【作者】 林韵如；

【导师】 章永红；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2013， 博士

【摘要】 目的：乳腺癌为女性最常见的恶性肿瘤之一,发病率越占全身各种恶性肿瘤的7%-10%。发病率较高的是绝经期前后的妇女。通过对台湾省地区几间医院女性患者进行乳腺癌与中医体质和证型类型分布规律方面和受体(ER,PR,HER-2三大受体是阳性还是阴性)情况调查研究,初步探讨乳腺癌的患病中医体质和证型类型分布特点；二是探明乳腺癌体质与受体情况的相关性。方法：调查对象：本次调查以台湾地区收集首次病理诊断为乳腺癌患者问卷,以及就诊于台北医院的门诊及住院部乳腺癌病例和癌友新生命协会乳腺癌病例。调查内容：1、使用王琦教授创制的中医体质量表为基础,制订了《中医体质及健康状况自填式问卷》(以下简称《问卷表》)。中医体质分型是以王琦教授体质分类为标准,体质类型分为九大型,即：平和质、气虚质、阳虚质、阴虚质、瘀血质、痰湿质、湿热质、气郁质、特禀质等。2、目前依照较有权威性的乳腺癌中医证候分类和预后因素的相关性的研究为国家中医药管理局制定的分型标准。《中医病症疗效标准》是国家中医药管理局颁布zY/T001.2—94将乳腺癌分成3型：肝郁痰凝、冲任失调、正虚毒炽,此即是本次研究乳腺癌辨证分型的依据。3、使用免疫组化(HC)检测乳腺癌受体ER、PR、Her-2。研究相关参数：发病年龄、月经状态、肿瘤大小、淋巴结转移状态、临床病理类型、临床分期同ER、PR、Her-2的相关性。实施方法：本研究是有效取得适合本研究研究范围之对象,因此采取便利抽样本。而是对门诊及住院、癌友协会临床诊断为乳腺癌患者发放《问卷表》,并请患者当场收回信息采集由门诊及住院、癌友协会专业医师负责,相关信息输入并存放在体检中心电脑系统。收集病例共100例,使用流行病学病例分析。运用计数资料经卡方检验,P>0.05,并提示无显着性差异,具有可比性。采用SPSS17.0统计软件,统计学方法对计数资料进行秩和检验、卡方检验,对多变量数据进行Logistic回归分析等。结果：1、台湾地区100例乳腺癌患者中医体质分布由多到少依次为：气郁质(20%),阴虚质(16%),阳虚质(15%),气虚质(14%),血瘀质(12%),平和质(10%),痰湿质(5%),湿热质(4%),特禀质(4%)。体质与年龄、激素受体表达之间无明显相关性(P<0.05)。2、台湾地区100例乳腺癌患者中医证型类型分布由多到少依次为：100例中,肝郁痰凝型为35例,占35%；冲任失调型为53例,占53%；正虚毒炽型为12例,占12%。3、台湾地区乳腺癌患者中医体质与受体ER、PR、Her-2受体表达情况进行统计学分析,100例患者中,患者的体质类型与ER、PR受体表达情况进行统计学分析,结果显示,P>0.05,提示各体质类型与ER、PR受体之间无明显统计学差异。体质类型与Her-2受体表达情况进行统计学分析,结果显示,Her-2阳性表达率与乳腺癌实证型体质要素无明显相关性,与虚证型体质要素具有相关性,阳虚、气虚患者Her-2阳性表达率高,提示应于益气温阳药物可改善患者预后。4、台湾地区乳腺癌患者中医证型类型,与受体ER、PR、Her-2受体表达情况进行统计学分析,肝郁痰凝型阳性率与正虚毒炽型比较,而差异无显着性(P=0.074)；肝郁痰凝型ER阳性率与冲任失调型比较,而差异有显着性(P=0.022)。各证型PR、Her-2阳性率比较,而差异无显着性。乳腺癌早期多是肝郁痰凝型,后期以正虚毒炽型为主。肝郁痰凝型表达水平高于冲任失调型,而PR、Her-2的表达与中医证型皆无明显相关性。5、台湾地区三阴性乳腺癌患者中医体质分布为：平和质0例、气虚质4例、阳虚质2例、阴虚质1例、血瘀质2例、痰湿质3例、湿热质1例、气郁质6例、特禀质2例。6、台湾地区三阴性乳腺癌患者中医证型类型在早、中期以肝郁痰凝证和冲任失调证为主,在晚期以正虚毒炽证为主；冲任失证预后不良的组织学类型比例高于其它证型；正虚毒炽证预后不良的临床病理指标多于其它证型,提示正虚毒炽证患者病情较重,预后可能要比其它证型差,三组证型预后的比较需要通过对患者有长期随访才能判断。结论：本文通过对100例台湾地区乳腺癌患者问卷调查,初步探讨乳腺癌的患病中医体质和证型类型分布特点；二是探明乳腺癌体质和证型与受体(ER、PR、Her-2)情况的相关性。本研究得出以下结论：1.台湾地区乳腺癌患者中医体质分布集中在气郁质、阴虚质、阳虚质、气虚质、血瘀质。2.台湾地区乳腺癌患者中医证型类型分布集中在冲任失调证和肝郁痰凝证。3.台湾地区乳腺癌患者中医体质与受体ER、PR受体表达情况进行统计学分析,结果显示,P>0.05,提示体质类型与ER、PR受体无明显统计学差异。体质类型与Her-2受体表达情况进行统计学分析,结果显示,Her-2阳性表达率与乳腺癌实证型体质要素无明显相关性,与虚证型体质要素具有相关性,阳虚、气虚患者Her-2阳性表达率高,提示应予以益气温阳药物可改善患者预后。4.台湾地区乳腺癌患者中医证型类型,与受体ER、PR受体表达情况进行统计学分析,结果显示,P>0.05,提示无明显统计学差异。证型与Her-2,冲任失调证的Her-2蛋白的表达明显高于其它两组,统计学分析,有显着性差异。5.台湾地区三阴性乳腺癌患者中医体质分布集中在气郁质、阴虚质、阳虚质、气虚质、血瘀质、痰湿质。6.台湾地区三阴性乳腺癌患者中医证型类型分布集中在早、中期以肝郁痰凝证和冲任失调证为主,在晚期以正虚毒炽证为主。更多还原

【Abstract】 Objective:Breast cancer one of the most common malignancy in women, the incidence of the more accounted for7%to10%of the systemic variety of malignant tumors. The higher incidence of premenopausal and postmenopausal women [1]. Preliminary study of breast distribution pattern of breast cancer with traditional Chinese medicine constitution and syndromes type receptor (ER, PR, HER-2three receptor positive or negative) Survey Research, Taiwan Province, a few hospitals in female patients the prevalence of cancer TCM constitution and syndromes type distribution characteristics; proven breast cancer physique receptor status.Methods:This study is effective to obtain the object of the scope