广东地区结直肠腺瘤性息肉伴上皮内瘤变患者中医证候规律研究OA

Objective:To explore the distribution of traditional Chinese medicine syndrome patterns in patients with colorectal adenomatous polyps and intraepithelial neoplasia in Guangdong region.Methods:A statistical analysis was conducted on 635 cases of colorectal adenomatous polyps and intraepithelial neoplasia treated at Guangdong Provincial Hospital of Chinese Medicine from January 2013 to January 2019.According to the pathological type of polyps,patients were divided into a high-grade group(288 cases)and a low-grade group(347 cases).The distribution of syndrome elements and syndrome types was compared between the two groups.Results:①Distribution of traditional Chinese medicine syndrome elements:A total of 134 syndrome elements in the low-grade group and 165 in the high-grade group were extracted for analysis.There was no significant difference in the distribution of disease location elements between the two groups(P＞0.05).There was a significant difference in the distribution of excess syndrome elements between the two groups(P＜0.05).In the low-grade group,dampness was the most common,followed by blood stasis and qi stagnation;in the high-grade group,dampness was also the most common,followed by blood stasis,pus,qi stagnation,and toxin.There was no significant difference in the distribution of deficiency syndrome elements between the two groups(P＞0.05).In both groups,qi deficiency was the most common,followed by yin deficiency and qi sinking,while yang deficiency was the least common.②Association analysis of syndrome elements:In the low-grade group,the disease location elements spleen,stomach,and large intestine were closely associated with the disease nature elements dampness,qi stagnation,and blood stasis.Under second-order association rules,the highest support was large intestine → dampness,followed by stomach → dampness,spleen → dampness,large intestine → qi stagnation,large intestine → blood stasis,and large intestine → yin deficiency,among others.Under third-order association rules,the highest support was large intestine → qi stagnation+dampness,followed by large intestine → blood stasis+dampness,large intestine → yin deficiency+dampness,and large intestine → heat+dampness.In the high-grade group,the disease location elements spleen and large intestine were closely associated with the disease nature elements dampness,qi deficiency,and blood stasis.Under second-order association rules,the highest support was large intestine → dampness,followed by spleen → dampness,stomach → dampness,lower abdomen → dampness,large intestine → blood stasis,large intestine → qi deficiency,and large intestine → qi stagnation.Under third-order association rules,the highest support was large intestine → blood stasis+dampness,followed by large intestine → pus+dampness,large intestine → qi deficiency+dampness,and large intestine → qi stagnation+dampness.③ Cluster analysis of syndrome elements:In the low-grade group,clustering phenomena included qi stagnation with large intestine and spleen with qi deficiency,corresponding to the syndromes of qi stagnation in the large intestine and spleen qi deficiency.In the high-grade group,clustering phenomena included lower abdomen with qi stagnation,large intestine with pus,and spleen with qi deficiency,corresponding to the syndromes of qi stagnation in the lower abdomen,pus accumulation in the large intestine,and spleen qi deficiency.Conclusion:The primary disease location of colorectal polyps is the large intestine,with dampness as the main excess pathogen and qi deficiency as the main deficiency syndrome.The excess pathogenesis of high-grade intraepithelial neoplasia differs from that of low-grade,characterized by internal obstruction of dampness and turbidity,which over time transforms into stasis,pus,and toxin.Blood stasis may be an important factor in polyp carcinogenesis.Through cluster analysis,the low-grade group can be categorized into two syndromes:qi stagnation in the large intestine and spleen qi deficiency,while the high-grade group can be categorized into three syndromes:qi stagnation in the lower abdomen,pus accumulation in the large intestine,and spleen qi deficiency.This suggests that with disease progression,the affected disease locations increase,and the severity of the condition worsens.