發(fā)布時(shí)間：2018-05-09 12:18

  本文選題：乳腺癌 + 分子分型��； 參考：《南京中醫(yī)藥大學(xué)》2017年博士論文

【摘要】：目的:探討乳腺癌分子分型與不同中醫(yī)分期辨證的相關(guān)性,為乳腺癌的臨床中西醫(yī)結(jié)合診治、預(yù)后判斷等提供新思路,以便能盡早應(yīng)用中醫(yī)藥去干預(yù)與預(yù)防乳腺癌復(fù)發(fā)轉(zhuǎn)移,同時(shí),為建立完善、全面、規(guī)范化的乳腺癌中醫(yī)辨證體系進(jìn)行有益探索。方法:通過(guò)統(tǒng)一問卷式調(diào)查表,對(duì)2016年4月至12月在江蘇省中醫(yī)院乳腺外科、腫瘤內(nèi)科與普內(nèi)科、江蘇省腫瘤醫(yī)院及馬鞍山市中醫(yī)院南院治療并符合納入標(biāo)準(zhǔn)的乳腺癌患者(手術(shù)前62例,手術(shù)后62例、圍化療期66例及鞏固期64例,共254例(含174名不同患者))進(jìn)行調(diào)查,然后,根據(jù)2010年中華中醫(yī)藥學(xué)會(huì)乳腺病防治協(xié)作工作委員會(huì)在上海中醫(yī)藥雜志第44卷第1期發(fā)布的乳腺癌分期辨證規(guī)范(試行)為主的診斷標(biāo)準(zhǔn)對(duì)資料進(jìn)行中醫(yī)辨證分型,應(yīng)用Microsoft Office Excel軟件建立數(shù)據(jù)庫(kù),應(yīng)用SPASS16.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析中醫(yī)證型與分子分型的關(guān)系。結(jié)果:174例不同中醫(yī)分期辨證的乳腺癌患者平均年齡(52.2±11.49)歲,發(fā)病高峰年齡段為50-59歲(與其余年齡組比較,P0.05),年齡呈正態(tài)分布,以Luminal B型最多。(1)手術(shù)前:Luminal A型、Luminal B型及三陰型患者的中醫(yī)證型皆以肝郁痰凝證為主,分別占各自分子亞型的66.7%(Luminal A型與LuminaB型比例相同)及70%(三陰型)。在此中醫(yī)證型及各自分子亞型中,Luminal A型有87.5%的患者年齡在40歲及以上;Luminal B型則有85.0%。Her-2擴(kuò)增型患者的中醫(yī)證型以痰瘀互結(jié)證為主,占Her-2擴(kuò)增型的80.0%,且集中在50歲及以上者。(2)手術(shù)后:Luminal A型、Her-2擴(kuò)增型及三陰型患者手術(shù)后的中醫(yī)證型只表現(xiàn)為單一的氣血兩虛證。LuminalB型乳腺癌患者的中醫(yī)證型以氣血兩虛證為主,在Luminal B型患者中占77.8%,其余22.2%表現(xiàn)為脾胃不和證,這些脾胃不和證的患者年齡都至少40歲。(3)圍化療期:經(jīng)過(guò)2次化療后,Luminal A型患者表現(xiàn)為肝腎虧虛證(42.9%)或脾腎兩虛證(57.1%)兩個(gè)主要中醫(yī)證型,年齡小于50歲者以脾腎功能受損為主,年齡50歲及以上者則以肝腎功能受損較顯著。Luminal B型患者表現(xiàn)的中醫(yī)證型多樣且分布較均勻,其中,肝腎虧虛證與氣血兩虛證各占Luminal B型的24.2%,脾腎兩虛證稍多,占30.3%,脾胃不和證稍少,占21.2%。Her-2擴(kuò)增型患者主要中醫(yī)證型為肝腎虧虛證,占75%。這類患者一般年齡在50歲及以上,約占同齡人群的72.7%。三陰型患者則有一半表現(xiàn)為脾腎兩虛證,28.6%表現(xiàn)為肝腎虧虛證。(4)鞏固期:Luminal A型患者表現(xiàn)為單一的沖任失調(diào)證。Luminal B型乳腺癌患者的中醫(yī)證型以沖任失調(diào)證較多,在36例Luminal B型患者中占69.5%,其余為脾腎兩虛證(22.2%),氣血兩虛證(8.3%)。Her-2擴(kuò)增型患者的中醫(yī)證型為沖任失調(diào)證及氣血兩虛證各半。其中沖任失調(diào)證患者的年齡都在50歲及以上。三陰型患者的中醫(yī)證型為沖任失調(diào)證(占17例的64.7%),脾腎兩虛證(5.9%)及氣血兩虛證(29.4%)。結(jié)論:中醫(yī)藥治療手術(shù)前Luminal A型、Luminal B型及三陰型乳腺癌患者應(yīng)重視疏肝解郁,化痰散結(jié);治療Her-2擴(kuò)增型患者,尤其是50歲及以上者,應(yīng)重視化痰散結(jié),活血化瘀。中醫(yī)藥治療手術(shù)后乳腺癌患者應(yīng)以補(bǔ)益氣血為主,但對(duì)于一些40歲及以上Luminal B型患者應(yīng)隨證適當(dāng)調(diào)和脾胃。在圍化療期,中醫(yī)藥治療50歲以下Luminal A型患者要注重恢復(fù)其脾腎功能,50歲以上者則要注意顧護(hù)肝腎功能。對(duì)Luminal B型患者,中醫(yī)治療應(yīng)觀其脈癥,隨證治之。中醫(yī)藥治療Her-2擴(kuò)增型患者應(yīng)重視顧護(hù)肝腎功能。三陰型患者的中醫(yī)藥治療應(yīng)重視肝、脾、腎,但以脾腎為要。對(duì)于不同分子分型及年齡的圍化療期患者,中醫(yī)治療或以補(bǔ)益肝腎為主,或側(cè)重補(bǔ)益脾腎。中醫(yī)藥治療鞏固期患者,扶正可以調(diào)理沖任為主,對(duì)于50歲以下的Her-2擴(kuò)增型患者,扶正則可重視氣血的生化。在中醫(yī)藥早期干預(yù)用藥中,疏肝解郁,化痰散結(jié),隨證適當(dāng)兼顧活血化瘀可預(yù)防乳腺癌的發(fā)生。待手術(shù)的患者可以益氣生血為大法來(lái)防治手術(shù)后出現(xiàn)氣血兩虛證。待化療的患者,治療要重視肝、脾、腎。對(duì)不同分子分型及年齡的患者,或以補(bǔ)益肝腎為主,或側(cè)重補(bǔ)益脾腎。中醫(yī)藥在預(yù)防鞏固期患者復(fù)發(fā)轉(zhuǎn)移方面,扶正可以調(diào)理沖任為要,但要注意調(diào)理沖任的同時(shí)不能升高雌激素水平,尤其是Luminal型的患者。乳腺癌是一個(gè)有實(shí)體腫塊的疾病,郁滯是其發(fā)生發(fā)展的要素,因此,疏肝解郁,化痰散結(jié),隨證適當(dāng)兼顧活血化瘀可貫穿乳腺癌的整個(gè)治療過(guò)程。上述只是主要治療原則,臨床可見多種不同兼證,治療時(shí)也應(yīng)適當(dāng)兼顧。
[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.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R273

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