胆囊息肉样病变的中医体质探析及与胆囊癌的相关性分析

发布时间：2018-05-26 14:21

本文选题：胆囊息肉样病变 + 息肉直径　；参考：《安徽中医药大学》2016年硕士论文

【摘要】：目的:探讨胆囊息肉样病变不同直径大小的体质分布及胆囊息肉样病变病理性质与体质之间的关系,为胆囊息肉样病变的中医预防与治疗提供思路。方法:选取武警安徽省总队医院体检中心或住院部符合各组纳入条件的人群作为研究对象,其中将体检中心健康人群作为对照组;直径8mm的胆囊息肉样变患者作为胆囊息肉(非危险)组;直径≥8mm的胆囊息肉样变患者作为胆囊息肉(危险)组。分析比较三组之间的体质分布特点及差异,研究两组胆囊息肉中息肉多发体质与临床检查结果间是否具有特异性,探析胆囊息肉(危险)组患者的病理性质与体质之间的关系,并初步研究胆囊癌患者的体质分布情况及相关性。结果:(1)(1)三组CHOL均值进行两两之间的差异均具有统计学意义(P0.05);(2)胆囊息肉(危险)组中的LDL-C均值与胆囊息肉(非危险)组和对照组两组的差异分别具有统计学意义(P0.05),而胆囊息肉(非危险)组与对照组之间的差异无统计学意义(P0.05)。(2)(1)对照组与胆囊息肉(非危险)组之间,对照组中平和质的分布显著多(P0.0167);胆囊息肉(非危险)组中气虚质的分布显著多于对照组(P0.0167);胆囊息肉(非危险)组中痰湿质的分布显著多于对照组(P0.0167);两组间其余体质分布情况中,差异均无统计学意义(P0.0167)。(2)对照组与胆囊息肉(危险)组之间,对照组中平和质的分布显著多于胆囊息肉(危险)组(P0.0167);胆囊息肉(危险)组中阳虚质、痰湿质、湿热质的分布显著多于对照组(P0.0167);两组间其余体质分布差异均无统计学意义(P0.0167)。(3)胆囊息肉(非危险)组与胆囊息肉(危险)组之间,胆囊息肉(危险)组中阳虚质的分布显著多于胆囊息肉(非危险)组(P0.0167)。两组间其余体质分布差异均无统计学意义(P0.0167)。(3)两组胆囊息肉样变间的合并病对比,胆囊息肉(危险)组中高血脂症患者明显多于胆囊息肉(非危险)组(P0.05)。(4)胆囊息肉(非危险)组与胆囊息肉(危险)组之间,在生长部位(胆囊体和胆囊底)、胆囊壁厚度方面的差异具有统计学意义(P0.05)。(5)(1)胆囊息肉(非危险)组中,气虚质患者的合并病发病率分别为:高血脂症(13.04%)=高血压病(13.04%)=脂肪肝(13.04%)糖尿病(8.7%)=肝囊肿(8.7%)胆结石(4.35%);痰湿质患者的合并病发病率分别为:脂肪肝(43.48%)高血压病(39.13%)高血脂症(26.09%)糖尿病(17.39%)肝囊肿(13.04%)胆结石(4.35%);(2)胆囊息肉(危险)组中,痰湿质患者的合并病发病率分别为:高血脂症(45.45%)高血压病(31.82%)糖尿病(18.18%)脂肪肝(13.64%)=乙肝(13.64%)肝囊肿(9.09%)胆结石(4.55%);湿热质患者的合并病发病率分别为:高血脂症(40%)脂肪肝(25%)肝囊肿(20%)=胆结石(20%)高血压病(10%)=糖尿病(10%)=乙肝(10%);阳虚质患者的合并病发病率分别为:高血脂症(15.79%)肝囊肿(10.53%)高血压病(5.26%)=胆结石(5.26%)。(6)胆囊息肉(危险)组中,胆固醇性息肉患者体质分布情况为:痰湿质(22.09%)阳虚质(18.6%)湿热质(13.95%)气虚质(11.63%);胆囊腺肌增生体质分布情况为:气虚质、痰湿质和气郁质各有1例;腺瘤性息肉患者体质分布情况为:阳虚质(36.36%)=湿热质(36.36%)痰湿质(18.18%)血淤质(9.09%)(7)胆囊癌患者中,性别女性7位,占77.78%;年龄为53~84岁,平均年龄为69.22岁;急性发作者6例,占66.7%;合并胆结石者占88.89%(8/9);B超或CT获取胆囊癌病情3例,占33.3%;肿瘤标志物CA199升高者5例,占55.56%;意外胆囊癌5例,占55.56%;病理类型以腺癌(7例)为主,占77.78%;癌变部位多位于体部(6例),占66.7%;体质类型分为湿热质、血瘀质、阳虚质。结论:(1)(1)对照组中,以平和质患者分布为主;(2)胆囊息肉(非危险)组中,以气虚质、痰湿质患者分布为主;(3)胆囊息肉(危险)组中,以阳虚质、痰湿质、湿热质患者分布为主,且阳虚质患者显著多于胆囊息肉(非危险)组;(4)痰湿质多见于胆囊息肉样病变患者。(2)(1)在胆囊息肉(非危险)组中,脂肪肝、高血压病、高血脂症和糖尿病在痰湿质患者中的发病率较高;(2)胆囊息肉(危险)组中,高血脂症和高血压病在痰湿质患者中发病率较高;高血脂症和脂肪肝在湿热质患者中发病率较高。(3)胆囊癌患者多见于老年女性、合并胆结石、湿热质和血瘀质等特点的人群。
[Abstract]:Objective: To investigate the distribution of different diameter of polypoid lesions of the gallbladder and the relationship between the pathological properties of polypoid lesions of the gallbladder and the relationship between the physique of the gallbladder in order to provide ideas for the prevention and treatment of traditional Chinese medicine for polypoid lesions of the gallbladder. The healthy people of the physical examination center were used as the control group. The patients with polyposis of gallbladder polyps with diameter 8mm were used as the group of gallbladder polyps (non dangerous) and the patients with gallbladder polyps with diameter more than 8mm were used as the group of gallbladder polyps. The characteristics and differences of the physical distribution between the three groups were analyzed and compared, and the multiple polyps in the two groups of gallbladder polyps were studied. Whether the clinical