基于阴道镜成像探讨高级别宫颈上皮内瘤变局部病变分区与五脏证素的相关性

发布时间：2018-04-30 14:27

本文选题：高级别宫颈上皮内瘤变 + 宫颈病变分区　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:采用证素辨证,以高级别宫颈上皮内瘤变(high-grade squamous intraepithelial lesion,HSIL)患者为研究对象,对研究对象进行四诊信息采集,并应用阴道镜显像及组织病理技术,确定HSIL病变在宫颈的坐标方位。探讨HSIL中医证的分布特点,及HSIL宫颈病变分区与五脏证素的相关性。方法:病例来源于2016年1月至2017年1月就诊于福建省第二人民医院门诊或住院部,经病理检查确诊为HSIL的患者。由同一位经过培训的医师对所有病例按照CIN证素调查表进行规范的中医四诊信息采集,参考朱文峰《证素辨证学》辨证原理进行中医辨证。分析所有病例的阴道镜检查图谱和组织病理,构建阴道镜中医望诊坐标,确定HSIL病变在宫颈的坐标方位。探讨HSIL中医证的分布特点,及宫颈病变分区与五脏证素的相关性。结果:1.课题收集HSIL病例93例,年龄分布:30-49岁最多,65人(69.9%),60-69岁最少,4人(4.30%);BMI指数:18.4-23.9最多,66人(70.97%);职业:公司职员最多,34人(36.56%),其次为无业人员,26人(27.96%);避孕方式:使用节育环、无固定避孕方式最多,各23人(24.73%);首次性生活年龄:小于等于20岁最多,38人(40.86%);妊娠次数:3次及以上最多,47人(50.54%)。2.HSIL中医证的分布:①病性证素:湿最多,61例(65.59%),其后依次是热、阴虚、阳虚、血瘀。②病位证素:胞宫最多,38例(40.86%),其后依次是肝、脾、肾、心、小腹。③证:肝经湿热证最多,23例(24.73%),其后依次是肾阴虚夹湿证、脾虚证、肝阴虚证、脾经湿热证、胞宫湿热证、肾阳虚证。④五脏病位证素:肝最多,33例(37.50%),其后依次为脾 28 例(31.82%),肾 24 例(27.27%),心 3 例(3.40%),无病位在肺者。3.HSIL患者宫颈病变分区:①望诊坐标宫颈病变分布:37个坐标中有26个可见宫颈病变,第一轮第11象限最多,16例(18.18%),其次为宫颈管内15例(17.04%),第一轮第7象限13例(14.77%);43例患者病变部位涉及多个坐标;②四象限宫颈病变分布:均可见病变区域,左上象限最多,24例(27.27%),其后依次是右下象限、右上象限、左下象限,12例患者病变涉及多个象限;③轮数宫颈病变分布:病变局限于第一轮最多,51例(57.95%),其后依次是局限于宫颈管内、局限于第二轮,26例患者病变涉及两轮及以上。4.HSIL宫颈病变分区与五脏证素相关性:①望诊坐标宫颈病变与五脏病位:五脏病位证素在37个坐标分布中有统计学意义(P=0.002)。肝病变在第一轮第7象限,脾病变在第一轮第11象限,肾病变在宫颈管内,与其他脏证素的坐标分布有差异(α≤0.008);②四象限宫颈病变与五脏病位:五脏病位证素在四象限的分布有统计学意义(P=0.000121)。肝病变在左上象限,脾病变在右上象限,肾病变在宫颈管内,与其他脏证素的象限分布有差异(α≤0.005);③轮数宫颈病变与五脏病位:五脏病位证素的轮数分布有有统计学意义(P=0.008)。肝病变涉及2轮及以上,脾病变局限于第一轮,肾病变局限于宫颈管,与其他脏证素的轮数分布有差异(α≤0.005)。结论:1.HSIL好发于性生活动活跃的年龄,无隔离措施的性行为、过早性生活、妊娠次数多是HSIL的高危因素。2.湿是HSIL的基本病性证素,热、阴虚、阳虚、血瘀为兼夹致病因素;HSIL的五脏病位证素肝为主,兼及脾、肾、心;肝经湿热证是HSIL最常见的证,脾虚证、肾阴虚夹湿证次之。3.HSIL宫颈病变可以是单个病灶,也可以是多点病灶,多点病灶可以累及多个坐标方位。不同病位证素的HSIL病变可聚集于特定的某一象限、某一轮或某一区域。4.HSIL宫颈病变分区与五脏证素有关,病变的坐标、象限、轮数可用于HSIL望诊。病变位于第一轮第7象限/病变位于左上象限/病变涉及两轮及以上与病位在肝有关;病变位于第一轮第11象限/病变位于右上象限/局限于第一轮与病位证素在脾有关;病变位于宫颈管内与病位在肾有关。
[Abstract]:Objective: to apply the syndrome differentiation to the patients with high level cervical intraepithelial neoplasia (high-grade squamous intraepithelial lesion, HSIL) as the research object, to collect the four diagnosis information of the subjects, and to use the colposcopy imaging and histopathology to determine the coordinates of the HSIL lesions in the cervix of the uterine cervix, and to explore the distribution characteristics of the TCM syndrome of HSIL and HSIL, and HSIL. The correlation between the cervical lesions and the five Zang syndrome factors. Methods: the cases were diagnosed in the outpatient or inpatient department of the second people's Hospital of Fujian province from January 2016 to January 2017. The patients were diagnosed with HSIL by pathological examination. All cases were collected by the same trained physician for the standardized TCM four diagnosis information according to the CIN syndrome questionnaire. Refer to Zhu Wenfeng < syndrome differentiation > syndrome differentiation principle for TCM syndrome differentiation. Analyze the colposcopy atlas and histopathology of all cases, construct the coordinate of the Chinese examination of the colposcopy, determine the coordinates of the HSIL lesions in the cervix, discuss the distribution characteristics of the HSIL TCM syndrome, and the correlation between the cervical lesions and the five zang organs. Results: 1. subjects are collected. 93 cases of HSIL cases, age distribution: 30-49 years old, 65 (69.9%), 60-69 years old, 4 people (4.30%); BMI index: 18.4-23.9 most, 66 (70.97%); Occupation: most staff, 34 (36.56%), next to no workers, 26 (27.96%); contraceptive method: the use of contraceptive ring, the most non fixed contraceptive methods, the first sexual age: Less than 20 years old, 38 people (40.86%), pregnancy times: 3 times and above, 47 people (50.54%).2.HSIL TCM Syndrome Distribution: (1) disease syndrome: wet most, 61 cases (65.59%), followed by heat, yin deficiency, Yang deficiency, blood stasis. 2. Syndrome elements: the most of the uterus, 38 cases (40.86%), followed by the liver, spleen, kidney, heart, abdomen. 