基于络病理论探讨VEGF、MVD、LVD与子宫内膜癌的相关性的研究
摘要
研究目的：
1、通过对络病理论的文献整理,结合子宫内膜组织血供丰富、代谢旺盛的特点以及女性特殊的生理病理特点,首次提出基于络病理论的子宫内膜癌病机。
2、通过回顾性研究218例子宫内膜增生及子宫内膜癌病例的中医四诊资料及临床资料,分析子宫内膜增生及子宫内膜癌的中医证型分布规律。
3、通过测定47例子宫内膜非典型增生及子宫内膜癌病理组织的血管内皮生长因子(VEGF)、微血管密度(MVD,以CD105标记)和微淋巴管密度(LVD,以D2-40标记),探讨其在子宫内膜非典型增生与子宫内膜癌中的表达规律。
4、通过测定子宫内膜非典型增生及子宫内膜癌VEGF、MVD、LVD,探讨其与中医证型间的相关性,以及与临床分期、组织学分级及肌层浸润的相关性,初步探索基于络病理论的子宫内膜癌病机的实验基础。
研究方法：
1、文献整理：分别以“络病理论”、“络病”、“络脉”、“络”、“肿瘤”、“癌”、“妇科”、“胞络”、“子宫内膜癌”、"Endometrial carcinoma""tumor"、"cancer/carcinoma"、"TCM collateral disease theory"、"collateral disease"、"collateral"为关键词,检索出符合要求的文献,通过文献整理,总结络病理论在肿瘤防治的应用前景和VEGF与子宫内膜癌的相关性。
2、理论研究：分别以“络病理论”、“络病”、“络”、“子宫内膜癌”“病机”、“胞络”为关键词,检索符合要求的文献,结合子宫内膜血供丰富、代谢旺盛的特点和女性特殊生理病理的特点,提出基于络病理论的子宫内膜癌病机。
3、回顾性分析2]8例子宫内膜增生及子宫内膜癌病例的中医四诊资料,分析总结中医证型分布。
4、用免疫组化的方法测定子宫内膜非典型增生和子宫内膜癌病理组织的VEGF、MVD、LVD,分析其在两者中表达的规律；
5、根据VEGF、MVD、LVD检测结果,研究其与中医证型和临床分期、组织学分级及肌层浸润的相关性。
研究结果：
1、根据络病理论,结合子宫内膜的特点和女性特殊的生理病理特点,提出基于络病理论的子宫内膜癌病机为胞络虚滞、(火)毒损胞络、络息成积。
2、218例子宫内膜增生及子宫内膜癌病例的中医证型可分为气虚证、血热证、血瘀证和湿毒瘀结证。随着子宫内膜单纯性增生、复杂性增生、子宫内膜非典型增生向子宫内膜癌的进展,气虚证所占比例逐渐减少,血瘀证、血热证比例逐渐升高,在子宫内膜癌病例中并开始出现湿毒瘀结证。在子宫内膜良性病变中,虚证表现突出,其中以肾虚和脾虚为主。在子宫内膜非典型增生及内膜癌病例中,血瘀和血热的表现比虚证的表现更加突出。
3、测定子宫内膜癌病理组织的VEGF、MVD、LVD,结果显示测定值均高于子宫内膜非典型增生病例,具有统计学意义
4、测定子宫内膜非典型增生和子宫内膜癌病理组织的VEGF、MVD和LVD。结果显示：不同中医证型其测定值不同。湿毒瘀结证中三者测定值均为最高。VEGF的表达以血热证中含量最低,其次为气虚证、血瘀证。MVD及LVD的表达均以气虚证最低,湿毒瘀结证最高；前者血热证高于血瘀证,后者血瘀证高于血热证。结合临床病理情况分析,三者的测定值还与临床分期、组织学分级、肌层浸润情况相关。
结论：
1、基于络病理论的子宫内膜癌病机为胞络虚滞、(火)毒损胞络和络息成积。其中,胞络虚滞为始动因素,(火)毒损胞络为根本原因,络息成积为关键环节。
2、子宫内膜增生及子宫内膜癌中医证型可以分为气虚证、血热证、血瘀证和湿毒瘀结证。在子宫内膜良性病变中,虚证表现突出,气虚中又以肾虚为主,其次为脾虚。而在癌前病变及癌变后,血瘀和血热的表现比虚证表现明显；在癌变后,出现了湿毒瘀结证。提示在子宫内膜良性病变治疗中,应以补气扶正为主。在子宫内膜非典型增生及子宫内膜癌治疗中,应注意解毒化瘀通络,同时辅以补气扶正。解毒通络和化瘀通络的选择根据证型中热毒与瘀血所占比重而有所侧重。
3、在子宫内膜癌病例中,VEGF、MVD及LVD的表达高于子宫内膜非典型增生的病例,提示子宫内膜癌的血管生成及淋巴管生成比子宫内膜非典型增生显著,具有统计学意义。
4. VEGF、MVD、LVD的表达在湿毒瘀结证中均为最高,之后由高到低依次为VEGF—血瘀证、气虚证和血热证；MVD—血热证、血瘀证和气虚证；LVD—血瘀证、血热证和气虚证。提示在临床治疗中,应根据辨证选用通络的方法；不同证型对新生血管占优势还是新生淋巴管占优势有一定指导意义。VEGF、 MVD、LVD与临床分期、组织学分级和肌层浸润相关,三者联合可以作为子宫内膜癌生长、转移和预后的重要指标。
Objective:
