高危型人乳头瘤病毒感染与中医体质的相关性研究

【作者】 王琳；

【导师】 王清；

【作者基本信息】 北京中医药大学 ， 中医妇科学， 2015， 硕士

【摘要】 研究背景：据WHO统计,全球每年预计有493000例宫颈恶性肿瘤新发病例,大约有273000例患者死于宫颈癌,其中发展中国家占4/5以上。我国是宫颈癌的高发地区,平均每年有132300例宫颈癌患者,总发病率为27%。大量的研究资料表明持续的高危型人乳头瘤病毒(High risk human papillomavirus, HR-HPV)感染是导致宫颈高度上皮内瘤变,以及进一步发展为宫颈癌的重要危险因素。目前,中西医对HR-HPV感染的治疗并没有疗效可靠的治疗方法,因此对HR-HPV感染的治疗重在预防。而中医体质学说的发展,为我们研究疾病与人体的关系提供了新的思路,体质不仅是疾病发生的基础,而且又是决定疾病进展、变化、转归及预后的重要因素。因此,研究HR-HPV感染患者的体质及相关因素对宫颈病变及宫颈癌的防治是十分必要的。研究目的：通过收集调查HR-HPV持续感染人群及健康人群的基本资料及体质情况,试图从中医体质学的角度探讨影响HR-HPV感染的易感体质及相关因素,以期在HR-HPV感染的个体化诊疗、辨证施治及预防方面提供一定的帮助。研究方法：本课题采用病例对照的研究方法,结合宫颈高危型HPV-DNA PCR分型检测结果,筛选高危型HPV-DNA阳性的120例患者作为病例组,同时根据病例对照研究方法的原则选取120例无其他疾病且高危型HPV-DNA阴性的健康女性作为对照组,两组均填写基本情况调查表及《中医体质分类与判定自测表》,搜集研究对象的基本资料、计算其体质类型,建立Microsoft Excel数据库,使用SPSS 17.0统计软件进行统计学分析,并得出结论。研究结果：1.通过单因素分析得出HR-HPV持续感染患者与健康女性在受教育程度、工作压力、妊娠及流产次数、初次性生活年龄、性伴侣数、避孕方式、尿路感染、阴道炎、盆腔炎、吸烟、饮食偏嗜、肿瘤家族史等方面差异有统计学意义(P<0.05)。2. HR-HPV持续感染患者与健康女性体质分布存在显著性差异(P<0.01),HR-HPV持续感染阳性组患者的体质出现偏颇体质聚集现象,主要以阳虚质(36.67%)为主,健康对照组女性体质以平和质(72.5%)为主。研究结论：1HR-HPV持续感染与多种因素有关,平时应注意摄生调摄,清淡饮食,注意营养,忌食生冷,劳逸结合,适当参加体育运动,避免不健康的性行为,采取避孕套避孕,避免多次人流或刮宫,养成健康良好的行为生活方式。2. HR-HPV持续感染与中医体质类型有潜在的相关性,阳虚体质的女性更容易持续感染HR-HPV。因此,临床医师及患者在对HR-HPV感染的临床防治和日常调护过程中,应重视顾护阳气,提高机体抗病能力。更多还原

【Abstract】 Background:According to the statistics of WHO, there is an estimated 493,000 new cases of cervical invasive cancer each year in the world,273,000 patients died of cervical cancer, which more than 4/5 were in the developing countries[1].China is a high incidence area of cervical cancer, there is an average of 132,300 new cases every year, the total incidence was 0.27%.A lot of research data shows that sustained high-risk human papillomavirus infection is an important risk factor in the high-grade cervical intraepithelial neoplasia, and the further development of cervical cancer[3-4l At present, there is no reliable effect to the treatment of traditional Chinese and Western medicine of HR-HPV, therefore, HR-HPV infection focus on the prevention. While the development of the Constitution theory of traditional Chinese medicine (TCM) provides a new idea for us to study the relationship between disease and human body, Constitution is not only a key factor in the occurrence of the disease, but also an important factor in determining the course and outcome of disease progression. Therefore, studying the patient’s constitution and related factors of HR-HPV infection is very necessary in prevention and treatment of cervical lesions and cervical cancer.Objective:Through the collection of basic data and constitution of HR-HPV infected people, I try to discuss the influence of HR-HPV infection in constitution and related factors from the Constitution theory of TCM, in the hope of providing some help in individual treatment, syndrome differentiation and prevention of HR-HPV infection.Method:This subject adopts case-control study, combined with cervical high risk HPV-DNA PCR testing results, I screened 120 patients of HR-HPV-positive as case group, then select 120 healthy women without other disease and HR-HPV-negative as control group, these people all fill in basic situation questionnaire and "the classification and determination of TCM Constitution self-test table", so as to get the basic information and the constitution classification situation of research objects, establishing Microsoft Excel database, using SPSS 17.0 statistical software for statistical analysis,and draws the conclusion.Results:1.The univariate analysis shows that HR-HPV persistent infection is associated with the level of education, work pressure, pregnancy and abortion, age of first sex, contraception, urinary tract infection, vaginitis, pelvic inflammatory disease, smoking, diet habit, family history of cancer and other factors.2. There is a significant difference between the patients of HR-HPV persistent infection and healthy women’s constitution distribution (P< 0.01), the group of HR-HPV-positive appeared the phenomenon of biased constitution aggregation, mainly in the Yang deficiency type(34.17%) and the Qi deficiency type(14.17%), healthy women in control group are mostly Peace constitution (72.5%).Conclusion:l.HR-HPV persistent infection is associated with a variety of factors, we should pay attention to health adjustment, bland diet, nutrition, forbidding to eat raw and cold foodstuffs, mixing work with adequate rest, suitable for sports, take contraceptive condoms to avoid multiple abortion or curettage, develop a healthy way of life at ordinary times.2.There is a potential association between persistent HR-HPV infection and TCM constitution type, Yang deficiency and Qi deficiency of women are more vulnerable to persistent infection of HR-HPV. Therefore, clinicians and patients should pay attention to take care of Yang Qi in the process of clinical prevention, treatment and daily nursing.更多还原