“带下六证”辨析联合阴道镜检查甄别宫颈鳞状上皮内病变

Application of“Six Leukorrhagia-Syndrome”Discriminating Combined with Colposcopy Examination in Screening Cervical Squamous Intraepithelial Lesions

目的:回顾性分析宫颈鳞状上皮内病变(SIL)患者阴道镜检查表现及“带下六证”分布特征,探讨中西医诊断宫颈SIL的临床应用。方法:纳入154例宫颈SIL患者,根据病理结果分为低级别鳞状上皮内病变(LSIL)和高级别鳞状上皮内病变(HSIL),回顾性分析其阴道镜检查(转化区类型、一级征象、二级征象、非特异性征象)结果及“带下六证”(湿热、湿毒、血瘀、脾虚、肝郁、肾虚)的证素分布,探讨阴道镜检查结果、中医证素与活检病理结果的相关性。结果:LSIL组脾虚证频数最高,其次为湿热证;HSIL组脾虚证频数最高,其次为湿毒证(P<0.05)。LSIL组Ⅰ型转化区频数最高,其后依次为Ⅱ型转化区、Ⅲ型转化区;HSIL组Ⅱ型转化区频数最高,其后依次为Ⅰ型转化区、Ⅲ型转化区(P<0.05)。Logistic回归分析显示,厚醋白、粗镶嵌和脾虚湿毒证与HSIL的检出具有相关性(P<0.05),其余征象与HSIL的检出未见显著相关性(P>0.05)。结论:宫颈SIL患者,脾虚湿侵是基础,随着病变深入,湿热进展为湿毒。宫颈初筛异常转诊阴道镜检查,适时引入“带下六证”辨析,有利于协同预判宫颈病变程度,对于镜下Ⅰ、Ⅱ2型转化区,厚醋白、粗镶嵌的识别,以及脾虚湿毒证的辨析,可以指导阴道镜活检,提高HSIL检出率。中医药治疗宫颈SIL时,可考虑健脾化湿解毒之法。

Objective:According to a retrospective analysis of cervical squamous intraepithelial lesion(SIL)patients undergoing colposcopy examination and"Six Leukorrhagia-Syndrome"discriminating,to explore the clinical application of Chinese and western medicine in diagnosing cervical squamous intraepithelial lesion.Methods:Totally 154 cervical SIL patients were divided into low-grade squamous intraepithelial lesion(LSIL)group and high-grade squamous intraepithelial lesion(HSIL)group based on the pathological results.The results of colposcopy examination(transformation zone type,primary sign,secondary sign and non-specific sign)and the distribution of"Six Leukorrhagia-Syndrome"(dampness-heat,dampness-toxin,blood stasis,spleen deficiency,liver depression and kidney deficiency)elements were retrospectively analyzed,to explore the correlation among colposcopy examination,TCM syndrome elements and pathological results of biopsy.Results:The frequency of spleen deficiency was the highest in LSIL group,followed by dampness-heat syndrome,and the frequency of spleen deficiency syndrome was the highest in HSIL group,followed by dampness-toxin syndrome(P<0.05).In LSIL group,the frequency of typeⅠtransformation zone was the highest,followed by typeⅡand typeⅢtransformation zone,and in the HSIL group,the frequency of typeⅡtransformation zone was the highest,followed by typeⅠand typeⅢtransformation zone successively(P<0.05).Logistic regression analysis showed that HSIL detection was correlated with thick vinegar white,rough mosaic and spleen deficiency dampness-toxin syndrome(P<0.05),while no significant correlation was found between other signs and HSIL detection(P>0.05).Conclusion:Spleen deficiency and dampness invasion were the basis in patients with cervical SIL,and with the development of the disease,damp-heat developed into dampness-toxin.It was conducive to the prediction of the degree of cervical lesions if combined with"Six Leukorrhagia-Syndrome"discriminating timely,while referral to colposcopy examination for abnormal cervical screening.It can guide colposcopy biopsy and improve HSIL detection rate in valid identified typeⅠandⅡtransformation zone,thick vinegar white,rough mosaic under the microscope,as well as spleen deficiency dampnesstoxin syndrome.The method of invigorating spleen,reducing dampness and detoxifying detoxification may be considered in the treatment of cervical SIL with traditional Chinese medicine.