Endometrial carcinoma (EC) is one of the common female malignant tumors in female reproductive duct. Statistical data have shown that incidence of EC is getting more common while onset age are getting much younger. In some countries, the incidence of endometrial carcinoma lines the first in female malignant tumors. Recent years, epidemiological studies have found that5%of EC patients were und-er40years old, and19%were under45. With the prolonging human average life, the influence of EC to female life quality and healthy is much more remarkable than ever. There are two pathological types in EC. Typel has a slow progression and better therapeutic effect. Early detection and early therapy could significantly promote life quality and survival time. How to improve the early detection, early therapy and prognosis prediction of EC had already became a Imminent problem for gynecologist, and could have remarkable influnce to EC patient as well.
Most of TCM research in EC were focused on the therapy method,as well as the effective medicines and their monomers, especially on the adjuvant therapy; few were interest in TCM sydromes types; none in TCM pathogenesis. After the documents systematization and theoretical probe in "TCM Collateral Disease" theory, considering the characteristic of blood supply and metabolism in EC, combined with female pathological and physiological characteristic; we conclude the pathogenesis of EC as "Deficiency and stagnation in uterine collaterals""Uterine collaterals injured by toxins"."The masses obstruction of collaterals " A retrospective research was hold in218cases with endometrial hyperplasia diseases and EC, to analyze and summarize the distribution of TCM syndromes. A research was hold in47cases of endometrial atypical hyperplasia and EC diagnosed by pathology. After detecting the tissue level of VEGF、MVD、LVD, we evaluate and analyze their expression in pathological tissue to find their relativity with TCM syndromes and provide the experimental basis on "TCM Collateral Disease"; explore the correlation between the value of MVD. LVD and clinical stages、histological grade、myometrial invasion condition.
Methods:
1. Documents systematization and theoretical probe: Document Retrieval using "TCM collateral disease theory"、"collateral disease"、"collateral"、"tumor"、"cancer/carcinoma"、"Gynecology""uterine collateral" as key words, summarize the pathophysiological changes of EC in TCM collateral disease theory.
2. To analyze and summarize the distribution of TCM syndromes, a retrospective research was hold in218cases with endometrial hyperplasia diseases and EC.