of research for this study, and therefore take the convenience sampling this. But outpatient and inpatient clinical diagnosis of cancer Society of Friends for patients with breast cancer issue questionnaire, and patients on the spot to recover the information collected by the outpatient and inpatient cancer Friends of professional physicians responsible, relevant information is entered and stored in the examination center computer systems. Collection cases for a total of100cases, the use of epidemiological case analysis.Using count data by the chi-square test, P>0.05, and prompted no significant difference comparable. SPSS17.0statistical software, statistical methods of count data rank sum test, chi-square test, and logistic regression analysis of multivariate data. Results:1,Distribution of TCM constitution of Taiwan,100breast cancer patients in order from largest to smallest:qi quality (20%), yin deficiency (16%) the yang quality (15%), Qi deficiency (14%), blood stasisquality (12%), peace and quality (10%), phlegm (5%), hot and humid quality (4%), special intrinsic quality.No significant correlation (P<0.05) between the constitution and age, hormone receptor expression.2, Taiwan,100patients with breast cancer TCM type distribution in order from largest to smallest:98cases, the liver depression Tanning type35cases,35%; Chong and Ren disorders type for52cases (52%);positive imaginary poison Chi type13cases (13%); dialectical two cases can not be accounted for2%. The difference was statistically significant between Syndromes and pathological staging. Taiwan receptor ER, PR and Her-2receptor expression in breast cancer patients with TCM constitution were statistically analyzed100patients, immunohistochemical examination of nine cases, the remaining91patientstypes of constitutions and ER, PR receptor expression statistical analysis, P>0.05, prompted the various physical types and ER, PR receptor was no statistically significant difference. Types of constitutions and the Her-2receptor expression statistical analysis of the results showed no significant correlation between elements of the Her-2positive expression rate of breast cancer evidence-type constitution, Yang and Qi Deficiency physical elements patients with Her-2positive expression rate, suggesting that should Yiqiwenyang drugs can improve the prognosis of patients.4, Taiwan breast TCM Syndrome type receptor ER, PR, Her-2receptor expression were analyzed statistically, the liver depression Tanning positive rate and positive imaginary poison Chi comparison, and the difference was not statisticallysignificant (P=0.074); liver depression Tanning ER-positive rate and Chong and Ren disorders, and the difference was statistically significant (P=0.022). Syndromes PR, Her-2positive rate comparison, and the difference was not significant. Early breast cancer is liver depression the Tanning-type, late positive imaginary poison Chi type. Liver depression the Tanning-type expression levels higher than Chong and Ren disorders and PR, Her-2’s