食管癌高危人群舌象特征分析與應用探索
發(fā)布時間：2018-08-17 13:08
【摘要】：研究背景河北省磁縣是我國食管癌的高發(fā)區(qū),食管癌的發(fā)病率為91.5/10萬,明顯高于全國平均水平。2005年磁縣開始實施食管癌早診早治項目,針對當?shù)馗呶Ｈ巳?40-69歲)進行內(nèi)鏡普查,對發(fā)現(xiàn)可疑病變進行組織病理學檢查。然而,當?shù)厥彻馨┑陌l(fā)病率并沒有得到有效控制。中醫(yī)認為舌通過經(jīng)絡連接到人體內(nèi)部器官,器官條件、屬性和功能的變化可以通過觀察舌象被發(fā)現(xiàn),中醫(yī)舌診在食管癌篩查中的作用值得深入研究。第一部分：食管癌高危人群舌象特征分析目的分析食管癌高危人群不同病理診斷者之間舌象的差異,包括舌象顏色空間色值和舌象特征。方法在食管癌高發(fā)區(qū)河北省磁縣納入篩查者3053例,依據(jù)病理及胃鏡診斷結果,分為正常組(包括炎癥組、非炎癥組)、食管低級別上皮內(nèi)瘤變組(以下稱食管低級別瘤變組)、食管高級別上皮內(nèi)瘤變組(以下稱食管高級別瘤變組)。收集篩查者的基本信息資料,利用舌面診測信息采集系統(tǒng)(DS01-B),采集提取篩查者的舌象顏色空間色值(包括HSV、Lab、RGB三種顏色空間色值)及舌象特征(包括舌體顏色、舌苔顏色、舌體胖瘦等共10項)。結果1.正常組、食管低級別瘤變組、食管高級別瘤變組間性別、年齡的整體分布可見明顯的統(tǒng)計學差異(P0.01)。2.在HSV顏色空間中,食管高級別瘤變組與正常組間S值比較,顯示出明顯的統(tǒng)計學差異(P0.05)。3.在Lab顏色空間中,正常組與食管低級別+高級別上皮內(nèi)瘤變組間b值比較,顯示出明顯的統(tǒng)計學差異(P0.05)。4.正常組、食管低級別瘤變組、食管高級別瘤變組間舌體瘀斑的整體分布可見明顯統(tǒng)計學差異(P0.01),舌體瘀斑在食管低級別瘤變組、食管高級別瘤變組中的比例,高于正常組。5.在正常組中,炎癥組與非炎癥組間舌體顏色整體分布可見明顯統(tǒng)計學差異(P0.01)。6.癌+癌前病變組與非炎癥組間舌體瘀斑的整體分布可見明顯統(tǒng)計學差異(P0.01)。結論正常組與食管低級別瘤變組、食管高級別瘤變組之間舌象特征具有差異,其中舌體瘀斑具有明顯統(tǒng)計學差異。第二部分：基于舌象特征的食管癌及癌前病變logistic回歸模型的建立與驗證目的利用舌象特征和性別、年齡,建立食管癌及癌前病變logistic回歸模型,分析食管癌及癌前病變的危險因素,探討食管癌的中醫(yī)病因病機及中醫(yī)證型,并進行模型在食管癌篩查中的應用探索。方法將納入研究的3883例篩查者,依據(jù)入組時間分為訓練組(3053例)及檢測組(830例)。將訓練組的舌象特征及性別年齡進行賦值,建立食管癌及癌前病變logistic回歸模型,并通過檢測組驗證模型的準確性。結果1. Logistic回歸分析顯示,紅舌、舌體瘀斑、黃白相兼苔是食管癌的高危因素。2. Logistic回歸模型的內(nèi)部診斷特異性為72.80%,敏感性為61.60%,總符合率為72.3%。外部診斷特異性為80.35%,敏感性為63.41%,總符合率為79.51%。結論基于舌象特征、性別、年齡建立的食管癌logistic回歸模型,發(fā)現(xiàn)舌象特征中的紅舌、舌體瘀斑、黃白相兼苔是食管癌及癌前病變的高危因素,將模型用于檢驗食管癌高危人群,與病理診斷間有較高的符合率。
[Abstract]:Background Cixian County, Hebei Province, is a high incidence area of esophageal cancer in China. The incidence of esophageal cancer is 91.5/100,000, which is significantly higher than the national average. In 2005, Cixian began to implement the project of early diagnosis and treatment of esophageal cancer. Endoscopic screening was carried out for the local high-risk population (40-69 years old) and the suspicious lesions were detected by histopathological examination. The incidence of esophageal cancer has not been effectively controlled. Traditional Chinese medicine holds that the tongue is connected to the internal organs, organ conditions, attributes and functions of the human body through meridians and collaterals. The role of tongue diagnosis in esophageal cancer screening deserves further study. Part I: Analysis of tongue characteristics in high-risk groups of esophageal cancer. Methods A total of 3053 cases were screened in Cixian County of Hebei Province, a high-risk area of esophageal cancer, and were divided into normal group (including inflammation group, non-inflammation group) and low-grade esophageal intraepithelial neoplasia group (hereinafter referred to as feeding group). The basic information of screeners was collected, and the tongue color space color values (including HSV, Lab, RGB) and tongue features (including tongue color) were collected and extracted by the tongue diagnosis information collection system (DS01-B). Results 1. There were significant differences in sex and age distribution among the normal group, low grade esophageal neoplasia group and high grade esophageal neoplasia group (P 0.01). 2. In the HSV color space, the S value between the high grade esophageal neoplasia group and the normal group was significantly different (P 0.05). 3. In Lab, there were significant differences in the S value between the high grade esophageal neoplasia group and the normal group (P 0.05). In color space, there were significant differences in B values between normal group and esophageal low-grade + high-grade intraepithelial neoplasia group (P 0.05). 4. There were significant differences in the overall distribution of tongue ecchymosis between normal group, esophageal low-grade neoplasia group and esophageal high-grade neoplasia group (P 0.01). The proportion of high-grade neoplasia group was higher than that of the normal group. 5. In the normal group, the overall distribution of tongue color between inflammation group and non-inflammation group was significantly different (P 0.01). 6. The overall distribution of tongue ecchymosis between cancer + precancerous lesion group and non-inflammation group was significantly different (P 0.01). There were significant differences in tongue features between the high-grade canal neoplasia group and the tongue ecchymosis group. Part 2: Establishment and validation of logistic regression model of esophageal cancer and precancerous lesions based on tongue features Objective To establish logistic regression model of esophageal cancer and precancerous lesions by using tongue features and gender, age, and analyze food intake. Methods 3883 cases of esophageal cancer screening were divided into training group (3053 cases) and testing group (830 cases) according to the time of enrollment. Results 1. Logistic regression analysis showed that red tongue, tongue ecchymosis, yellow and white fur were the high risk factors of esophageal cancer. 