3. A research was hold in47cases of endometrial atypical hyperplasia and EC diagnosed by pathology. After detecting the tissue level of VEGF、MVD、LVD, we evaluate and analyze their expression in pathological tissue to find their relativity with TCM syndromes; explore the correlation between the expression value of MVD、LVD and clinical stages、histological grade、myometrial invasion condition
Results:
1. With the rapid progression of "TCM collateral disease" theory, the theory has great contribution in cardio-cerebrovascular disease. Also in tumor prevention and cure, the theory focused in Inhibitory effects on tumor angiogenesis, endothelial cell-targeted therapy and prevention on the happening of the drug resistance. Based on the TCM collateral disease theory, combined with the female physiological characteristics and EC pathophysiological specialisity, we conclude the pathogenesis of EC as "Deficiency and stagnation in uterine collaterals"、"Uterine collaterals injured by toxins"、"The masses obstruction of collaterals"
2. The TCM syndromes of218cases varied in4syndromes:"qi deficiency""blood-heat"、"blood stasis"、"accumulation of damp toxins". With developing progress of endometrial hyperplasia diseases from hyperplasia to carcinoma, the proportion of "qi deficiency" decreased, the proportion of "blood-heat" and "blood stasis" increased;"accumulation of damp toxins" finally emerges in EC Defiency syndromes are the major syndromes in Endometrial benign lesion, and most of them are "kidney deficiency" and "spleen deficiency"."Blood-heat" and "blood stasis" are the major sydromes both in endometrial atypical hyperplasia and EC, as well as the difiency sydromes were less common
3. The expression value and positive proportion of VEGF、MVD and LVD in EC are higher than those in endometrial atypical hyperplasia, with statistical significance.
4. In the47cases of endometrial atypical hyperplasia and EC, the highest value of VEGF、MVD and LVD can be seen in "accumulation of damp toxins" syndrome."Blood-heat" has the lowest VEGF level, followed by "qi deficiency" and "blood stasis". The expression level of MVD and LVD lines the lowest in "qi deficiency", and highest in "accumulation of damp toxins". The level of MVD is much higher in "Blood-heat" than "blood stasis"; but LVD is on the contrary. Correlations also can be found between the value of MVD、LVD and clinical stages、histological grade、myometrial invasion condition.
Conclusion:
1. Based on the TCM collateral disease theory, combined with the female physiological characteristics and EC pathophysiological specialicity, we conclude the pathogenesis of EC as "Deficiency and stagnation in uterine collaterals"" Uterine collaterals injured by toxins" and " The masses obstruction of collaterals"."Deficiency and stagnation in uterine collaterals" is the initial factor;"Uterine collaterals injured by toxins" is the fundamental cause; and "The masses obstruction of collaterals" is the key link.
2."Qi deficiency"、"Blood-heat"、"Blood stasis"、"Accumulation of damp toxins" are the four TCM syndromes in endometrial hyperplasia and EC."Qi deficiency" are the major syndromes in endometrial benign lesions, and most of them are "kidney deficiency", followed by "spleen deficiency". In non-endometrial benign lesions,"Blood-heat" and "Blood stasis" are the major syndromes instead of "Qi deficiency". The results indicate that "Invigorating qi and strengthening body resistance" could be a key method in endometrial benign lesions therapy."Detoxification"、"Clots Absorption"、"Dredging collaterals" combined with "Invigorating qi and strengthening body resistance" method could have much better curative effects in endometrial atypical hyperplasia and EC therapy. The therapy methods choose from "Detoxification and dredging collaterals" or "Clots absorption and dredging collaterals", are mostly depend on the proportion of "Blood-heat"、and "Blood stasis" in the very syndrome.
3. The expression level of VEGF、MVD and LVD are much higher in EC than in endometrial atypical hyperplasia. In the47cases of endometrial atypical hyperplasia and EC, the highest value of VEGF、MVD and LVD can be seen in "accumulation of damp toxins" syndrome; followed in order by "blood stasis""qi deficiency","blood-heat" on VEGF; followed in order by "blood stasis""blood-heat","qi deficiency" on MVD; and followed in order by "blood stasis","blood-heat","qi deficiency" on LVD."Dredging collaterals" could be an effective method in clinical therapy according to TCM syndrome differentiation. Combined analysis of MVD and LVD could precisely evaluate growth、metastasis and prognosis of EC.
