乳腺癌分子分型与中医分期辨证相关性研究

发布时间：2018-05-09 12:18

本文选题：乳腺癌 + 分子分型　；参考：《南京中医药大学》2017年博士论文

【摘要】：目的:探讨乳腺癌分子分型与不同中医分期辨证的相关性,为乳腺癌的临床中西医结合诊治、预后判断等提供新思路,以便能尽早应用中医药去干预与预防乳腺癌复发转移,同时,为建立完善、全面、规范化的乳腺癌中医辨证体系进行有益探索。方法:通过统一问卷式调查表,对2016年4月至12月在江苏省中医院乳腺外科、肿瘤内科与普内科、江苏省肿瘤医院及马鞍山市中医院南院治疗并符合纳入标准的乳腺癌患者(手术前62例,手术后62例、围化疗期66例及巩固期64例,共254例(含174名不同患者))进行调查,然后,根据2010年中华中医药学会乳腺病防治协作工作委员会在上海中医药杂志第44卷第1期发布的乳腺癌分期辨证规范(试行)为主的诊断标准对资料进行中医辨证分型,应用Microsoft Office Excel软件建立数据库,应用SPASS16.0统计软件进行统计分析中医证型与分子分型的关系。结果:174例不同中医分期辨证的乳腺癌患者平均年龄(52.2±11.49)岁,发病高峰年龄段为50-59岁(与其余年龄组比较,P0.05),年龄呈正态分布,以Luminal B型最多。(1)手术前:Luminal A型、Luminal B型及三阴型患者的中医证型皆以肝郁痰凝证为主,分别占各自分子亚型的66.7%(Luminal A型与LuminaB型比例相同)及70%(三阴型)。在此中医证型及各自分子亚型中,Luminal A型有87.5%的患者年龄在40岁及以上;Luminal B型则有85.0%。Her-2扩增型患者的中医证型以痰瘀互结证为主,占Her-2扩增型的80.0%,且集中在50岁及以上者。(2)手术后:Luminal A型、Her-2扩增型及三阴型患者手术后的中医证型只表现为单一的气血两虚证。LuminalB型乳腺癌患者的中医证型以气血两虚证为主,在Luminal B型患者中占77.8%,其余22.2%表现为脾胃不和证,这些脾胃不和证的患者年龄都至少40岁。(3)围化疗期:经过2次化疗后,Luminal A型患者表现为肝肾亏虚证(42.9%)或脾肾两虚证(57.1%)两个主要中医证型,年龄小于50岁者以脾肾功能受损为主,年龄50岁及以上者则以肝肾功能受损较显著。Luminal B型患者表现的中医证型多样且分布较均匀,其中,肝肾亏虚证与气血两虚证各占Luminal B型的24.2%,脾肾两虚证稍多,占30.3%,脾胃不和证稍少,占21.2%。Her-2扩增型患者主要中医证型为肝肾亏虚证,占75%。这类患者一般年龄在50岁及以上,约占同龄人群的72.7%。三阴型患者则有一半表现为脾肾两虚证,28.6%表现为肝肾亏虚证。(4)巩固期:Luminal A型患者表现为单一的冲任失调证。Luminal B型乳腺癌患者的中医证型以冲任失调证较多,在36例Luminal B型患者中占69.5%,其余为脾肾两虚证(22.2%),气血两虚证(8.3%)。Her-2扩增型患者的中医证型为冲任失调证及气血两虚证各半。其中冲任失调证患者的年龄都在50岁及以上。三阴型患者的中医证型为冲任失调证(占17例的64.7%),脾肾两虚证(5.9%)及气血两虚证(29.4%)。结论:中医药治疗手术前Luminal A型、Luminal B型及三阴型乳腺癌患者应重视疏肝解郁,化痰散结;治疗Her-2扩增型患者,尤其是50岁及以上者,应重视化痰散结,活血化瘀。中医药治疗手术后乳腺癌患者应以补益气血为主,但对于一些40岁及以上Luminal B型患者应随证适当调和脾胃。在围化疗期,中医药治疗50岁以下Luminal A型患者要注重恢复其脾肾功能,50岁以上者则要注意顾护肝肾功能。对Luminal B型患者,中医治疗应观其脉症,随证治之。中医药治疗Her-2扩增型患者应重视顾护肝肾功能。三阴型患者的中医药治疗应重视肝、脾、肾,但以脾肾为要。对于不同分子分型及年龄的围化疗期患者,中医治疗或以补益肝肾为主,或侧重补益脾肾。中医药治疗巩固期患者,扶正可以调理冲任为主,对于50岁以下的Her-2扩增型患者,扶正则可重视气血的生化。在中医药早期干预用药中,疏肝解郁,化痰散结,随证适当兼顾活血化瘀可预防乳腺癌的发生。待手术的患者可以益气生血为大法来防治手术后出现气血两虚证。待化疗的患者,治疗要重视肝、脾、肾。对不同分子分型及年龄的患者,或以补益肝肾为主,或侧重补益脾肾。中医药在预防巩固期患者复发转移方面,扶正可以调理冲任为要,但要注意调理冲任的同时不能升高雌激素水平,尤其是Luminal型的患者。乳腺癌是一个有实体肿块的疾病,郁滞是其发生发展的要素,因此,疏肝解郁,化痰散结,随证适当兼顾活血化瘀可贯穿乳腺癌的整个治疗过程。上述只是主要治疗原则,临床可见多种不同兼证,治疗时也应适当兼顾。
[Abstract]:Objective: To explore the correlation between the molecular classification of breast cancer and the differentiation of different TCM stages, to provide new ideas for the diagnosis and treatment of breast cancer in the clinical combination of traditional Chinese and Western medicine and the prognosis in order to intervene and prevent the recurrence and metastasis of breast cancer as soon as possible. At the same time, it is beneficial to establish a comprehensive, comprehensive and standardized TCM syndrome differentiation system for breast cancer. Methods: through a unified questionnaire, 62 cases of breast cancer were treated in the Jiangsu Province Traditional Chinese Medicine Hospital breast surgery from April 2016 to December, the oncology department and the general internal medicine, the Jiangsu tumor hospital and the southern hospital, which met the standard of breast cancer (62 cases before operation, 62 cases after hand operation, 66 cases in the perioperative period of chemotherapy and 64 cases in consolidation period). According to the Microsoft Office Excel software, Microsoft Office Excel software was used to establish the data according to the standard of diagnosis of breast cancer in the first phase of the forty-fourth volume of the Chinese Journal of traditional Chinese medicine (China Journal of traditional Chinese Medicine) in 2010. SPASS16.0 statistical software was used to analyze the relationship between TCM syndrome type and molecular typing. Results: the average age of 174 cases of breast cancer patients with different TCM stages was (52.2 + 11.49) years, the peak age of the onset was 50-59 years (compared with the other age groups, P0.05), and the age was positively distributed, with the most Luminal B type. (1) Luminal before operation: Luminal The TCM syndrome types of A, Luminal B and three yin type were mainly liver depression and phlegm syndrome, which accounted for 66.7% (Luminal A type and LuminaB type) and 70% (three yin type) respectively. Among the TCM Syndrome Types and their molecular subtypes, 87.5% of Luminal A type patients were aged 40 years and above; Luminal B type had 85.0%.Her-2 expansion. The TCM syndrome type of the patients with increased type was mainly Sputum Stasis Syndrome, accounting for 80% of Her-2 amplification type, and concentrated in 50 years old and above. (2) after operation, the TCM syndrome type of Luminal A type, Her-2 amplification type and three yin type after