| ObjectiveTo establish a hierarchical and quantitative diagnostic criteria of deficiency syndrome for primary bronchial lung cancer.MethodAccording to the characteristics and clinical manifestations of lung cancer, as well as information from the TCM diagnostic methods in Diagnostics of TCM, we tried to bring in all related diagnostic items and instituted clinical observing table. Patients were selected according to the inclusion criteria and exclusion criteria. Making sure to fill in the clinical observing table truly and objectively and inputting data with Epidata 3.1.Analyzing with SPSS20.0 and Excel, Chi square test and rank sum test were used to analyze the differences of gender, age, primary site, pathological type, clinical stage and KPS of deficiency syndrome.Selecting diagnostic items of deficiency syndrome from national standard and TCM books, using Chi square test, OR value and 95% confidence interval to get the final diagnostic items. Items were valued by conditional probability. Diagnostic threshold was established by using maximum likelihood methods. The grading standards were established by using four points methods. Finally, the items were layered according to the basic theory of TCM and clinical experience.Results1.Deficiency of qi1.1 This study included 226 patients of qi deficiency and 219 patients without it, account for 50.8% and 49.2% separately. There was no statistical difference in gender, age, primary site, pathological type, clinical stage between the two groups, but KPS was different, in general, KPS of patients in qi deficiency group were lower.1.2 After statistical analysis, we established the quantitative and classification diagnostic criteria of qi deficiency syndrome for lung cancer as follows:fatigue (22), shortness of breath (11), pulse feeble (11), lazy to talk (8), low voice (7), chest tightness (7), abdominal distention (7), sighing (7), amnesia (6), asthma (6), soreness and debility of waist (6), palpitations (5), bloating (5), god exhausted (4), insomnia (4), tooth-marked tongue (4), fullness in stomach (4), anorexia (3), stringy-tready pulse (3), tinnitus (3), urinary frequent (3), dreaminess (2).The diagnostic threshold of qi deficiency syndrome was 41 points, and 41 points to 51 points were divided into mild qi deficiency,51-74 points were divided into moderate qi deficiency,74 points or above were severe qi deficiency.1.3 Establishment of hierarchical diagnostic criteria for qi deficiency syndrome:god exhausted, fatigue, shortness of breath, lazy to talk and pulse feeble were qualitative symptoms for qi deficiency; asthma and low voice were localizing symptoms for lung qi deficiency; palpitations, chest tightness, insomnia, dreaminess and amnesia were localizing symptoms for heart qi deficiency; anorexia, abdominal distention and tooth-marked tongue were localizing symptoms for spleen qi deficiency; fullness in stomach and bloating were localizing symptoms for stomach qi deficiency; sighing and stringy-tready pulse were localizing symptoms for liver qi deficiency; soreness and debility of waist, tinnitus and urinary frequent were localizing symptoms for kidney qi deficiency.2.Deficiency of yin2.1 This study included 127 patients of yin deficiency and 318 patients without it, account for 28.5%and 71.5% separately. There was no statistical difference in age, primary site, pathological type, clinical stage and KPS between the two groups, but the difference between gender was statistically significant, in general, the ratio of male of yin deficiency syndrome was higher than that of female.2.2 Quantitative and classification diagnostic criteria of yin deficiency syndrome: feverish sensation of five centers (16), night sweat (16), dry pharynx (9), dry mouth (8), palpitations (6), hoarseness (5), less fur (5), dry lips (5), dry stool (5), red tongue (4), sticky sputum (3), insomnia (3), dreaminess (3), anorexia (2),dry eyes (2), tinnitus (2).The diagnostic threshold of yin deficiency syndrome was 25 points, and 25 points to 35 points were divided into mild yin deficiency,35-55 points were divided into moderate yin deficiency, 55 points or above were severe yin deficiency.2.3 Establishment of hierarchical diagnostic criteria for yin deficiency syndrome: feverish sensation of five centers, dry pharynx, dry mouth, red tongue, less fur and night sweat were qualitative symptoms for yin deficiency