1、通过对络病理论的文献整理,结合子宫内膜组织血供丰富、代谢旺盛的特点以及女性特殊的生理病理特点,首次提出基于络病理论的子宫内膜癌病机。
2、通过回顾性研究218例子宫内膜增生及子宫内膜癌病例的中医四诊资料及临床资料,分析子宫内膜增生及子宫内膜癌的中医证型分布规律。
3、通过测定47例子宫内膜非典型增生及子宫内膜癌病理组织的血管内皮生长因子(VEGF)、微血管密度(MVD,以CD105标记)和微淋巴管密度(LVD,以D2-40标记),探讨其在子宫内膜非典型增生与子宫内膜癌中的表达规律。
4、通过测定子宫内膜非典型增生及子宫内膜癌VEGF、MVD、LVD,探讨其与中医证型间的相关性,以及与临床分期、组织学分级及肌层浸润的相关性,初步探索基于络病理论的子宫内膜癌病机的实验基础。
研究方法：
1、文献整理：分别以“络病理论”、“络病”、“络脉”、“络”、“肿瘤”、“癌”、“妇科”、“胞络”、“子宫内膜癌”、"Endometrial carcinoma""tumor"、"cancer/carcinoma"、"TCM collateral disease theory"、"collateral disease"、"collateral"为关键词,检索出符合要求的文献,通过文献整理,总结络病理论在肿瘤防治的应用前景和VEGF与子宫内膜癌的相关性。
2、理论研究：分别以“络病理论”、“络病”、“络”、“子宫内膜癌”“病机”、“胞络”为关键词,检索符合要求的文献,结合子宫内膜血供丰富、代谢旺盛的特点和女性特殊生理病理的特点,提出基于络病理论的子宫内膜癌病机。
3、回顾性分析2]8例子宫内膜增生及子宫内膜癌病例的中医四诊资料,分析总结中医证型分布。
4、用免疫组化的方法测定子宫内膜非典型增生和子宫内膜癌病理组织的VEGF、MVD、LVD,分析其在两者中表达的规律；
5、根据VEGF、MVD、LVD检测结果,研究其与中医证型和临床分期、组织学分级及肌层浸润的相关性。
研究结果：
1、根据络病理论,结合子宫内膜的特点和女性特殊的生理病理特点,提出基于络病理论的子宫内膜癌病机为胞络虚滞、(火)毒损胞络、络息成积。
2、218例子宫内膜增生及子宫内膜癌病例的中医证型可分为气虚证、血热证、血瘀证和湿毒瘀结证。随着子宫内膜单纯性增生、复杂性增生、子宫内膜非典型增生向子宫内膜癌的进展,气虚证所占比例逐渐减少,血瘀证、血热证比例逐渐升高,在子宫内膜癌病例中并开始出现湿毒瘀结证。在子宫内膜良性病变中,虚证表现突出,其中以肾虚和脾虚为主。在子宫内膜非典型增生及内膜癌病例中,血瘀和血热的表现比虚证的表现更加突出。
3、测定子宫内膜癌病理组织的VEGF、MVD、LVD,结果显示测定值均高于子宫内膜非典型增生病例,具有统计学意义
4、测定子宫内膜非典型增生和子宫内膜癌病理组织的VEGF、MVD和LVD。结果显示：不同中医证型其测定值不同。湿毒瘀结证中三者测定值均为最高。VEGF的表达以血热证中含量最低,其次为气虚证、血瘀证。MVD及LVD的表达均以气虚证最低,湿毒瘀结证最高；前者血热证高于血瘀证,后者血瘀证高于血热证。结合临床病理情况分析,三者的测定值还与临床分期、组织学分级、肌层浸润情况相关。
结论：
1、基于络病理论的子宫内膜癌病机为胞络虚滞、(火)毒损胞络和络息成积。其中,胞络虚滞为始动因素,(火)毒损胞络为根本原因,络息成积为关键环节。
2、子宫内膜增生及子宫内膜癌中医证型可以分为气虚证、血热证、血瘀证和湿毒瘀结证。在子宫内膜良性病变中,虚证表现突出,气虚中又以肾虚为主,其次为脾虚。而在癌前病变及癌变后,血瘀和血热的表现比虚证表现明显；在癌变后,出现了湿毒瘀结证。提示在子宫内膜良性病变治疗中,应以补气扶正为主。在子宫内膜非典型增生及子宫内膜癌治疗中,应注意解毒化瘀通络,同时辅以补气扶正。解毒通络和化瘀通络的选择根据证型中热毒与瘀血所占比重而有所侧重。
3、在子宫内膜癌病例中,VEGF、MVD及LVD的表达高于子宫内膜非典型增生的病例,提示子宫内膜癌的血管生成及淋巴管生成比子宫内膜非典型增生显著,具有统计学意义。
4. VEGF、MVD、LVD的表达在湿毒瘀结证中均为最高,之后由高到低依次为VEGF—血瘀证、气虚证和血热证；MVD—血热证、血瘀证和气虚证；LVD—血瘀证、血热证和气虚证。提示在临床治疗中,应根据辨证选用通络的方法；不同证型对新生血管占优势还是新生淋巴管占优势有一定指导意义。VEGF、 MVD、LVD与临床分期、组织学分级和肌层浸润相关,三者联合可以作为子宫内膜癌生长、转移和预后的重要指标。
Objective:
Endometrial carcinoma (EC) is one of the common female malignant tumors in female reproductive duct. Statistical data have shown that incidence of EC is getting more common while onset age are getting much younger. In some countries, the incidence of endometrial carcinoma lines the first in female malignant tumors. Recent years, epidemiological