乳腺癌中医证型与分子分型及相关基因表达的关联性研究

发布时间：2018-03-18 04:02

本文选题：乳腺癌　切入点：中医分型　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨乳腺癌中医证型与分子分型及相关基因表达的关联性,将宏观的中医辨证与临床客观的量化指标相结合,分析其内在联系,为乳腺癌的辨证分型及中西医结合治疗提供客观依据。方法：选取2015年4月-2015年12月期间在江苏省中医院及江苏省肿瘤医院住院并拟行手术治疗的乳腺癌患者100例。对其进行中医辨证,并收集患者的一般临床资料,包括性别、年龄、术后病理指标(ER、PR、HER-2、Ki67、VEGF、EGFR、p53)等指标,用SPSS19.0统计软件包建立数据库,分析中医证型与客观指标之间的关联性,计数资料采用卡方检验,组间计量资料采用方差分析,以P0.05表示有统计学意义。结果：乳腺癌发病率年龄呈正态分布,41-50岁为高发年龄段(P0.05)。肝郁气滞证、热毒蕴结证及冲任失调证为乳腺癌最常见证型(P0.05)。肝郁气滞证与浸润性导管癌高发生率、ER高阳性率、Luminal型乳腺癌高发生率及VEGF高表达有相关性(P0.05)。热毒蕴结证与浸润性导管癌高发生率、三阴性乳腺癌高发生率、p53高表达、Ki-67高水平及EGFR高表达有相关性(P0.05)。冲任失调证与浸润性导管癌高发生率、ER高阳性率、p53高表达、Luminal B型乳腺癌高发生率及VEGF高表达有相关性(P0.05)。气血两虚证与浸润性导管癌高发生率、HER-2高阳性率、p53高表达、Luminal B型乳腺癌高发生率、HER-2过表达型乳腺癌高发生率及EGFR高表达有相关性(P0.05)。脾胃虚弱证与浸润性导管癌高发生率、Luminal B型乳腺癌高发生率及ER高阳性率有相关性(P0.05)。肝肾阴虚证与浸润性导管癌高发生率、Luminal B型乳腺癌高发生率及Ki-67高水平有相关性(P0.05)。结论：乳腺瘤的中医辨证分型与分子分型及相关基因表达具有关联性。肝郁气滞证对化疗敏感,可能配合抑制血管生成药物效果更佳,中医方而主要为配合手术及放化疗,减轻毒副反应。热毒蕴结证恶性程度高,对化疗效果欠佳,对内分泌治疗不敏感,分子靶向药物对其效果较差,中医治疗是主要治疗手段,要加强抗肿瘤治疗的力度。冲任失调证对化疗敏感,可能配合抑制血管生成药物效果更佳。气血两虚证恶性程度高,对蒽环类及紫杉类药物敏感,对内分泌治疗效果欠佳,对曲妥珠单抗(赫赛汀)靶向治疗有效,中医方面要加强抗肿瘤治疗的力度。脾胃虚弱证对化疗敏感,对内分泌治疗敏感,中医在抗肿瘤治疗的同时注重健脾和胃。肝肾阴虚证肿瘤增殖迅速,可能对化疗药物治疗更有效,同时也要加强中医抗肿瘤治疗的力度。
[Abstract]:Objective: to explore the relationship between TCM syndromes and molecular typing and related gene expression in breast cancer, and to analyze the internal relationship between macroscopical TCM syndrome differentiation and clinical objective quantitative indexes. Methods: select breast cancer patients who were hospitalized in Jiangsu Provincial traditional Chinese Medicine Hospital and Jiangsu Cancer Hospital from April 2015 to December 2015 and planned to perform surgical treatment for breast cancer. To differentiate the symptoms and signs of traditional Chinese medicine, The general clinical data of the patients, including sex, age, postoperative pathological index, et al., were collected. The database was established by SPSS19.0 statistical software package, and the correlation between TCM syndromes and objective indexes was analyzed. The counting data were checked by chi-square test. Results: the age of breast cancer incidence was normal distribution (41-50 years old) as the high incidence age group (P 0.05). The most common type of breast cancer is heat toxin accumulation syndrome and Chong-Ren disorder. The high rate of ER positive and the high expression of VEGF are related to the high incidence of liver stagnation and qi stagnation and invasive ductal carcinoma. There is a correlation between heat toxin accumulation syndrome and infiltrating ductal carcinoma. High incidence of ductal cancer, The high expression of Ki-67 and the high expression of EGFR were correlated with the high expression of Ki-67 and EGFR in triple negative breast cancer. The high positive rate of ER and the high expression of VEGF in breast cancer were correlated with the high positive rate of ER and the high expression of p53 in Luminal B breast cancer and the high expression of VEGF in breast cancer. High positive rate of HER-2 and high positive rate of p53 p53 overexpression of Luminal B breast cancer and high expression of EGFR were associated with high expression of P0.050.Spleen-stomach deficiency syndrome and infiltrating conduction were associated with the high incidence of P0.050.Spleen-stomach deficiency and infiltrating ductal carcinoma were associated with high expression of p53 and high expression of P0.050.The relationship between HER-2 overexpression and high expression of EGFR was found in this paper. The high incidence of luminal B breast cancer and the high positive rate of ER were correlated with P0.05.The high incidence rate of luminal B breast cancer and the high level of Ki-67 were correlated with the high incidence of liver and kidney yin deficiency and invasive ductal carcinoma. Conclusion: the breast tumor has a high level of P0.05. conclusion: there is a significant correlation between the high incidence of luminal B breast cancer and the high positive rate of ER. TCM syndrome differentiation is related to molecular typing and related gene expression. Liver stagnation syndrome is sensitive to chemotherapy. It may be better to cooperate with anti-angiogenic drugs, and the traditional Chinese medicine prescription is mainly combined with surgery, radiotherapy and chemotherapy to alleviate the toxic side effects. The heat toxin accumulation syndrome has a high degree of malignancy, is not effective in chemotherapy, and is insensitive to endocrine therapy. Molecular targeted drugs have poor effect on them. Traditional Chinese medicine (TCM) is the main treatment method. It is necessary to strengthen the intensity of anti-tumor treatment. The syndrome is sensitive to chemotherapy and may be more effective in combination with anti-angiogenesis drugs. The degree of malignancy of qi and blood deficiency syndrome is high. It is sensitive to anthracycline and yew drugs, not good for endocrine therapy, and effective for tratozumab (Herceptin) targeted therapy. In traditional Chinese medicine, the strength of anti-tumor treatment should be strengthened. The spleen and stomach deficiency syndrome is sensitive to chemotherapy. Sensitive to endocrine therapy, Chinese medicine pays attention to invigorating spleen and stomach while anti-tumor treatment. Liver and kidney yin deficiency syndrome tumor proliferation rapidly, may be more effective to chemotherapy drugs treatment, but also to strengthen the strength of anti-tumor treatment of traditional Chinese medicine.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R273

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