HR-HPV感染及宫颈病变的中医证候规律研究

Study on traditional Chinese medicine syndrome regularity of HR-HPV infection and cervical lesions

关键词:  HR-HPV感染  宫颈病变  中医证候规律

Key words:  HR-HPV infection  cervical lesion  traditional Chinese medicine syndrome regularity

摘要:

[目的] 研究高危型人乳头瘤病毒（HR-HPV）感染及宫颈病变患者的中医证候演变规律，为HPV感染及宫颈病变的中医治疗提供证据支持。[方法] 纳入2020年9月—2022年8月就诊于天津中医药大学第二附属医院妇科门诊，存在HR-HPV感染并行阴道镜检查的患者943例，收集中医四诊信息，根据阴道镜后病理结果分为HPV感染组、低级别鳞状上皮内病变组（LSIL组）、高级别鳞状上皮内病变组（HSIL组），分析比较各组中医证候特征。[结果] HR-HPV感染及宫颈病变的主要病位占比为胞宫（76.78%），其次为肝（75.19%）、肾（42.52%）、脾（25.45%）；主要病性因素为湿（72.85%），其次为气滞（69.46%）、阴虚（65.32%）、血瘀（59.60%）、阳虚（52.92%）等。聚类分析结果：HPV感染组中医证型为湿滞胞宫证、肝郁气滞证、阴虚火旺证、肾阳气虚证、心脾两虚证；LSIL组为胞宫湿热证、肝郁气滞证、肾阳气虚证；HSIL组为湿热下注证、肝郁气滞证、脾肾两虚证。[结论] HR-HPV感染及宫颈病变多系湿邪为患，可参照带下病论治。本病核心病位在胞宫，合并肝脾肾多脏腑为病，病性因素以湿邪为主，呈现虚实错杂，正虚邪实的病理特点，情志为病是本病的重要特征。

Abstract:

[Objective] To study the evolution of traditional Chinese medicine（TCM） syndromes in patients with HR-HPV infection and cervical lesions，and provide evidence support for TCM treatment of HPV infection and cervical lesions. [Methods] 943 patients with HR-HPV infection and colposcopy were included in the gynecological clinic of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from September 2020 to August 2022. The information of the four diagnostic methods of traditional Chinese medicine was collected. According to the pathological results after colposcopy，they were divided into HPV infection group，LSIL group and HSIL group. TCM syndrome characteristics of each group were analyzed and compared. [Results] The main location of HR-HPV infection and cervical lesions was the uterus（76.78%），followed by liver（75.19%），kidney（42.52%） and spleen（25.45%）；The main pathogenic factor was dampness（72.85%），followed by qi stagnation（69.46%），yin deficiency（65.32%），blood stasis（59.60%） and yang deficiency（52.92%）. The results of cluster analysis showed that the TCM syndromes of HPV infection group were dampness stagnation in the uterus，liver depression and qi stagnation，yin deficiency and fire hyperactivity，kidney-yang and qi deficiency，and heart and spleen deficiency. In LSIL group，there were damp-heat syndrome in the uterus，liver depression and qi stagnation syndrome，kidney yang and qi deficiency syndrome；HSIL group was divided into damp-heat down-injection syndrome，liver-qi stagnation syndrome，spleen and kidney deficiency syndrome. [Conclusion] HR-HPV infection and cervical lesions are mostly caused by dampness，which can be treated with reference to the illness bellow the belt. The core area of this disease is located in the uterus. It is complicated with multiple viscera of liver，spleen and kidney. The pathogenic factors are mainly dampness and evil，presenting the pathological characteristics of deficiency and excess mixed，and positive deficiency and evil excess. Emotional illness is an important feature of this disease.