studies have found that5%of EC patients were und-er40years old, and19%were under45. With the prolonging human average life, the influence of EC to female life quality and healthy is much more remarkable than ever. There are two pathological types in EC. Typel has a slow progression and better therapeutic effect. Early detection and early therapy could significantly promote life quality and survival time. How to improve the early detection, early therapy and prognosis prediction of EC had already became a Imminent problem for gynecologist, and could have remarkable influnce to EC patient as well.
Most of TCM research in EC were focused on the therapy method,as well as the effective medicines and their monomers, especially on the adjuvant therapy; few were interest in TCM sydromes types; none in TCM pathogenesis. After the documents systematization and theoretical probe in "TCM Collateral Disease" theory, considering the characteristic of blood supply and metabolism in EC, combined with female pathological and physiological characteristic; we conclude the pathogenesis of EC as "Deficiency and stagnation in uterine collaterals""Uterine collaterals injured by toxins"."The masses obstruction of collaterals " A retrospective research was hold in218cases with endometrial hyperplasia diseases and EC, to analyze and summarize the distribution of TCM syndromes. A research was hold in47cases of endometrial atypical hyperplasia and EC diagnosed by pathology. After detecting the tissue level of VEGF、MVD、LVD, we evaluate and analyze their expression in pathological tissue to find their relativity with TCM syndromes and provide the experimental basis on "TCM Collateral Disease"; explore the correlation between the value of MVD. LVD and clinical stages、histological grade、myometrial invasion condition.
Methods:
1. Documents systematization and theoretical probe: Document Retrieval using "TCM collateral disease theory"、"collateral disease"、"collateral"、"tumor"、"cancer/carcinoma"、"Gynecology""uterine collateral" as key words, summarize the pathophysiological changes of EC in TCM collateral disease theory.
2. To analyze and summarize the distribution of TCM syndromes, a retrospective research was hold in218cases with endometrial hyperplasia diseases and EC.
