University of TCM were typed according to four syndrome differentiation. 31 was in phlegm and stasis due to stagnation of lung syndrome group, 27 in superabundance of dampness and phlegm due to spleen-asthenia syndrome group, 23 in phlegm and disturbance of heat due to yin-deficiency syndrome group, and 13 in deficiency of both qi and yin syndrome group. About 24 CT appearances such as vacuole sign, pleural effusion, vascular bundling, and pleural indentation were the variables of the study. CT scanning of the thorax, abdomen and brain were taken for all the patients. The accordance between the CT appearance and TCM syndrome types for advanced stage PPC was analyzed. The SPSS 10.0 statistic software was applied in the study.RESULTS: There is accordance between deficiency of both qi and yin syndrome and the T, N stages and sex. The OR value of sex, T stage and N stage are respectively 8.572, 2.633 and 11.993. The Logistic forecast equation isP=1/[1+e^{（-6.310+2.148sex+0.968T+2.484M）}]. The acuity of equation is 39. 13%. Theeigenvalue of equation is 83.1%.There is accordance between phlegm and disturbance of heat due to yin-deficiency syndrome and lobulation sign. The lobulation sign was more common in phlegm and disturbance of heat due to yin-deficiency syndrome group. The OR value of lobulation sign is 3.315. TheLogistic forecast equation is P=l/Ll+e J. The eigenvalue ofequation is 44.64%. The vacuole sign, pleural effusion, T, M stages is the discriminative variable about superabundance of dampness and phlegm due to spleen-asthenia syndrome. The OR value of vacuole sign, pleural effusion, T stage and M stage are respectively 6. 315, 8.149, 2. 187 and 2. 901. The Logistic forecast equation is P=l/[l + e" ^6-658+1.843V+2.098PE+0.782T+i.605N) L The acu.tyof equation is 74. 07%. The eigenvalue of equation is 74. 63%. There is accordance between phlegm and stasis due to stagnation of lung syndrome and vascular bundling, pleural indentation. The vascular bundling and pleural indentation were more common in phlegm and stasis due to stagnation of lung syndrome group. The OR value of vascular bundling, pleural indentation and vascular bundling*pleural indentation are respectively 3.920, 3.255 and 10. 133. The- （-1.999 +3. 920PI+3. 255VB ） Logistic forecast equation is P=l/[1 + e ]. Theeigenvalue of equation is 60. 34%.CONCLUSIONS: There are accordance between the Traditional Chinese Medicine types and the CT appearance of advanced stage PPC. The CT appearance of primary PPC may be considered the objective evidence for syndrome types of TCM, which are contributed to determine selecting treatment and therapeutic effect. It is necessary to further study the mechanism between the CT appearance and the syndrome types of TCM.更多还原