An Exploratory Study On Quantitative And Hierarchical Diagnostic Models Of Primary Lung Cancer

Objective:To establish a quantified criterion and the system of hierarchical diag-nosis for primary lung cancer heat syndrome initially.Methods:The first past:1. The research observed 270 patients of primary lung cancer who were diagnosed according to "Diagnosis criteria for primary lung cancer" as a reference standard of western medicine.The 270 patients were divided into heat syndrome group and non- heat syndrome group according to "clinic termi-nology of traditional chinese medical diagnosis and treatment-syndromes" as a reference standard of TCM medicine.2. to investigate clinical characteristics of lung cancer heat syndrome, these factors including 216 patients’gender, age, smoking history,life history, TNM stage, patholog-ocal types, primary site, met-astases,pleural effusion,pericar-dial effusion and treatments were observed. 3. to collect informa-tion with the four diagnostic methods in patients with primary lung cancer, based on the clinical questionnaire. Clinical manifesta-tions of heat syndrome collecting from national and scholar standards were heat syndrome criterion indicator.According to heat syndrome group and non-heat syndrome group of syndrome frequencies, using chi square test removed the similar indexes between the two groups. Study indexes were valued by conditio-nal probability.Diagnositic Scores Table was established by using the maximum likelihood methods. The grading standards was established by using four points method. The cluster analysis was used to study the classifi-cation diagnosis model with heat syndrome initially.4.54 patients with the rest of 270 patients were diagnosed with lung cancer heat syndrome criterion developed in this study and "clinic terminology of traditional chinese medical diagnosis and treatment-syndromes". It was used for quantitative diagnostic criteria of the prospective inspection by count sensitivity, specificity accuracy and likeli-hood ratio. At the same time,216 patients were retrospectively test. In order to determine the final quantified diagnosis criterion.The second past:1. By using the method of integrated retrieval,we use "primary lung cancer", "lung cancer", "syndrome differentia-tion", "trad-itional chinese" to search these articles relate to the syndrome differentia-tion of lung cancer in China National Knowledge Infrastructure, China Biology Medicine disc, Chinese scientific journal database.2. According to the search terms, I use excel to record cards, the source of differentitation strandard and the type of heat syndrome from 36 articles to establish the literature database of lung heat syndrome. By the way of literature research,I analysis the heat syndrome oflung cancer.3.122 heat syndrome cases from 270 lung cancer cases were discriminated using the heat syndrome diagnosis to record the type of heat syndrome. I establish the system of hierarchical diagnosis for primary lung cancer heat syndrome initially by combining literature to clinical. Conclusion:The first past:1. These factors including smoking, eating spicy and greasy foods,radiothe-rapy, targeted therapy didn’t generate heat syndrome, heat syndrome had no sig-nificant effect on the patients’gender,age,TNM stage,pathologocal types, pri-mary site,metastases, pleural effusion and pericardial effusion.2. Through the statistical analysis, we established the classing and quan-tizing diagnostic criteria on intermediate and advanced stage primarily lung cancer heat syndrome as follow:red tongue(23), rapid pulse(19),preference for cool (17), heat (15), deep-colored urine (12), ye How fur (11), slippery pulse(9), halitosis (8),red complexion (7), feverish sensation over five centers (7), swell-ing and pain in throat(7),oral ulcer and tongue sores(7), swelling and aching of gum(6), hemoptysis(6), yellow phlegm(4), insomnia(4),dry mouth(4),dry throat (4), dysphoria(3), irascibility (3), bitter taste in mouth(3), dry eye (3), cons-tipation (3); If a lung cancer patient’s heat syndrome invovled the syndromes above, and their numerical value larger than 60,he can be diagnosed as lung cancer heat syndrome. If their numeri- cal value adds up to 60-91,he can be diagnosed as slight heat syndro- me; if he got 91-106,he can be diagnos-ed as midrange heat syndrome; if his numerical value larger than 121,he can be diag-nosed as serious heat syndrome.3. The retrospective study shown the results of test about the classing and quantizing diagnostic criteria:sensitivity 96.97%,specificity 93.16%,accuracy rating 94.91%,masculine likelihood ratio 10.15, Negative likelihood ratio 3.25%. The perspective study shown the results of test about the classing and quanti-zing diagnostic criteria:sensitivity 95.65%,specificity 93.55%,accuracy rating 94.44%,masculine likelihood ratio 8.16, Negative likelihood ratio 4.65%. This topic carry out retrospective and prospective study by clinical epidemio-logy diagnostic test method, which confirm the sensitivity,specificity, accuracy rating,masculine likelihood ratio of the degree-classify criterion. At the same time,the negative likelihood ratio was very low. Therefore, it is a fine crite-rion by statistics.4. If a heat syndrome patient had hemoptysis,yellow phlegm, dry throatand swelling and pain in throat,he could been diagnosed as syndrome of lung excessive heat. If he had oral ulcer and tongue sores, insomnia, he could been diagnosed as syndrome of heart excessive heat. If he had swelling and aching of gum,bitter taste in mouth,halitosis, he could been diagnosed as syndrome of stomach excessive heat. If he had dysphoria,irascibility, red complexion, he could been diagnosed as syndrome of liver excessive heat. If he had dry mouth, preference for cool,red tongue, yellow fur, rapid pulse, heat, slippery pulse, deep-colored urine, constipation, he could been diagnosed as syndrome of excessive heat.The second past:1.There are 24 types of heat syndrome in literature research and 22 types of heat syndrome in clinical study both total of 25 kinds of syndromes.2.The first grade is heat syndrome. The second grade is excess heat syndro-me and deficiency heat syndrome. The third grade are Yin deficiency heat synd-rome, phlegm heat syndrome,heat syndrome, damp heat,toxic heat, blood heat synd-rome, blood stasisheat syndrome and wind heat syndrome. The fourth grade are Yin deficiency heat syndrome syndrome of yin deficiency due to heart heat, yin deficiency due to stomach heat,yin deficiency due to stomach heat,y4n deficiency due to lung heat, yin deficiency due to kidney heat, syndrome of phl-egmheat obstructing lung,syndrome of exuberance of heart fire, syndrome of exuberance of stomach fire, syndrome of exuberance ofliver fire, syndrome of exuberance of lung heat,dampness-heat of bladder, dampness-heat of liver and gallbladder, dampness-heat of large intestine, dampness-heat stagnating in spleen, syndrome of dampness-heat in uterus,dampness-heat stagnating in heart, dampness heat stagnating in waist.