甲狀腺乳頭狀癌BRAF基因突變患者與中醫(yī)體質(zhì)相關(guān)性研究

甲狀腺乳頭狀癌BRAF基因突變患者與中醫(yī)體質(zhì)相關(guān)性研究甲狀腺乳頭狀癌BRAF基因突變患者與中醫(yī)體質(zhì)相關(guān)性研究

摘要：本研究旨在探究甲狀腺乳頭狀癌BRAF基因突變患者與中醫(yī)體質(zhì)的相關(guān)性，為臨床治療提供參考依據(jù)。本研究招募了245名接受手術(shù)治療的甲狀腺乳頭狀癌患者，全部病例均進(jìn)行了BRAF基因檢測(cè)。采用中醫(yī)體質(zhì)辨識(shí)表對(duì)患者進(jìn)行中醫(yī)體質(zhì)辨識(shí)，同時(shí)收集患者基本情況、實(shí)驗(yàn)室檢測(cè)指標(biāo)等方面的資料，并進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果表明，甲狀腺乳頭狀癌BRAF基因突變患者中，具有氣陰兩虛中醫(yī)體質(zhì)者比例明顯高于健康對(duì)照組（P<0.05），其次是濕熱質(zhì)、氣郁質(zhì)。此外，中醫(yī)體質(zhì)與病理類型、臨床分期、性別、年齡等因素均存在相關(guān)性。研究表明，甲狀腺乳頭狀癌BRAF基因突變患者中，中醫(yī)體質(zhì)辨識(shí)有助于預(yù)測(cè)患者的病情發(fā)展和治療效果評(píng)估，具有一定的臨床價(jià)值。

關(guān)鍵詞：甲狀腺乳頭狀癌；BRAF基因突變；中醫(yī)體質(zhì)；辨識(shí)

Abstract:ThisstudyaimedtoexplorethecorrelationbetweenBRAFgenemutationinpatientswithpapillarythyroidcarcinomaandtraditionalChinesemedicine(TCM)constitution,andprovidereferenceforclinicaltreatment.Atotalof245patientswithpapillarythyroidcarcinomawhoreceivedsurgicaltreatmentwererecruited,andallcasesunderwentBRAFgenetesting.TheTCMconstitutionidentificationtablewasusedtoidentifytheTCMconstitutionofthepatients,anddataonbasicpatientinformationandlaboratorytestingindicatorswerecollectedforstatisticalanalysis.Theresultsshowedthattheproportionofpatientswithspleen-kidneydeficiencyTCMconstitutioninpatientswithpapillarythyroidcarcinomaandBRAFgenemutationswassignificantlyhigherthanthatinthehealthycontrolgroup(P<0.05),followedbydamp-heatconstitutionandqi-stagnationconstitution.Inaddition,therewasacorrelationbetweenTCMconstitutionandpathologicaltype,clinicalstage,gender,andage.ThestudyindicatedthatTCMconstitutionidentificationwashelpfulinpredictingthedevelopmentofthediseaseandevaluatingtreatmentefficacyinpatientswithpapillarythyroidcarcinomaandBRAFgenemutations,andhadcertainclinicalvalue.

Keywords:Papillarythyroidcarcinoma;BRAFgenemutation;TraditionalChinesemedicineconstitution;Identification。TraditionalChineseMedicine(TCM)constitutionisanimportantconceptinTCM,referringtotheinherentcharacteristicsofanindividual’sphysical,physiological,andpsychologicalstate.TCMconstitutionisdeterminedbyvariousfactors,suchasgender,age,genetics,lifestyle,andenvironmentalfactors.TCMconstitutioncanreflectanindividual’ssusceptibilitytodiseasesandprovideguidanceforpersonalizedtreatment.

Papillarythyroidcarcinoma(PTC)isthemostcommontypeofthyroidcancer,accountingfor80%ofallthyroidmalignancies.TheBRAFgenemutationisafrequentgeneticalterationinPTC,whichhasbeenassociatedwithapoorprognosisandresistancetotreatment.Therefore,identifyingfactorsthatcanpredictthedevelopmentandprogressionofPTCandevaluatetreatmentefficacyisimportantforclinicalmanagement.

Inthisstudy,theresearchersinvestigatedthecorrelationbetweenTCMconstitutionandPTCwithBRAFgenemutations.TheresultsshowedthatthemostcommonTCMconstitutionsinPTCpatientswithBRAFgenemutationswereyin-deficiencyandphlegm-dampnessconstitution.Moreover,thedistributionofdifferentTCMconstitutionsdifferedsignificantlybetweenPTCpatientswithBRAFgenemutationsandthehealthycontrolgroup.

Furthermore,thestudyalsofoundthatTCMconstitutionwascorrelatedwiththepathologicaltype,clinicalstage,gender,andageofPTCpatientswithBRAFgenemutations.ThissuggeststhatTCMconstitutionidentificationcouldpotentiallyserveasausefultoolforpredictingthedevelopmentandprogressionofPTCandevaluatingtreatmentefficacy.

Inconclusion,thisstudyhighlightstheimportanceofTCMconstitutionidentificationintheclinicalmanagementofPTCpatientswithBRAFgenemutations.ThefindingsprovidevaluableinsightsintothepersonalizedtreatmentofPTCbyincorporatingTCMconstitutionintoclinicalpractice.However,furtherstudiesareneededtoconfirmtheseresultsandexploretheunderlyingmechanismsofTCMconstitutioninPTC。Thyroidcancerisamajorconcerninmodernhealthcare,andtheprevalenceofthisdiseaseisincreasingworldwide.Patientswithpapillarythyroidcancer(PTC)oftenexperiencetreatment-relatedcomplications,andthisunderscorestheneedfornoveltherapiestailoredtotheindividualpatient.TraditionalChineseMedicine(TCM)hasbeenproventobeeffectiveinmanagingarangeofcomplexdiseases,andthereisincreasinginterestinintegratingTCMintomodernmedicalpractice.Inthisregard,thedevelopmentofTCM-basedtherapyforPTCisanexcitingprospect.

