组织细胞坏死性淋巴结炎中医证型与病理分型的相关性研究

The correlations between traditional Chinese medicine syndromes of histiocytic necrotizing lymphadenitis and its pathological types

目的分析组织细胞坏死性淋巴结炎(histiocytic necrotizing lymphadenitis,HNL)患者的中医证型与病理分型的相关性,以发现其分布规律。方法对符合标准的166例HNL患者的基线资料、中医四诊信息及临床特征等进行中医证候判别;行完整淋巴结活检以病理组织学确诊,进行病理分型;采用多因素方差分析对HNL患者中医证型与病理分型进行相关性分析。结果166例HNL患者中,属风热痰毒证96例(57.83%)、热毒壅盛证57例(34.34%)、痰瘀互结证13例(7.83%);病理分型为增生型96例(57.83%)、坏死型59例(35.54%)、黄色瘤样型11例(6.63%)。临床特征资料显示,3种中医证型的靶淋巴结最大径、疼痛评分、体温比较,差异均有统计学意义(F值分别为3.737、34.484、34.805,P值均<0.05);WBC比较,差异无统计学意义(F=1.194,P>0.05)。3种病理分型的靶淋巴结疼痛评分、体温比较,差异均有统计学意义(F值分别为12.153、25.931,P值均<0.05);靶淋巴结最大径、WBC比较,差异无统计学意义(F值分别为2.249、0.671,P值均>0.05)。对应分析结果显示,风热痰毒证与增生型、热毒壅盛证与坏死型的点集合基本重合,痰瘀互结证与黄色瘤样型的点集合最接近(χ^2=235.100,P<0.001)。结论HNL的3种中医证型与病理分型存在一一对应关系,其中,风热痰毒证病理学改变多倾向于增生型,热毒壅盛证多倾向于坏死型,痰瘀互结证多倾向于黄色瘤样型。

Objective To investigate the interaction between traditional Chinese medicine(TCM)syndromes of histiocytic necrotizing lymphadenitis(HNL)and pathological types of HNL,so as to discover the distribution rule of TCM syndromes for indiction of intervention of HNL.Methods A total of 166 patients with HNL were included.The baseline data of the patients,clinical feature,the four diagnosis information of TCM and histopathological of cervical lymph node were collected.The syndromes of TCM were judged.The pathological types were confirmed by cervical lymph node biopsy.The Multi-way ANOVA was used to analyze the correlation between traditional Chinese medicine syndromes of HNL and its pathological types.Results Among the 166 patients,the ratio of different types are as follow:wind-heat and phlegm-toxin syndrome(57.83%,96/166),heat-toxin exuberance syndrome(34.34%,57/166),and phlegm and blood stasis syndrome(7.83%,13/166).The pathological types include proliferative type(57.83%,96/166),necrotizing type(35.54%,59/166),and xanthomatous type(6.63%,11/166).There were significant differences in targeted lymph node diameter,pain scores,body temperature(F value were 3.737,34.484,34.805,all Ps<0.05),while the difference of WBC(F=1.194,P>0.05)among three TCM Syndrome types were notsignificant.There were significant differences in pain scores,body temperature(F value were 12.153,25.931,all Ps<0.05),but not for the targeted lymph node diameter,WBC(F value were 2.249,0.671,all Ps>0.05)among three pathological types.The corresponding analysis result showed that,on point sets,wind-heat and phlegm-toxin syndrome were correlated with proliferative type,heat-toxin exuberance syndrome correlated with necrotizing type,and phlegm and blood stasis syndrome correlated with xanthomatous type(χ^2=235.100,P<0.001).Conclusions There is a close correlation between syndrome types of TCM and pathological types of HNL.The pathological change of wind-heat and phlegm-toxin syndrometends toproliferative type,heat-toxin exuberance syndrome tends to necrotizing type,and phlegm and blood stasis syndrome tends to xanthomatous type.