本文選題：高級別宮頸上皮內(nèi)瘤變 + 宮頸病變分區(qū)�。� 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:采用證素辨證,以高級別宮頸上皮內(nèi)瘤變(high-grade squamous intraepithelial lesion,HSIL)患者為研究對象,對研究對象進(jìn)行四診信息采集,并應(yīng)用陰道鏡顯像及組織病理技術(shù),確定HSIL病變在宮頸的坐標(biāo)方位。探討HSIL中醫(yī)證的分布特點,及HSIL宮頸病變分區(qū)與五臟證素的相關(guān)性。方法:病例來源于2016年1月至2017年1月就診于福建省第二人民醫(yī)院門診或住院部,經(jīng)病理檢查確診為HSIL的患者。由同一位經(jīng)過培訓(xùn)的醫(yī)師對所有病例按照CIN證素調(diào)查表進(jìn)行規(guī)范的中醫(yī)四診信息采集,參考朱文峰《證素辨證學(xué)》辨證原理進(jìn)行中醫(yī)辨證。分析所有病例的陰道鏡檢查圖譜和組織病理,構(gòu)建陰道鏡中醫(yī)望診坐標(biāo),確定HSIL病變在宮頸的坐標(biāo)方位。探討HSIL中醫(yī)證的分布特點,及宮頸病變分區(qū)與五臟證素的相關(guān)性。結(jié)果:1.課題收集HSIL病例93例,年齡分布:30-49歲最多,65人(69.9%),60-69歲最少,4人(4.30%);BMI指數(shù):18.4-23.9最多,66人(70.97%);職業(yè):公司職員最多,34人(36.56%),其次為無業(yè)人員,26人(27.96%);避孕方式:使用節(jié)育環(huán)、無固定避孕方式最多,各23人(24.73%);首次性生活年齡:小于等于20歲最多,38人(40.86%);妊娠次數(shù):3次及以上最多,47人(50.54%)。2.HSIL中醫(yī)證的分布:①病性證素:濕最多,61例(65.59%),其后依次是熱、陰虛、陽虛、血瘀。②病位證素:胞宮最多,38例(40.86%),其后依次是肝、脾、腎、心、小腹。③證:肝經(jīng)濕熱證最多,23例(24.73%),其后依次是腎陰虛夾濕證、脾虛證、肝陰虛證、脾經(jīng)濕熱證、胞宮濕熱證、腎陽虛證。④五臟病位證素:肝最多,33例(37.50%),其后依次為脾 28 例(31.82%),腎 24 例(27.27%),心 3 例(3.40%),無病位在肺者。3.HSIL患者宮頸病變分區(qū):①望診坐標(biāo)宮頸病變分布:37個坐標(biāo)中有26個可見宮頸病變,第一輪第11象限最多,16例(18.18%),其次為宮頸管內(nèi)15例(17.04%),第一輪第7象限13例(14.77%);43例患者病變部位涉及多個坐標(biāo);②四象限宮頸病變分布:均可見病變區(qū)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例患者病變涉及多個象限;③輪數(shù)宮頸病變分布:病變局限于第一輪最多,51例(57.95%),其后依次是局限于宮頸管內(nèi)、局限于第二輪,26例患者病變涉及兩輪及以上。4.HSIL宮頸病變分區(qū)與五臟證素相關(guān)性:①望診坐標(biāo)宮頸病變與五臟病位:五臟病位證素在37個坐標(biāo)分布中有統(tǒng)計學(xué)意義(P=0.002)。肝病變在第一輪第7象限,脾病變在第一輪第11象限,腎病變在宮頸管內(nèi),與其他臟證素的坐標(biāo)分布有差異(α≤0.008);②四象限宮頸病變與五臟病位:五臟病位證素在四象限的分布有統(tǒng)計學(xué)意義(P=0.000121)。肝病變在左上象限,脾病變在右上象限,腎病變在宮頸管內(nèi),與其他臟證素的象限分布有差異(α≤0.005);③輪數(shù)宮頸病變與五臟病位:五臟病位證素的輪數(shù)分布有有統(tǒng)計學(xué)意義(P=0.008)。肝病變涉及2輪及以上,脾病變局限于第一輪,腎病變局限于宮頸管,與其他臟證素的輪數(shù)分布有差異(α≤0.005)。結(jié)論:1.HSIL好發(fā)于性生活動活躍的年齡,無隔離措施的性行為、過早性生活、妊娠次數(shù)多是HSIL的高危因素。2.濕是HSIL的基本病性證素,熱、陰虛、陽虛、血瘀為兼夾致病因素;HSIL的五臟病位證素肝為主,兼及脾、腎、心;肝經(jīng)濕熱證是HSIL最常見的證,脾虛證、腎陰虛夾濕證次之。3.HSIL宮頸病變可以是單個病灶,也可以是多點病灶,多點病灶可以累及多個坐標(biāo)方位。不同病位證素的HSIL病變可聚集于特定的某一象限、某一輪或某一區(qū)域。4.HSIL宮頸病變分區(qū)與五臟證素有關(guān),病變的坐標(biāo)、象限、輪數(shù)可用于HSIL望診。病變位于第一輪第7象限/病變位于左上象限/病變涉及兩輪及以上與病位在肝有關(guān);病變位于第一輪第11象限/病變位于右上象限/局限于第一輪與病位證素在脾有關(guān);病變位于宮頸管內(nèi)與病位在腎有關(guān)。
[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.

【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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