2. Logistic regression model had 72.80% specificity, 61.60% sensitivity and 72.3% overall coincidence rate. The diagnostic specificity was 80.35%, the sensitivity was 63.41%, and the total coincidence rate was 79.51%. There was a high coincidence rate between the two diagnoses.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R735.1
[Abstract]:Background Cixian County, Hebei Province, is a high incidence area of esophageal cancer in China. The incidence of esophageal cancer is 91.5/100,000, which is significantly higher than the national average. In 2005, Cixian began to implement the project of early diagnosis and treatment of esophageal cancer. Endoscopic screening was carried out for the local high-risk population (40-69 years old) and the suspicious lesions were detected by histopathological examination. The incidence of esophageal cancer has not been effectively controlled. Traditional Chinese medicine holds that the tongue is connected to the internal organs, organ conditions, attributes and functions of the human body through meridians and collaterals. The role of tongue diagnosis in esophageal cancer screening deserves further study. Part I: Analysis of tongue characteristics in high-risk groups of esophageal cancer. Methods A total of 3053 cases were screened in Cixian County of Hebei Province, a high-risk area of esophageal cancer, and were divided into normal group (including inflammation group, non-inflammation group) and low-grade esophageal intraepithelial neoplasia group (hereinafter referred to as feeding group). The basic information of screeners was collected, and the tongue color space color values (including HSV, Lab, RGB) and tongue features (including tongue color) were collected and extracted by the tongue diagnosis information collection system (DS01-B). Results 1. There were significant differences in sex and age distribution among the normal group, low grade esophageal neoplasia group and high grade esophageal neoplasia group (P 0.01). 2. In the HSV color space, the S value between the high grade esophageal neoplasia group and the normal group was significantly different (P 0.05). 3. In Lab, there were significant differences in the S value between the high grade esophageal neoplasia group and the normal group (P 0.05). In color space, there were significant differences in B values between normal group and esophageal low-grade + high-grade intraepithelial neoplasia group (P 0.05). 4. There were significant differences in the overall distribution of tongue ecchymosis between normal group, esophageal low-grade neoplasia group and esophageal high-grade neoplasia group (P 0.01). The proportion of high-grade neoplasia group was higher than that of the normal group. 5. In the normal group, the overall distribution of tongue color between inflammation group and non-inflammation group was significantly different (P 0.01). 6. The overall distribution of tongue ecchymosis between cancer + precancerous lesion group and non-inflammation group was significantly different (P 0.01). There were significant differences in tongue features between the high-grade canal neoplasia group and the tongue ecchymosis group. Part 2: Establishment and validation of logistic regression model of esophageal cancer and precancerous lesions based on tongue features Objective To establish logistic regression model of esophageal cancer and precancerous lesions by using tongue features and gender, age, and analyze food intake. Methods 3883 cases of esophageal cancer screening were divided into training group (3053 cases) and testing group (830 cases) according to the time of enrollment. Results 1. Logistic regression analysis showed that red tongue, tongue ecchymosis, yellow and white fur were the high risk factors of esophageal cancer. 2. Logistic regression model had 72.80% specificity, 61.60% sensitivity and 72.3% overall coincidence rate. The diagnostic specificity was 80.35%, the sensitivity was 63.41%, and the total coincidence rate was 79.51%. There was a high coincidence rate between the two diagnoses.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R735.1
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