3. A research was hold in47cases of endometrial atypical hyperplasia and EC diagnosed by pathology. After detecting the tissue level of VEGF、MVD、LVD, we evaluate and analyze their expression in pathological tissue to find their relativity with TCM syndromes; explore the correlation between the expression value of MVD、LVD and clinical stages、histological grade、myometrial invasion condition
Results:
1. With the rapid progression of "TCM collateral disease" theory, the theory has great contribution in cardio-cerebrovascular disease. Also in tumor prevention and cure, the theory focused in Inhibitory effects on tumor angiogenesis, endothelial cell-targeted therapy and prevention on the happening of the drug resistance. Based on the TCM collateral disease theory, combined with the female physiological characteristics and EC pathophysiological specialisity, we conclude the pathogenesis of EC as "Deficiency and stagnation in uterine collaterals"、"Uterine collaterals injured by toxins"、"The masses obstruction of collaterals"
2. The TCM syndromes of218cases varied in4syndromes:"qi deficiency""blood-heat"、"blood stasis"、"accumulation of damp toxins". With developing progress of endometrial hyperplasia diseases from hyperplasia to carcinoma, the proportion of "qi deficiency" decreased, the proportion of "blood-heat" and "blood stasis" increased;"accumulation of damp toxins" finally emerges in EC Defiency syndromes are the major syndromes in Endometrial benign lesion, and most of them are "kidney deficiency" and "spleen deficiency"."Blood-heat" and "blood stasis" are the major sydromes both in endometrial atypical hyperplasia and EC, as well as the difiency sydromes were less common
3. The expression value and positive proportion of VEGF、MVD and LVD in EC are higher than those in endometrial atypical hyperplasia, with statistical significance.
4. In the47cases of endometrial atypical hyperplasia and EC, the highest value of VEGF、MVD and LVD can be seen in "accumulation of damp toxins" syndrome."Blood-heat" has the lowest VEGF level, followed by "qi deficiency" and "blood stasis". The expression level of MVD and LVD lines the lowest in "qi deficiency", and highest in "accumulation of damp toxins". The level of MVD is much higher in "Blood-heat" than "blood stasis"; but LVD is on the contrary. Correlations also can be found between the value of MVD、LVD and clinical stages、histological grade、myometrial invasion condition.
Conclusion:
1. Based on the TCM collateral disease theory, combined with the female physiological characteristics and EC pathophysiological specialicity, we conclude the pathogenesis of EC as "Deficiency and stagnation in uterine collaterals"" Uterine collaterals injured by toxins" and " The masses obstruction of collaterals"."Deficiency and stagnation in uterine collaterals" is the initial factor;"Uterine collaterals injured by toxins" is the fundamental cause; and "The masses obstruction of collaterals" is the key link.
2."Qi deficiency"、"Blood-heat"、"Blood stasis"、"Accumulation of damp toxins" are the four TCM syndromes in endometrial hyperplasia and EC."Qi deficiency" are the major syndromes in endometrial benign lesions, and most of them are "kidney deficiency", followed by "spleen deficiency". In non-endometrial benign lesions,"Blood-heat" and "Blood stasis" are the major syndromes instead of "Qi deficiency". The results indicate that "Invigorating qi and strengthening body resistance" could be a key method in endometrial benign lesions therapy."Detoxification"、"Clots Absorption"、"Dredging collaterals" combined with "Invigorating qi and strengthening body resistance" method could have much better curative effects in endometrial atypical hyperplasia and EC therapy. The therapy methods choose from "Detoxification and dredging collaterals" or "Clots absorption and dredging collaterals", are mostly depend on the proportion of "Blood-heat"、and "Blood stasis" in the very syndrome.
3. The expression level of VEGF、MVD and LVD are much higher in EC than in endometrial atypical hyperplasia. In the47cases of endometrial atypical hyperplasia and EC, the highest value of VEGF、MVD and LVD can be seen in "accumulation of damp toxins" syndrome; followed in order by "blood stasis""qi deficiency","blood-heat" on VEGF; followed in order by "blood stasis""blood-heat","qi deficiency" on MVD; and followed in order by "blood stasis","blood-heat","qi deficiency" on LVD."Dredging collaterals" could be an effective method in clinical therapy according to TCM syndrome differentiation. Combined analysis of MVD and LVD could precisely evaluate growth、metastasis and prognosis of EC.
引文
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