examination results were specific, the relationship between the pathological properties and the constitution of the patients in the group of gallbladder polyps (dangerous), and the preliminary study of the distribution and correlation of the constitution of the patients with gallbladder cancer. Results: (1) the difference in the mean of 22 of the three groups of CHOL was statistically significant (P0.05); (2) in the group of gallbladder polyps (risk) The difference between the average LDL-C and the two groups of the gallbladder polyp (non dangerous) group and the control group was statistically significant (P0.05), but there was no significant difference between the gallbladder polyps (non dangerous) group and the control group (P0.05). (2) (1) the control group and the gallbladder polyp (non dangerous) group, the control group was significantly more distributed in the middle level and the mass (P0.0167); gallbladder polyp The distribution of qi deficiency in the (non dangerous) group was significantly more than that of the control group (P0.0167), and the distribution of phlegm wet quality in the group of gallbladder polyps (non dangerous) was significantly more than that of the control group (P0.0167), and there was no significant difference in the distribution of the remaining constitution between the two groups (P0.0167). (2) the distribution of the level and quality in the control group was significant between the group and the group of gallbladder polyps (dangerous). More than the gallbladder polyps (risk) group (P0.0167), the distribution of Zhongyang deficiency, phlegm, moisture and heat in the group of gallbladder polyps was more than that of the control group (P0.0167); the distribution of the remaining constitution between the two groups was not statistically significant (P0.0167). (3) gallbladder polyps (non risk) group and gallbladder polyp (dangerous) group, gallbladder polyp (dangerous) group (dangerous) group (risk) of the deficiency of the quality of the group. There was no significant difference in the distribution of gallbladder polyps (P0.0167). There was no significant difference in the distribution of the remaining constitution between the two groups (P0.0167). (3) the combination of the two groups of gallbladder polyps was compared, and the hyperlipidemia patients in the group of gallbladder polyps (dangerous) were significantly more than those of the gall bladder (non dangerous) group (P0.05). (4) gallbladder polyps (non dangerous) and gallbladder rest. The difference in the thickness of the gallbladder wall was statistically significant (P0.05). (5) (1) in the group of gallbladder polyps (non dangerous), the incidence of combined disease in patients with Qi deficiency was: hyperlipidemia (13.04%) = hypertension (13.04%) = fatty liver (13.04%) diabetes (8.7%) = hepatic cyst (8.7%) gallbladder (8.7%) Stone (4.35%); the incidence of combined disease in patients with phlegm and dampness were fatty liver (43.48%) hypertension (39.13%) hyperlipidemia (26.09%) diabetes (17.39%) liver cyst (13.04%) gallstone (4.35%); (2) gallbladder polyp (dangerous) group, the incidence of complication of hyperlipidemia (45.45%) hypertension (31.82%) diabetes (31.82%) diabetes mellitus (18.18%), respectively. Fatty liver (13.64%) = hepatitis B (13.64%) hepatic cysts (9.09%) gallstones (4.55%); the incidence of combined diseases in patients with humid heat were: hyperlipidemia (40%) fatty liver (25%) liver cyst (20%) = cholelithiasis (20%) hypertension (10%) = diabetes (10%) = hepatitis B (10%), and the incidence of hyperlipidemia in patients with hyperlipidemia (15.79%) liver cyst (10.53%), respectively. Hypertension (5.26%) = cholelithiasis (5.26%). (6) in the group of polyps of the gallbladder (dangerous), the physical distribution of the patients with cholesterol polyps was: phlegm wet (22.09%), Yang deficiency (18.6%) and damp heat (13.95%) Qi deficiency (11.63%); the distribution of the hyperplastic constitution of the gallbladder gland muscle was: Qi deficiency, phlegm and qi depression, and the physical distribution of the patients with adenomatous polyps. The condition was: Yang deficiency (36.36%) = damp heat (36.36%) phlegm and moisture content (18.18%) and blood stasis (9.09%) (7) of gallbladder cancer, 7 of gall bladder cancer, 77.78%; age 53~84 years, the average age of 69.22 years, 6 cases of acute hair authors, 66.7% and 88.89% (8/9) with cholelithiasis; B ultrasound or CT to obtain gallbladder cancer in 3 cases, 33.3%; tumor marker CA199 increase 5 cases, accounted for 55.56%, 5 cases of accidental gallbladder cancer, accounting for 55.56%, pathological type was mainly adenocarcinoma (7 cases), accounting for 77.78%, the tumor location was located in the body part (6 cases), accounting for 66.7%, and the physical types were divided into damp heat, blood stasis and Yang deficiency. Conclusion: (1) (1) the control group was distributed mainly in the flat and mass patients; (2) in the group of gallbladder polyps (non dangerous), Qi deficiency and phlegm wet quality (3) in the group of gallbladder polyps (dangerous), Yang deficiency, phlegm dampness and damp heat were the main distribution, and the patients with Yang deficiency were significantly more than the gallbladder polyps (non dangerous) group; (4) the phlegm moisture content was found in the patients with gallbladder polyps. (2) (1) in the group of gallbladder polyps (non dangerous), fatty liver, hypertension, hyperlipidemia and diabetes in phlegm dampness The incidence of hyperlipidemia and hypertension in patients with phlegm wet quality was higher in the group of gallbladder polyps (2). The incidence of hyperlipidemia and fatty liver in patients with damp heat was higher. (3) the patients with gallbladder cancer were often seen in the elderly women with the characteristics of gallstones, damp heat and blood stasis.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R273;R259

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