乳腺癌证候学特点研究

【作者】 李亚男；

【导师】 曹阳；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2009， 硕士

【摘要】 乳腺癌是女性最常见的恶性肿瘤之一,是各个国家共同关心的问题。就世界范围而言,其发病率呈上升趋势,它已成为世界上许多妇女的头号杀手。乳腺癌治疗包括手术、放疗、化疗、内分泌、生物治疗、中医药治疗等几种方式。本研究目的在应用中西医结合方式探讨乳腺癌的发病、进展及转归,将中医证候学要素与肿瘤标志物、受体、转移情况相结合,揭示其内在相关性,以指导治疗临床辨证治疗。目的:探索乳腺癌中医证候特点方法:采用回顾性研究方法,总结乳腺癌患者的证型分布特点,并归纳各证候要素与肿瘤标志物、受体、转移情况等各因素,对病例计数资料采用SPSS 15.0软件r×c x~2检验方法,从中发现乳腺癌中医证候要素与肿瘤标志物、受体、转移的相关性。研究结果:1、纳入病例多为应用多种治疗手段的中晚期女性乳腺癌患者,均表现为虚实夹杂的证候特点。实证以肝郁气滞、痰凝、血瘀证候为主。虚证以阳气虚证候为主。在阳气虚兼加证中以阳气虚+痰湿+血瘀证多见,其次分别为阳气虚+肝郁气滞+痰湿、阳气虚+肝郁气滞+血瘀、阳气虚+痰湿证。阴血虚兼加证中,以阴血虚+肝气郁滞、阴血虚+痰湿、阴血虚+血瘀证较多见。2、痰湿、血瘀证候要素易出现CA125、CA153升高趋势,其阳气虚与阴血虚证候要素与肿瘤标记物的异常升高无相关性。3、ER、PR的表达与肝郁气滞、痰湿、血瘀、阳气虚、阴血虚等各证候要素均无明显相关性。但分布比例上看阳气虚患者在ER、PR阳性表达率较阴血虚患者更高。4、痰湿、血瘀证候要素易出现腋窝淋巴结转移、肝转移、肺转移趋势;阳气虚证候易出现肝转移趋势;阳气虚与阴血虚证候与腋窝淋巴结、肺转移无相关性。5、各证候要素与骨转移无相关性。结论:(1)经过多种治疗手段的中晚期乳腺癌患者往往存在本虚标实的证候类型特点,各证候要素中虚证以阳气虚主,实证以肝郁气滞、痰湿、血瘀为主。(2)痰湿、血瘀证候要素影响CA125、CA153肿瘤标记物的表达。(3)ER、PR的表达与肝郁气滞、痰湿、血瘀、阳气虚、阴血虚等各证候要素均无明显相关性。但分布比例上看阳气虚患者在ER、PR阳性表达率较阴血虚患者更高。(4)痰湿、血瘀证候患者腋窝淋巴结转移、肝转移、肺转移的危险性更高,肝郁气滞证候患者转移危险性较低;阳气虚候肝转移危险性更高。更多还原

【Abstract】 Breast cancer is one of the most common malignant cancers of women,and is the international issue worldwide.Its incidence is rising,and has beco me the number one killer of women in many parts of the world.The treatment s of breast cancer include surgery,radiotherapy,chemotherapy,endocrine,b iological treatment,Chinese medicines and so on.The purpose of this study is to explore the incidence、the progress and outcome of breast cancer in t he method of Chinese and Western medicine.This study reveals the relationsh ip of Chinese medicine syndromes,tumor markers、receptors and the metastas is of breast cancer.It also provides a very good guider to the usage of Chi nese Medicine,to determine the efficacy and how to delay theprogress of th e cancer.Purpose:to study the characteristic of Chinese Medicine Sydromes in pa tients suffing from breast cancer.Methods:This study retrospectively analyzed syndrome type distribution of the breast cancer in patients(a total of 86 patients in this group) who are confirmed diagnosis,and summarized the relationship of Chinese Medicine syndromes,tumor markers,receptors and the metastasis of breast cancer.The factors were dated and were assessed by spss 15.0 software.(RXC) X~2 test was used to evaluate the relationship between them,so as to find the prevention and treatment methods of tumors rationally,meanwhile to improve the efficacy of clinical treatments.Results:1、The patients involved have received many medthods.The excess syndromes are mainly liver qi depression,static blood and phlegm.The deficiency syndrome is Yang qi deficiency,ln yang qi deficiency syndromes,static blood-phlegm syndrome is quite common,liver qi depression-phlegm syndrome and phlegm-dampness syndrome are sequent.In yin blood deficiency syndromes,liver qi depression is common,depression-phlegm and static blood syndromes are sequent.2、Patients with phlegm-dampness syndrome and static blood syndrome tendly have high CA125 and CA153,while yang qi deficiency and yin blood deficiency syndromes is irrelevant with the rising of tumor markers.3、ER and PR are irrelevant with liver qi depression,phlegm-dampness,blood stasis,Yang qi deficiency,yin blood deficiency syndromes.However,the distribution and the proportion of patients with Yang qi deficiency are higher than that in patients with yin blood deficiency in the ER,PR positive expression.4、Patients with phlegm-dampness and blood stasis syndromes have a higher rate with lymph node metastasis,liver metastasis and lung metastasis.Patients with yang qi deficiency syndrome tendly have a higher rate of liver of matastasis.Patients with yang qi deficiency syndrome and yin blood deficiency syndromes are irrelevant with lymph node metastasis and lung metastasis.Conclusion:1、The breast cancer patients who use a variety of treatment is often exist the characteristic of deficiency-excess complex syndrome.The main deficiency is the yang qi defiency.The main excess syndromes are liver qi depression, phlegm-dampness and blood stasis syndromes.2、phlegm-dampness syndrome and blood stasis syndrome effect CA125,CA153 tumor marker expression.3、ER,PR expression had no significant correlation with.the liver qi depression,phlegm-dampness,blood stasis,yang qi deficiency,yin blood deficiency Syndromes.4、The breast cancer patients with phlegm-dampness and blood stasis syndromes have a a higher positive rate with lymph node metastasis,liver metastasis and lung metastasis.Patients with liver qi depression,opposite.Patients with yang deficiency syndrome have a higher rate of liver of matastasis.更多还原