宫颈上皮内瘤变中医证候分布规律初探

【作者】 韩倩娟；

【导师】 程慕溪；

【作者基本信息】 北京中医药大学 ， 中西医结合妇科学， 2011， 硕士

【摘要】 宫颈上皮内瘤变(cervical intraepithelial neoplasia, CIN)是与宫颈浸润癌密切相关的一组癌前病变,它反映了宫颈癌发生发展变化的全过程。随着宫颈细胞学监测的推广和开展,临床上CIN的发病率日益增多。CIN包括非典型增生和原位癌,通常分为3个级别：CINⅠ级一般指轻度不典型增生；CINⅡ级指中度不典型增生；CINⅢ级指重度不典型增生和原位癌。CIN临床表现无特异性,主要症状、体征不明显。由CIN发展成宫颈癌是一个较为长时间的过程,一般需要10年左右的时间。其转归包括消退或逆转、持续存在、癌变。目前西医治疗包括随访、药物治疗、物理治疗与手术治疗。通过查阅文献,结合各版教材,不难发现临床对于CIN的中医证治分型并无统一的标准。而中医中药在改善患者症状、体征方面,在延缓病程进展方面起到了不可忽视的作用。本研究对门诊及住院部的120例CIN患者的病例资料进行了调查研究。目的：旨在通过研究了解其发病的危险因素,探讨CIN中医证候分布规律,为临床辨证治疗提供准确的依据,为早期预防提供有益的指导。方法：建立CIN患者一般情况、症状及证型的数据库,运用描述性统计方法对CIN危险因素及中医证候的分布规律进行初步研究。结论：经统计分析发现,(1)本次调查的CIN患者20岁以下无发病,年龄多集中在26～30岁之间。90%以上的患者初次性交年龄集中在16～25岁。88.3%的患者有妊娠史,妊娠>3次者占34.2%；78.3%的患者有人流史,人流>3次的占10%。阴道分娩者占46.7%。91.7%的患者均采取避孕措施,不避孕者仅10人；无性防护者占64.2%。65%的人有工作单位,69.2%的人接受过较高等教育。(2)CIN证型中,湿热内蕴45例,占37.5%；肾虚失固40例,占33.3%,其中肾阴虚15例(12.5%)、肾阳虚25例(20.8%)；脾虚生湿27例,占22.5%；湿毒瘀结8例,占6.7%。CINⅠ以湿热内蕴型为主,占41.1%(23例),脾虚生湿型次之,占28.6%(16例)；CINⅠ-Ⅱ以肾虚失固型为主,占43.5%(10例),湿热内蕴型次之,占30.4%(7例)；CINⅡ亦以肾虚失固型为主,占53.9%(7例),湿热内蕴型次之,占23.1%(3例)；CINⅡ-Ⅲ湿热内蕴型占37.5%(9例),肾虚失固型占33.4%(8例),两型仅差1例；CINⅢ患者全部为湿热内蕴型,共4例。表明CIN以正虚为本,以湿邪、热毒、血瘀为标,正虚邪实,湿邪为主要病理因素；病变涉及肝、脾、肾三脏；血瘀寓于本病发病的过程。更多还原

【Abstract】 Cervical intraepithelial neoplasia (CIN) is a group of precancerous lesions which is closel yrelated with invasive cervicalcancer. It reflects the entire development process of cervical carcinoma. With the promotion of cervical cytology and to carry out monitoring,the incidence of CIN in clinical is increasing.CIN,which includes atypical hyperplasia and carcinoma in situ, is usually divided into three levels:CIN I level generally refers to mild dysplasia; CIN II level refers to moderate dysplasia; CIN III level refers to severe dysplasia and in situ cancer. CIN has no specific clinical features, and the main symptoms and signs is not obvious.It is a relatively lengthy process from CIN to cervical cancer,which normally takes about 10 years.It contains subside or reverse the outcome, maintenance, and cancer transplantation. At present,the western medicine treatment includes follow-up, medication, physical therapy and surgery. According to literatures and textbooks,it is not difficult to find that the Traditional Chinese Medicine treatment for CIN has no uniform standard type. However, the traditional Chinese medicine plays a vital role in improving symptoms and signs and slowing the progress of the cancer transplantation.In this study,the clinical data of 120 patients with CIN from outpatient and inpatient departments was investigated.Objective:To understand the risk factors and the distribution of the TCM syndrome of CIN,the study provide accurate basis for clinical differential therapy and useful guidance for the early prevention study.Methods:Establish the database of the general condition, symptoms and syndromes of the CIN patients, and then study the risk factors and distribution of syndromes using descriptive statistics.Conclusion:It can be indicated from the statistical analysis:(1)the investigation of the CIN patients 20 years of age without the disease, mosetly in the age of 26 to 30 years old.The majority (above 90%)concentrated in the age of first sexual intercourse 16 to 25 years old. 88.3% of patients with a history of pregnancy, pregnancy more than 3 times accounted for 34.2%;78.3% of patients had poured history, poured more than 3 times of 10%.46.7% of patients with vaginal delivery means delivery.91.7% of patients were taking contraceptive measures, no contraception is only 10.Patients in asexual protection measures accounted for 64.2% of all patients.65% of them have work units.69.2% of people received a relatively higher education.(2)In the all CIN syndrome types,45 patients were intrinsic accumulation of dampness heat as the main performance,which accounts for 37.5%.40 patients of the kidney insufficiency,which Lose the role of solid perturbation, accounting for 33.3%;Among them,15 patients were the kidney yin insufficiency as the main performance,which accounts for 12.5%; 25 patients were the kidney yang insufficiency as the main performance, which accounts for 20.8%.27 patients of the spleen insufficiency which can generate wet, accounting for 22.5%.8 patients of Wet poison stasis knot, accounting for 6.7%.23 cases of patients with CIN I mainly manifests intrinsic accumulation of dampness heat, accounting for 41.1%.16 cases of the spleen insufficiency patients followed, accounting for 28.6%.10 cases of patients with CINⅠ-Ⅱmainly manifests the kidney insufficiency, accounting for 43.5%.7 cases of the hot and humid type patients followed, accounting for 30.4%.7 cases of patients with CIN II also mainly manifests the kidney insufficiency, accounting for 53.9%.3 cases of the hot and humid type patients followed, accounting for 23.1%.9 cases of patients with CINⅡ-Ⅲmainly manifests intrinsic accumulation of dampness heat,accounting for 37.5%.8 cases of patients with CIN II mainly manifests the kidney insufficiency, accounting for 33.4%.The difference between the two types is only 1 patient.4 patients of CIN III all manifest intrinsic accumulation of dampness heat. It can be showed that the essence of CIN is weak bodies,which mixed with evil,such as:dampness,heat-toxin,blood stasis,etc.It also can be concluded that CIN lesions take dampness xie as the main pathologic factors, involving the liver, spleen, and kidney three viscera.It can be found that blood stasis may occur during the development process of the disease.更多还原