operation was only the single Qi and blood two deficiency syndrome of.LuminalB type of breast cancer patients with Qi and blood two deficiency syndrome, in Lum Among the patients with type inal B, the other 22.2% were spleen and stomach disharmony, the age of those with spleen and stomach disharmony was at least 40 years old. (3) after 2 chemotherapy, Luminal A patients showed liver kidney deficiency syndrome (42.9%) or two deficiency syndrome (57.1%) of spleen and kidney (57.1%) with two main TCM syndrome types, and those aged less than 50 years of age were mainly damaged by spleen and kidney function. The TCM syndrome types of.Luminal B patients with impaired liver and kidney function with impaired liver and kidney function were varied and evenly distributed, among them, the deficiency of liver kidney and kidney deficiency syndrome and Qi and blood two deficiency syndrome accounted for 24.2% of Luminal B, 30.3% of spleen and kidney deficiency syndrome, 30.3% of spleen and stomach, and less syndrome of spleen and stomach, and the main TCM syndrome of 21.2%.Her-2 amplification patients was liver and kidney. Deficiency syndrome, accounting for 75%., the general age of the patients was 50 years old and above, and about half of the 72.7%. three yin patients in the same age group were two deficiency syndrome of spleen and kidney and 28.6% of the liver and kidney deficiency syndrome. (4) the period of consolidation: the Luminal A patients showed that the TCM syndrome type of.Luminal B breast cancer patients with single scouring maladjustment syndrome was more maladjusted syndrome. In 36 cases of Luminal B patients, the other were spleen and kidney deficiency syndrome (22.2%), Qi and blood two deficiency syndrome (8.3%).Her-2 amplification type of TCM syndrome types were Chong and Ren disorder syndrome and Qi and blood two deficiency syndrome. Among them, the age of the patients with maladjusted syndrome was 50 years old and above. The TCM syndrome type of three yin type patients was 69.5% of 17 cases (17 cases). Two deficiency syndrome of kidney (5.9%) and Qi and blood two deficiency syndrome (29.4%). Conclusion: Traditional Chinese medicine treatment of Luminal A, Luminal B and three yin type breast cancer patients should pay attention to stagnation of liver and stagnation of phlegm, especially for the patients with Her-2 amplification, especially those aged 50 years old and above, should pay attention to the dissipating of phlegm and dissipating blood and dissipating blood stasis. But for some 40 years old and above Luminal B patients, the spleen and stomach should be reconciled properly. In the perioperative period of chemotherapy, the patients under the age of 50 years of age of traditional Chinese medicine should pay attention to restoring the function of the spleen and kidney, and the people over 50 years old should pay attention to the function of liver and kidney. For the Luminal B patients, the Chinese medicine should be treated with the pulse syndrome, and the Chinese medicine is treated with the TCM. The treatment of Her-2 amplification patients should pay attention to protecting the function of liver and kidney. The treatment of three yin patients should pay attention to the liver, spleen and kidney, but with the spleen and kidney. For the patients with different molecular types and age, TCM treatment or supplementing the liver and kidney, or focusing on the spleen and kidney. As for the Her-2 patients under the age of 50, Fu Zheng can pay attention to the biochemistry of Qi and blood. In the early intervention of traditional Chinese medicine, it can prevent the stagnation of the liver and dissipate the phlegm and dissipate the blood stasis. The patients in the operation can prevent the occurrence of breast cancer with proper consideration of activating blood and removing blood stasis. The patients in the operation can prevent and cure the deficiency of Qi and blood after the operation. The treatment should pay attention to liver, spleen and kidney. To patients with different molecular types and ages, or to complement the liver and kidney, or to focus on the spleen and kidney. Cancer is a disease with solid mass, and stagnation is the essential factor for its development. Therefore, it is necessary to remove stagnation of the liver and dissipate the phlegm and dissipate the blood stasis, which can run through the whole treatment process of breast cancer.

【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R273

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