基于舌象大数据的早期食管鳞癌中医证候转化规律分析

Analysis on Transformation Rules of Traditional Chinese Medicine Syndromes of Early Esophageal Squamous Cell Carcinoma Based on Tongue Image Big Data

目的将食管癌高发区舌象筛查与内镜筛查相结合,分析食管癌变过程中不同病理状态下舌象特征,探索食管癌前病变向早期食管鳞癌转化的舌象特征规律及中医病机特点。方法纳入河北磁县、四川盐亭、山西阳城地区2017年—2021年完成内镜筛查及舌象筛查的18954例人群,使用道生舌诊仪(DS01-B)在统一标准的光源环境下提取12种舌象特征。使用SPSS 24.0软件进行数据分析,并通过多因素Logistic回归对多种混杂因素进行控制,比较食管癌前病变及早期食管癌与病理正常人群之间的舌象特征差异。结果舌象分布分析显示,紫舌在食管癌前病变及早期食管癌组的比例高于病理正常组,且其在早期食管癌组的比例高于食管癌前病变组,Logistic回归分析结果显示紫舌在食管癌前病变及早期食管癌组的OR值分别为1.82(95%CI:1.45~2.28,P<0.001)、2.14(95%CI:1.51~3.05,P<0.001);红舌与裂纹舌主要在癌前病变组占比较高,其在早期食管癌组的比例略低于癌前病变组,Logistic回归分析结果显示其OR值分别为1.44(95%CI:1.25~1.66,P=0.003)、1.49(95%CI:1.30~1.72,P<0.001)。将其他差异具有统计学意义的舌象特征纳入多因素Logistic回归分析后,结果与前面分析相一致。结论食管癌前病变组紫舌、红色与裂纹舌的比例均高于病理正常组,而早期食管癌组紫舌的比例高于食管癌前病变组,红色与裂纹舌的比例略低于食管癌前病变组,反映出食管癌变过程中由阴虚燥热向瘀血内阻转化的中医病机规律。

Objective Tongue images screening and endoscopic screening in areas with high incidence of esophageal cancer were combined to analyze the characteristics of tongue images under different physiological states in process of esophageal carcinoma carcinogenesis,and to explore the characteristics of tongue images and the pathogenesis of traditional Chinese medicine(TCM)in the transformation from precancerous lesions of esophagus to early esophageal squamous cell carcinoma.Methods A total of 18954 patients who completed endoscopic screening and tongue images screening from 2017 to 2021 in Cixian County of Hebei Province,Yanting County of Sichuan Province,and Yangcheng County of Shanxi Province were enrolled.Twelve tongue image features were extracted by Daosheng Tongue Diagnostic Instrument(DS01-B)under a unified standard light source environment.SPSS 24.0 software was used for data analysis,and multivariate Logistic regression was used to control multiple confounding factors.The differences of tongue image features of esophageal precancerous lesions,early esophageal cancers,and pathological normal subjects were compared.Results The distribution analysis of tongue images showed that the proportions of purple tongue in the esophageal precancerous lesion group and the early esophageal cancer group were higher than that in the pathological normal group,and its proportion in the early esophageal cancer group was higher than that in the esophageal precancerous lesion group.The logistic regression analysis results showed that the OR values of purple tongue in the esophageal precancerous lesion group and the early esophageal cancer group were 1.82(95%CI:1.45~2.28,P<0.001)and 2.14(95%CI:1.51~3.05,P<0.001),respectively.Red tongue and fissured tongue had high proportions in the precancerous lesion group,while the proportions in the early esophageal cancer group were slightly lower than those in the esophageal precancerous lesion group.Logistic regression analysis results showed that the OR values were 1.44(95%CI:1.25~1.66,P=0.003)and 1.49(95%CI:1.30-1.72,P<0.001),respectively.Other statistically significant tongue image features were incorporated into multivariate Logistic regression analysis,and the results were consistent with the previous analysis.Conclusion The proportions of purple tongue,red tongue,and fissured tongue in the esophageal precancerous lesion group were higher than those in the pathological normal group.The proportion of purple tongue in the early esophageal cancer group was higher than that in the esophageal precancerous lesion group,while the proportions of red tongue and fissured tongue were slightly lower than those in the esophageal precancerous lesion group,reflecting the TCM pathogenesis of the transformation from yin deficiency and drynessheat to blood stasis in the process of esophageal cancer.