全身DWI监测乳腺癌术后患者随访期转移的中医辨证分型研究

The research of TCM syndrome classification for postoperative breast cancer with metastasis patients in follow-up period using whole-body magnetic resonance diffusion-weighted imaging

目的 ：评价DWI在监测乳腺癌术后随访期患者转移灶及指导临床治疗方面的应用价值,并探讨乳腺癌术后中医辨证分型与转移之间的关系。方法：回顾性分析行全身DWI的乳腺癌术后随访期患者159例,其中有病无证型29例,脾肾两虚证36例,气虚血瘀证45例,肝肾亏虚证49例,统计分析不同证型的转移情况。23例在首次检查后6~12个月内进行随访。结果：乳腺癌术后随访期气虚血瘀证者转移率高达31.1%（14/45）,有病无证型、脾肾两虚证、肝肾亏虚证的转移率分别为10.3%（3/29）、11.1%（4/36）和12.2%（6/49）,气虚血瘀证患者转移率与其他3型比较差异均有统计学意义（均P〈0.05）,随访期总的转移率为17.0%（27/159）。结论 ：全身DWI可监测并定期随访乳腺癌术后转移灶及指导临床综合治疗。乳腺癌术后患者随访期不同中医辨证分型与转移之间有一定关系,气虚血瘀证患者转移率最高,这一结论有助于通过中医辨证分型来预测乳腺癌预后及采用正确的治疗方案。

Objective：Evaluating the value of whole-body magnetic resonance diffusion-weighted imaging in monitoring postoperative breast cancer with metastasis patients in following-up period and in directing clinical treating. Discussing the relationship between the postoperative breast cancer with metastasis and the TCM syndrome classification. Methods：Retrospective analyzing159 postoperative breast cancer patients in following-up period from August 2009 to October 2012,including with disease and no syndrome syndrome（29cases）,vacuity of both the spleen and kidney syndrome（36cases）,blood stagnancy due to deficiency of QI syndrome（45cases）,vacuity of both the liver and kidney syndrome（49cases）. All the patients underwent whole-body magnetic resonance diffusion-weighted imaging examinations. The metastatic lesions of different TCM syndromes were summed up and analyzed. Results：For blood stagnancy due to deficiency of QI syndrome,the metastatic rate was 31.1% in following-up period;however,the metastatic rate of other three TCM syndromes were 10.3%,11.1% and 12.2%,respectively,（P〈0.05）. The total metastasis rate was 17.0%. We followed up 23 patients within 6 ~12 months after the first examination. Conclusion：The whole-body magnetic resonance diffusion-weighted imaging can monitor and follow up regularly metastasis of postoperative breast cancer patients in following-up period and could direct clinical treating. TCM syndrome classification has some relation with breast cancer metastasis. For Blood stagnancy due to deficiency of QI syndrome,the metastasis rate is the highest.,which can offer some useful enlightenment in predicting the prognosis under the guide of TCM syndrome classification and taking right therapeutic program.