The Distribution Of Systemic Inflammation In Patients With Primary Lung Cancer And Its Correlation With TCM Syndromes

Background:Inflammation is the local reaction to defense under the effect of inflammatory factors.The basic pathological progress includes metamorphic,oozy and hyperplasia.It's in the innate immune response stage.Inflammation can have both local and systemic manifestions.Locally there are red,swelling,heat pain and functional.disorders.Systemically there are heat,elevated white blood cell count,hyperplasia and function enhancement of mononuclear-macrophage system.Tumor is considered to be related to inflammation.In 1800,Galenus came up with the idea that tumor could be produced under the effect of inflammation.In 1863,Virchow noticed that there were lots of white blood cells around the tumor tissue,and verified the hypothesis of Galenus.Recently inflammation has attracted the attention of many scholars as the seventh hallmark of cancer.Cancer related inflammation also manefests in changed related biomarkers besides local microenvironment changes.Both clinical and basic experiments indicate that inflammation is closely related to the occurrence and development of lung cancer and can be used to guide clinical practice.And a number of previous studies have also shown that traditional Chinese medicine which is based on syndrome differentiation can effectively release the symptoms of cancer patients and prolongs their overall survival time.Based on the relationship between inflammation and the prognosis and symptoms of the patients with lung cancer,together with the efficacy and intervention concept of TCM treatment for cancer patients,we assume that "Chinese medicine treats tumor by changing the chronic inflammatory state induced by the tumor".Objective:To explore the distribution of the common inflammatory markers and their relationship with syndrome differentiation of traditional Chinese medicine,aiming to give guidance to Chinese medical practice such as clinical syndrome differentiation and drug usage.Methods:We conducted a cross-sectional study in 172 patients who had been diagnosed as primary lung cancer but had not reveived any treatment or those who had undergone west medicine treatment(more than 30 days after treatment,more than 21 days after chemotherapy,or more than 45 days after radiotherapy).Results:(?)The inclusion situation and the distribution of systemic inflammatory makers:(1)172 patients has been enrolled,of which 32 cases are with squamous cell carcinoma,106 cases adenocarcinoma,36 cases small cell lung cancer.The average age of all the pateints is 60 years old.Except for Monoclear Cell(MONO)and Eosinophilic Granulocyte,3%?88%of the patients had anomaly indexes.(2)?Smoking,disease history related to Chronic ObstructivePulmonary Diseases(COPD).glass shadow,pleural effusion,and atelectasis can have a significant influence on many systemic inflammation related indexes.The changes all indicate high inflammatory state.Compared with peripheral lung cancer,the change of indicators indicates a high inflammatory state in central lung cancer.?EGFR mutation affects multiple systemic inflammatory indexes,and the changes of indicators all point to low inflammatory state.?Using statin drugs,two indicators which were BASO%and hMONO were on the high side,and those with advanced lung cancer were higher in EO%and PLR,but lower in LYMPH and LMR.?Diabetes does not affect the distribution of each index.(?)Correlation analysis of systemic inflammation index and TCM syndrome:(1)Cold syndrome,compared with heat syndrome,only EO%is different.EO%of heat syndrome is higher than cold syndrome;the diagnosis of heat syndrome with EO%? 1.65%can be considered.(2)Compared with the Shi syndrome,the distribution of ALB and ALI in Xu symdrome is lower.The Xu syndrome can be diagnosed by ALB<37.4g/L.ALI<21.09.(3),Between Qi deficiency syndrome and non-Qi-deficiency syndrome.CRP,ALB and ANPG distribution are different.CRP and ANPG are higher.ALB is lower in Qi deficiency syndrome;CRP>3.48mg/L,ALB<35.80mg/L can be considered to diagnose Qi deficiency syndrome.?Many systemic inflanmmatory indexes were significantly different from those of the non-Yin-deficiency syndrome.The changes of the indexes all pointed to high inflammatory state;NEUT%>70.85%.GPS ? 1,mGPS>1.LYMPH%<23.55%,ALB<38.9g/L,LMR<3.26 were considered for the diagnosis of yin deficiency syndrome.When analyzed excluding the effect of pneumonia and COPD related medical history,we still got similar result.?Many systemic inflammatory indexes in phlegm dampness syndrome were significantly different from those of non-phlegm dampness syndrome.The index changes pointed to high inflammatory state(but the level of each index was lower than that of yin deficiency syndrome),and CRP>1.035mg/L and ANPG =3 were considered to diagnose phlegm dampness syndrome.When analyzed excluding the effect of pneumonia and COPD related medical history,only differences in EO and EO%could be seen(P<0.05).?Compared with the non-blood stasis syndrome,the distribution of many systemic inflammatory indexes in patients with blood stasis syndrome was different.Except for BASO%.the changes of the other indexes all pointed to low inflammatory state,and BASO%>0.55%.ALI>34.82;WBC<6.73 x 109/L,MONO<0.47 x 109/L,NEUT<4.88x 109/L,mGPS<lpoints were considered as the diagnosis of blood stasis syndrome.When analyzed excluding the effect of pneumonia and COPD related medical history,only differences in WBC and LYMPH%could be seen(P<0.05).?There is only difference in the distribution of EO%between those with heat toxin and those with non heat toxin.The EO%of heat toxin is greater than that of non-heat toxin.EO%>1.65%can be considered as the diagnostic value of heat toxin.Conclusion:1.The level of lymphocyte and lymphocyte ratio are usually low with high inflammatory state.2.Smoking,COPD related history,glass shadow,chest water,atelectasis,and lung cancer(central type)add to the risk of high in inflammatory state,and the inflammatory state of EGFR positive ones was low.3.All kinds of syndrome have relatively sensitive systemic inflammatory index.The inflammatory state of the patients with Yin deficiency syndrome.