3 syndrome: syndrome: Liver Meridian damp heat syndrome is most 23 cases (24.73%), followed by the kidney yin deficiency syndrome, spleen deficiency syndrome, liver yin deficiency syndrome, spleen meridian damp heat syndrome, damp heat syndrome of the uterus, kidney yang deficiency syndrome. 4. The most liver and 33 cases (37.50%), followed by spleen 28 cases (31.82%), kidney 24 cases (27.27%), 3 cases of heart (3.40%), no disease position in the lung.3.HSIL patients cervical lesions Zoning: 1 coordinate coordinates Cervical lesions distribution: there were 26 cervical lesions in the 37 coordinates, the first round eleventh quadrants, 16 (18.18%), the next 15 cases in the cervical canal (17.04%), the first round seventh quadrant 13 cases (14.77%), and the 43 patients involved multiple coordinates; (2) the four quadrant of cervical lesions were distributed in the lesion area, the upper left quadrant was the most, 24 cases (27.27%). Followed by the right lower quadrant, the right upper quadrant, the lower left quadrant, 12 cases of the disease involved multiple quadrants; (3) the distribution of cervical lesions: the lesions were limited to the first round, 51 cases (57.95%), followed by the cervix canal, limited to the second round, and 26 cases of the disease involving two rounds of.4.HSIL cervical lesions and five zang organs. Correlation: (1) the coordinates of the cervical lesions and the five zang organs: the 37 coordinates of the five Zang syndrome were statistically significant (P=0.002). The liver disease changed in the first round of the seventh quadrant, the spleen became in the first eleventh quadrant, the kidney became in the cervical canal, and the coordinate distribution of the other visceral elements was different (alpha < 0.008); and the four quadrant of cervical lesions and five Visceral position: the distribution of the five Zang syndrome in the four quadrant was statistically significant (P=0.000121). The liver disease changed in the left upper quadrant, the spleen became in the right upper quadrant, the kidney became in the cervical canal, and the quadrant distribution of the other visceral elements was different (alpha < 0.005); (3) the round number of cervical lesions and five viscera position: the number distribution of the five Zang syndrome factors was statistically significant P=0.008. The liver disease involves 2 rounds and above, the spleen disease is limited to the first round, the renal disease is limited to the cervical canal, and the number distribution of the other visceral factors is different (alpha < 0.005). Conclusion: 1.HSIL is well distributed in the active active age of the sex life, the sexual behavior of no isolation measures, the early sex life, the more pregnancy times is the high risk factor of HSIL,.2. wet HSIL is HSIL The basic disease factors, heat, yin deficiency, Yang deficiency and blood stasis are the causative factors of the disease. HSIL's five Zang syndrome is the most common syndrome of the spleen, kidney and heart; the liver meridian damp heat syndrome is the most common syndrome of HSIL, the spleen deficiency syndrome, the.3.HSIL cervical lesion of the kidney yin deficiency and the dampness syndrome can be a single focus, and can also be a multi point focus, and multiple focal lesions may involve multiple coordinates. HSIL lesions of different position syndromes can be clustered in a particular quadrant. The.4.HSIL cervical region of a certain round or region is related to the five zang organs. The coordinates, quadrants, and numbers of the lesions can be used for HSIL inspection. The lesion is located in the first round seventh quadrant / the lesion is located in the upper left quadrant / the lesion involves two rounds and the disease is related to the liver; the disease is related to the liver; In the first round, the eleventh quadrant / lesion located in the upper quadrant / restricted to the first round was related to the position of the disease factor in the spleen, and the lesion located in the cervical canal was related to the location of the disease in the kidney.

【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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