expression TCM type had no significant correlation.5, the distribution of triple negative breast cancer patients in Taiwan TCM constitution:peaceful quality, four cases of qi deficiency, yang quality, yin deficiency, blood stasis quality two cases, three cases of phlegm, hot and humid and qualityl case, qi quality six cases, two cases of special intrinsic quality.6Taiwan triple negative breast cancer patients TCM type in the early, mid-the liver depression Tanning card and Chong and Ren disorders card mainly positive imaginary poison Chi certificate in advanced; Chong and Ren lost cards and poor prognosis organizationhistological type is higher than the other syndromes; positive imaginary poison Chi certificate clinicopathological parameters of poor prognosis than other patterns, suggesting that the positive imaginary poison Chi permit patients with severe illness, the prognosis may be better than the other syndromes, three sets of card typeprognosis by long-term follow-up in order to determine the patient.Conclusions:In this paper, a survey questionnaire of100cases of breast cancer patients in Taiwan, preliminary study of the prevalence of breast cancer TCM constitution and syndromes type distribution characteristics; proven breast cancer physique and card type receptor (ER, PR, Her-2) case correlation. In this study, the following conclusions:1. Taiwan physical distribution of breast cancer patients with TCM concentrated in the qi quality, yin deficiency, yang quality, Qi deficiency, blood stasis quality.2. Taiwan TCM type of breast cancer patients focused on the distribution of red of any imbalance cards and liver depression Tanning card.3. TCM constitution of the breast cancer patients in Taiwan with the receptor ER, PR receptor expression were analyzed statistically, P>0.05, prompt physical type of ER, PR receptor was no statistically significant difference.Types of constitutions and the Her-2 receptor expression statistical analysis of the results showed no significant correlation between elements of the Her-2positive expression rate of breast cancer evidence-type constitution, Yang and Qi Deficiency physical elementspatients with Her-2positive expression rate, the tips should be Yiqiwenyang drugs can improve the prognosis of patients.4. Taiwan breast TCM Syndrome Type and receptor ER, PR receptor expression were analyzed statistically, P>0.05, no significant statistical difference prompted. Syndromes and Her-2, Chong and Ren disorders permit the Her-2protein expression was significantly higher than the other two groups, statistical analysis, there are significant differences.5. Taiwan triple negative breast cancer patients TCM constitution centralized distribution qi quality, yin deficiency, yang quality, qi deficiency, blood stasis quality, phlegm.6. Taiwan triple negative breast cancer patients TCM type distribution is concentrated in the early and mid-term disorders card the liver depression Tanning card and Chong and Ren mainly in the late positive imaginary poison Chi certificate.更多还原