syndrome; sticky sputum and hoarseness were localizing symptoms for lung yin deficiency; palpitations, insomnia, dreaminess were localizing symptoms for heart yin deficiency; anorexia, dry lips and dry stool were localizing symptoms for spleen yin deficiency; dry eyes was localizing symptom for liver yin deficiency; tinnitus was localizing symptom for kidney yin deficiency.3.Deficiency of blood3.1 This study included 59 patients of blood deficiency and 386 patients without it, account for 13.3% and 86.7% separately. There was no statistical difference in age, primary site, pathological type and clinical stage between the two groups, but the difference between gender and KPS were statistically significant, in general, the ratio of male of yin deficiency syndrome was higher than that of female. KPS of patients in blood deficiency group was lower.3.2 Quantitative and classification diagnostic criteria of blood deficiency syndrome: spasm of muscles and vessels (15), fine pulse (13), dizziness and giddiness (11), pale lips (11), pale complexion (7), sallow complexion (6), stringy-tready pulse (6), feeble pulse (5), palpitations (5), amnesia (5), dreaminess (4), insomnia (5), blurred vision (4), pale tongue (3). The diagnostic threshold of blood deficiency syndrome was 34 points, and 34 points to 42 points were divided into mild blood deficiency,42-61 points were divided into moderate blood deficiency,61 points or above were severe blood deficiency.3.3 Establishment of hierarchical diagnostic criteria for blood deficiency syndrome:pale complexion, sallow complexion, dizziness and giddiness, pale lips, pale tongue, fine pulse and feeble pulse were qualitative symptoms for blood deficiency syndrome; palpitations, amnesia, dreaminess, insomnia were localizing symptoms for heart blood deficiency; blurred vision, spasm of muscles and vessels and stringy-tready pulse were localizing symptoms for liver blood deficiency.4.Deficiency of yang4.1 This study included 143 patients of yang deficiency and 302 patients without it, account for 32.1% and 67.9% separately. There was no statistical difference in gender, age, primary site, pathological type and clinical stage between the two groups, but the difference between KPS was statistically significant, in general, KPS of patients in yang deficiency group was lower than that of non-yang deficiency group.4.2 Quantitative and classification diagnostic criteria of yang deficiency syndrome: lassitude (14), systemic or local aversion to cold (13), listlessness (13), cold limbs (11), coldness and soreness of waist and knees (8), asthma (6), tightness or ache in chest and heart (6), abdominal distention (6), blurred vision (6), weak pulse (5), urinary frequency at night (5), inability to taste food (4), tooth-marked tongue (3). The diagnostic threshold of yang deficiency syndrome was 32 points, and 32 points to 38 points were divided into mild yang deficiency,38-63 points were divided into moderate yang deficiency,63 points or above were severe yang deficiency.4.3 Establishment of hierarchical diagnostic criteria for yang deficiency syndrome: systemic or local aversion to cold, cold limbs, listlessness, lassitude and weak pulse were qualitative symptoms for yang deficiency syndrome; asthma was localizing symptom for lung yang deficiency; tightness or ache in chest and heart was localizing symptom for heart yang deficiency; inability to taste food, abdominal distention and tooth-marked tongue were localizing symptoms for spleen yang deficiency; blurred vision was localizing symptom for liver yang deficiency; coldness and soreness of waist and knees and urinary frequency at night were localizing symptoms for kidney yang deficiency.Conclusion1. This study based on syndrome elements and put forward the model of hierarchical diagnosis, which could make complicated syndrome organized, simplified and standardized. This model had good feasibility and practical value and it provided a methodological reference for future study of other diagnostic criteria.2. This study used scientific methods to establish a hierarchical and quantitative diagnostic criteria of deficiency syndrome for primary bronchial lung cancer initially, and the results were objective and true. They could be used for clinical differentiation, herbal prescription and therapeutic evaluation. |
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