于维霞++杨保林++张楠

摘要：目的 探讨中央型气道非小细胞肺癌的临床病理特征及其与中医证候的关系。方法 通过对109例肺癌患者问诊及体格检查等确定中医证候，对患者治疗时切除、常规病理检查后的剩余标本HE染色后进行病理学诊断及研究。分析患者临床病理特征与中医证候的关系。结果 中央型气道非小细胞肺癌由鳞癌（69/109，63.3%）、涎腺型癌（27/109，24.8%）、腺癌（10/109，9.2%）和其他少见癌（腺鳞癌，2/109，1.8%；肉瘤样癌，1/109，0.9%）组成。老年（>60岁）、男性、长期吸烟者以鳞癌多见，年轻、女性、无吸烟史患者以涎腺型癌为主。鳞癌及涎腺型癌均以气阴两虚证最为多见，分别占41.4%（29/70）及40.7%（11/27）；腺癌以气虚痰湿证最为多见，占50.0%（6/12）。在不同的性别组、吸烟史组及卡氏评分组中，中医证候的构成比差异均有统计学意义（P<0.05，P<0.01）。男性、吸烟患者以气阴两虚证为主，女性、无吸烟史者以气虚痰湿证及阴虚热毒证为主；卡氏评分≥60分组以气阴两虚证最为多见，<60分组以气虚痰湿证最为多见。结论 非小细胞肺癌患者组织学类型构成与年龄、性别、吸烟史有关，不同年龄、性别、吸烟史的患者中医证型分布也不相同。

关键词：中央型气道；非小细胞肺癌；病理组织学类型；中医证候

DOI：10.3969/j.issn.1005-5304.2017.01.009

中图分类号：R273.42 文献标识码：A 文章编号：1005-5304（2017）01-0032-05

Correlation Study on Clinical Pathological Features and TCM Syndromes in Central Air Way Non-small Cell Lung Cancer YU Wei-xia1， YANG Bao-lin1， ZHANG Nan2 （1. Dongzhimen Hospital， Beijing University of Chinese Medicine， Beijing 100700， China； 2. China Meitan General Hospital， Beijing 100028， China）

Absctact： Objective To discuss the correlation between the TCM syndromes and the clinical pathological features of central air way non-small cell lung cancer. Methods TCM syndromes were determined through inquiry and physical examination for 109 cases of lung cancer patients. Remaining specimens after excision and routine pathological examination were under HE staining for pathological diagnosis and study. The correlation between the TCM syndromes and the clinical pathological features was analyzed. Results The histological types of central airway non-small cell lung cancer comprised squamous cell carcinoma （69/109， 63.3%）， salivary type carcinoma （27/109， 24.8%）， adenocarcinoma （10/109， 9.2%） and other rare carcinomas （adenosquamous， 2/109， 1.8%； sarcomatoid carcinoma， 1/109， 0.9%）. The clinical and pathological features showed that the elderly， male， smoking patients most commonly suffered from squamous cell carcinoma， while the young， female， non-smoking patients suffered from salivary type carcinoma most frequently. The distribution characteristics showed that the qi-yin deficiency syndrome was most common in squamous cell carcinoma and salivary type carcinoma， accounting for 41.4% （29/70） and 40.7% （11/27） respectively； qi-deficiency and phlegm-dampness syndrome was most common in adenocarcinoma， accounting for 50.0% （6/12）. TCM syndrome types were closely related to sex， to smoking history， and to Karnofsky score respectively， with statistical significance （P<0.05， P<0.01）. The qi-yin deficiency syndrome was common in male， smoking patients， while the qi-deficiency and phlegm-dampness syndrome and yin-deficiency and heat-toxin syndrome were common in female and non-smokers. The qin-yin deficiency syndrome was common in patients of

基金项目：北京中医药大学中青年教师资助项目（2013-JYB22-JS-055）

Karnofsky score ≥60， and qi-deficiency and phlegm-dampness syndrome was most frequently found in <60 scores group. Conclusion The histological types of central air way non-small cell lung cancer are related to age， gender and smoking history of patients. Patients with different ages， genders and smoking histories distribute differently in TCM syndrome.

Key words： central airway； non-small cell lung cancer； histological type； TCM syndromes

原发性中央型气道非小细胞肺癌是指原发于气管、主支气管和右中间段支气管的非小细胞性恶性上皮性肿瘤，与其他部位肺癌相比，该部位肿瘤在病理组织学特征、临床特点、中医证候分布等方面有特殊性。本研究探讨中央型气道非小细胞肺癌的临床病理特点及中医证候分布情况，分析中医证候与病理组织学、临床特征、肿瘤TNM分期等的相关性，为中央型气道非小细胞肺癌的中西医结合治疗提供参考依据。

1 临床资料

1.1 研究对象

共纳入2013年6月-2014年5月间煤炭总医院肿瘤微创治疗中心收治的经支气管镜介入性治疗的肺癌患者109例，病理学诊断证实为原发性非小细胞肺癌，临床分期为Ⅲ、Ⅳ期，病变部位为中央型气道。年……