高级别宫颈上皮内瘤变锥切术前后中医证候演变规律

Evolution of TCM syndromes before and after Conization of High-Grade CIN

目的:探讨高级别宫颈上皮内瘤变(CIN)宫颈锥切术前后中医证候演变与治疗结局关系。方法:组织病理学确诊为CIN 3,首次行宫颈锥切治疗且切缘阴性的患者,术后规范随访2年(1、3、6、12、24个月)至随访终点(复发、治愈)。随访时行中医证候分析、阴道镜表征调研,比较复发组与治愈组随时段证候演变情况。结果:复发组与治愈组比较,中医证候术前及术后3个月分布差异无统计学意义(P> 0.05),为脾虚湿热证、肝郁湿热证、阴虚夹湿热证。术后6个月两组证候分布有统计学差异(P <0.05)。至治疗结局,两组的证候分布有统计学差异(P <0.001),复发组与术前相比差异无统计学意义(P> 0.05),治愈组与术前相比有统计学差异(P <0.001),其中正常证候者为主占92.11%,肾阴虚证占7.89%。结论:CIN证候是湿热为主兼夹脾虚、肝郁、肾虚。湿热盘踞是CIN复发的标志,随时段证候发生湿热祛除演变是CIN良性结局的标志。

Objective:To investigate the relationship between the evolution of TCM syndromes and prognostic outcome of high-grade cervical intraepithelial neoplasia(CIN) before and after cervical conization. Methods:The patients who were diagnosed as CIN 3 by histopathology and underwent cervical conization for the first time with negative margin were followed up for 2 years(1 month,3 months,6 months,12 months and 24 months)to the end point(recurrence or cure). During the follow-up,TCM syndrome analysis and colposcopy characterization investigation were carried out to compare the evolution at different time point between the recurrence group and the cure group. Results:There was no statistical difference in TCM syndrome distribution between the recurrence group and the cure group before the operation and at 3 months after the operation(P > 0. 05),the syndrome types were Spleen deficiency and damp-heat,Liver depression and damp-heat,as well as Yin deficiency and damp-heat. There was a significant difference in TCM syndrome distribution between the two groups at 6 months after the operation(P < 0. 05). There was a significant difference in the TCM syndrome distribution between the two groups at the end of follow-up(P < 0. 001).There was no statistical difference in the TCM syndrome distribution between before the operation and at the end point in the recurrence group(P > 0. 05);however the difference could be seen in the cure group(P < 0. 001).The patients with normal syndrome accounted for 92. 11%,and the patients with Kidney-Yin deficiency accounted for 7. 89%. Conclusion:Damp-heat syndrome is the main TCM syndrome of CIN,combined with Spleen deficiency,Liver depression or Kidney deficiency. The disappearance of damp-heat with time changes is a sign of benign outcome of CIN.