Correlation between immunohistochemical indicators and traditional Chinese medicine syndrome differentiation in localized high-risk prostate cancer
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摘要:
目的 探讨局部高危前列腺癌患者的免疫组织化学指标与中医证型的相关性。 方法 选取2019年1月至2019年12月于天津中医药大学第一附属医院和天津医科大学总医院确诊的50例局部高危前列腺癌患者的临床资料，采用神经内分泌细胞的标记物嗜铬粒蛋白 A（CgA）和突触素（Syn）及标志增殖细胞活性的Ki-67指数等免疫组织化学法指标，根据患者舌苔脉象，结合局部和全身症状进行临床中医辨证分型分析。 结果 局部高危前列腺癌患者的免疫组织化学指标表达情况中，Ki-67指数增高为最常见情况（P<0.05）。50例患者中，湿热蕴结证及肝肾阴虚证为最常见证型（P<0.05）。湿热蕴结证与Ki-67指数增高、CgA阳性具有相关性，瘀毒内结证与Ki-67指数增高、Syn阳性亦具有相关性，提示两证型预后较差（均P<0.05）。 结论 辨证为湿热蕴结证和瘀毒内结证的局部高危前列腺癌患者，肿瘤组织中多存在神经内分泌分化倾向，且细胞增殖活性较高，肿瘤恶性程度增加，增殖迅速，更易进展为激素非依赖性前列腺癌，从而耐受内分泌治疗。在西医内分泌治疗的基础上，应尽早结合中医辨证情况，充分发挥中医药辨证论治的优势，尽可能延缓疾病进展。 Abstract:Objective To explore the correlation between immunohistochemical indicators and traditional Chinese medicine (TCM) syndrome differentiation in localized high-risk prostate cancer. Methods The clinical data of 50 patients with localized high-risk prostate cancer undergoing treatment at the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine and the Tianjin Medical University General Hospital between January and December 2019 were collected. Immunohistochemical indicators such as chromogranin A (CgA) and synaptophysin (Syn), which are markers of neuroendocrine cells, and the Ki-67 index, which is a marker of proliferative cell activity, were used to analyze the clinical TCM syndrome differentiation based on the tongue coating and pulse symptoms of patients, combined with local and systemic symptoms. Result In patients with localized high-risk prostate cancer, an increased Ki-67 index was the most common condition (P<0.05). Among the 50 patients, the dampness–heat accumulation and the liver–kidney Yin deficiency syndromes were the most common TCM syndrome differentiation (P<0.05). The dampness–heat accumulation syndrome was correlated with increased Ki-67 index and positive CgA, and the internal syndrome of stasis and toxin was correlated with increased Ki-67 index and positive Syn, suggesting that the prognosis of the two syndromes is poor (P<0.05). Conclusions Patients with localized high-risk prostate cancer with differentiation of the dampness–heat accumulation syndrome and the internal syndrome of stasis and toxin showed neuroendocrine differentiation in tumor tissues, high cell proliferation activity, increased tumor malignancy, and rapid proliferation. On the basis of the endocrine therapy of western medicine, we should combine TCM syndrome differentiation as soon as possible, give full play to the advantages of TCM syndrome differentiation in treatment, and delay the progress of disease as much as possible.On the basis of the endocrine therapy of western medicine, we should combine TCM syndrome differentiation as soon as possible, give full play to the advantages of TCM syndrome differentiation in treatment, and delay the progress of disease as much as possible. -
表 1 局部高危前列腺癌患者的各中医证型与CgA、Syn和Ki-67指数的关系
组别 例数
（n=50）CgA阳性（n=17） Syn阳性（n=8） Ki-67指数
（$\bar{x}\pm \mathrm{s}$）湿热蕴结证组 16 10（62.50） 2（12.50） 44.38±28.20 瘀毒内结证组 4 0（0） 3（75.00） 65.00±17.32 肝肾阴虚证组 18 5（27.78） 3（16.70） 17.44±26.82 气阴两虚证组 12 2（16.67） 0（0） 21.42±27.86 （）内单位为% 
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表 2 局部高危前列腺癌患者的各中医证型组间的比较情况
组别
CgA阳性率
Syn阳性率
Ki-67指数
χ2
P
χ2
P
P湿热蕴结证组与瘀毒内结证组 5.00 0.025 6.67 0.010 0.179 湿热蕴结证组与肝肾阴虚证组 4.14 0.042 0.12 0.732 0.006 湿热蕴结证组与气阴两虚证组 5.88 0.015 1.62 0.204 0.031 瘀毒内结证组与肝肾阴虚证组 1.44 0.230 5.62 0.018 0.003 瘀毒内结证组与气阴两虚证组 0.76 0.383 11.10 0.001 0.008 肝肾阴虚证组与气阴两虚证组 0.50 0.481 2.22 0.136 0.695
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