目的:探讨中晚期原发性支气管肺癌患者舌苔脱落细胞的化学指标与中医证型和病理分型之间的关系,为中医肺癌的舌诊客观化研究提供参考依据。方法:选取2020年8月-2021年8月来河北省第四医院肿瘤内科及呼吸内科住院的152例中晚期原发性支气管肺癌患者,另选取45例正常舌象健康者为健康对照组。按肺癌的国际病理分类标准进行分型,中医辨证标准分为四个证型:气虚痰湿、气血瘀滞、阴虚热毒、气阴两虚,检测152位肺癌患者及45例健康对照组舌苔脱落细胞的化学指标琥珀酸脱氢酶(SDH)、乳酸脱氢酶(LDH) 、巯基(-SH)的含量及酸性磷酸酶(ACP)的活性,将结果进行比较。结果:健康对照组多见淡红舌薄白苔,占82.22 %;气虚痰湿证中晚期肺癌患者多见淡胖舌、白腻苔,占84.85 %;阴虚热毒证中晚期肺癌患者多以红绛舌、少苔为主,占69.77 %;气阴两虚证中晚期肺癌患者多以淡胖舌、薄白苔,且伴有齿痕为主,占82.93 %;气血瘀滞证中晚期肺癌患者多以紫暗舌、薄白苔为主,占88.57 %。病理分型鳞癌中以气虚痰湿型为主,占35.09 %;腺癌中以阴虚热毒型为主,占58.14 %;大细胞癌和小细胞癌以气血瘀滞型为主,占57.89 %;肺泡癌以气阴两虚型为主,占67.65 %。阴虚热毒组-SH含量较健康对照组高,LDH、SDH、ACP活性也较正常组高;气阴两虚组-SH含量及SDH、LDH 的活性明显低于健康对照组(P＜0.01),气虚痰湿组ACP含量明显降低(P＜0.01)。腺癌组-SH含量较正常组显著增高,LDH、SDH、ACP活性也较正常组显著升高(P＜0.01);大细胞癌和小细胞癌组LDH、SDH 、ACP活性较正常组下降最为明显(P＜0.01);鳞癌组-SH含量较正常组降低最为明显。结论:舌苔脱落细胞的化学指标与肺癌不同证型及病理学分期有一定的相关性,可作为判断中晚期肺癌中医证型、病理分型的辅助依据,同时为舌诊客观化研究提供依据。

Objective: To investigate the relationship between chemical indexes of exfoliated cells of tongue coating and TCM syndromes and pathological stages in patients with middle or advanced primary bronchial lung cancer and to provide objective basis for TCM syndrome differentiation. Methods: Chemical indexes of SDH, LDH, Mercapto (-SH) and acid phosphatase (ACP) of tongue coating cells were measured in 152 patients with advanced lung cancer. According to the TCM standard, 152 patients were divided into four types of syndromes, which are qi deficiency and phlegm dampness, qi and blood stagnation,yin deficiency and heat toxicity,and deficiency of qi and yin. Results: The pale red tongue with white thin coating was mostly found in the normal group, which accounts for 82.22 %. The pale fat tongue with white and greasy coating was mostly found in the syndrome of qi deficiency and phlegm dampness, which accounts for 84.85 %. The red tongue with little coating was mostly seen in patients with the syndrome of yin deficiency and heat toxicity, which accounts for 69.77 %. The pale fat tongue with teeth marks and thin coating was mostly found in the syndrome of deficiency of both qi and yin, which accounts for 82.93 %; The purple and dark tongue was mostly found in patients with the syndrome of qi and blood stasis, which accounts for 88.57 %. Syndrome of Qi deficiency and phlegm dampness was mostly found in the lung squamous carcinoma group, which accounts for 35.09 %. Syndrome of yin deficiency and heat toxicity was mostly found in the lung adenocarcinoma group, which accounts for 58.14 %. Syndrome of Qi and blood stagnation was mostly found in the large or small cell lung cancer group, which accounts for 57.89.09 %. Syndrome with deficiency of both qi and yin was mostly found in the alveolar carcinoma group, which accounts for 67.65 %. Content of -SH and activities of LDH, SDH in the qi-yin deficiency group was lower than that in the healthy control group(P<0.01), and activity of ACP in the qi-deficiency and phlegm-dampness group were significantly lowered (P<0.01). The content of -SH in the adenocarcinoma group was significantly higher than that in the normal group, and the activities of LDH, SDH and ACP were significantly higher than that in the normal group (P<0.01). The activities of LDH, SDH and ACP in the large and small cell carcinoma groups were significantly decreased compared with those in normal group (P<0.01). The -SH content in the squamous cell carcinoma group was mostly decreased and lower than that in the normal group. Conclusion: The chemical indexes of tongue coating exfoliated cells could be used to distinguish different TCM syndromes of middle and advanced lung cancer, which could be served as the objective basis for tongue diagnosis in TCM.