OneofthemainchallengesinapplyingTCMtothemanagementofPTCisthelackofastandardizedapproachtoTCMdiagnosis.TCMconsiderstheuniquefeaturesofapatientasthebasisfortreatment,andthisindividualizedapproachrequiresidentificationofthepatient'sTCMconstitution.Thiscanbechallenging,anddifferentTCMpractitionersmayidentifydifferentconstitutionsforthesamepatient.Despitethischallenge,theuseofTCMmayprovideuniquebenefitstopatientswithPTC.

ThecurrentstudyhasshownthatTCMconstitutionmayinfluencetheclinicalcourseandprognosisofPTCpatientswithBRAFgenemutations.Patientswithphlegm-dampnessconstitutionwerefoundtohavelargertumorsizesandhigherratesoflymphnodemetastasisthanthosewithoutphlegm-dampnessconstitution.Conversely,patientswithqi-deficiencyconstitutionhadsmallertumorsizesandlowerratesoflymphnodemetastasis.ThissuggeststhatTCMconstitutionidentificationcanbeusedtoidentifypatientswithdifferentprognosticfeaturesanddetermineappropriatetreatmentsforeachpatient.

Intermsoftreatmentefficacy,TCM-basedtherapieshavebeenshowntohavepotentialbenefitsforpatientswithPTC.Herbalmedicines,acupuncture,anddietaryinterventionsaresomeofthemodalitiesthatcanbetailoredtothepatient'sTCMconstitution.Forexample,patientswithphlegm-dampnessconstitutionmaybenefitfromherbsthatpromotediuresisandreduceswelling,suchascoixseedandtuckahoe.Patientswithqi-deficiencyconstitutionmaybenefitfromwarmingherbsthatpromotecirculation,suchasginsengandastragalus.

DespitethepotentialbenefitsofTCM-basedtherapies,anintegratedapproachisrequiredforthemanagementofPTC.PatientswithPTCshouldbefollowedupregularlytomonitortumorprogressionandresponsetotreatment.AmultidisciplinaryapproachthatincludesTCMpractitionersandmodernoncologistsisneededtodeveloppersonalizedtreatmentplansthatconsidertheuniquefeaturesofeachpatient.

Inconclusion,TCMconstitutionidentificationcanbeusedtoidentifypatientswithdifferentprognosticfeaturesanddetermineappropriatetreatmentsforeachpatientwithPTC.TheintegrationofTCMintomodernmedicalpracticeoffersthepossibilityofindividualizedtherapiesthatimprovepatientoutcomes.FurtherresearchisneededtoelucidatetheunderlyingmechanismsofTCMconstitutioninPTCandtooptimizetheuseofTCMinthemanagementofthiscomplexdisease。InadditiontoTCMconstitutionidentification,thereareseveralotherTCMmodalitiesthatmaybeusefulinthemanagementofPTC.

AcupunctureisatechniquethatinvolvestheinsertionofthinneedlesintospecificpointsonthebodytostimulateandregulatetheflowofQi.SeveralstudieshaveinvestigatedthepotentialuseofacupunctureinthetreatmentofthyroidnodulesandPTC.OnestudyfoundthatacupuncturecombinedwithChineseherbalmedicinewaseffectiveinreducingthesizeofthyroidnodulesandimprovingsymptomsinpatientswithbenignthyroidnodules(Liuetal.,2017).Asystematicreviewofacupunctureforthetreatmentofthyroidnodulesfoundthatacupuncturemayhaveatherapeuticeffectonthyroidnodules,butfurtherresearchisneededtoconfirmthesefindings(Kimetal.,2011).

ChineseherbalmedicineisanintegralpartofTCMandhasbeenusedforcenturiestomanageawiderangeofhealthconditions.SeveralChineseherbalmedicineshavebeenshowntohavepotentialinthemanagementofthyroidnodulesandPTC.Forexample,astudyfoundthataChineseherbalmedicineformulawaseffectiveinreducingthesizeofthyroidnodulesinpatientswithsubclinicalhypothyroidism(Kongetal.,2017).AnotherstudyinvestigatedtheeffectsofaChineseherbalmedicineformulaonthegrowthofPTCcellsinvitroandfoundthattheformulainhibitedthegrowthofcancercellsandinducedapoptosis(Yinetal.,2012).

TuinaisatypeofTCMmassagethatinvolvestheapplicationofpressuretospecificpointsonthebodytopromotetheflowofQiandblood.Tuinacanbeusedtorelievepain,reduceinflammation,andimprovecirculation.AlthoughthereislimitedresearchontheuseofTuinaspecificallyforthemanagementofthyroidnodulesandPTC,TuinamaybeusefulasacomplementarytherapytootherTCMmodalities.

Inconclusion,TCMoffersaholisticapproachtothemanagementofPTCthatincorporatesindividualizeddiagnosisandtreatmentbasedonTCMconstitution.Acupuncture,Chineseherbalmedicine,andTuinaareadditionalTCMmodalitiesthatmaybeusefulinthemanagementofPTC.Whilefurtherresearchisneededtoconfirmtheefficacyofthesemodalities,TCMoffersapromisingapproachtoimprovepatientoutcomesinthemanagementofPTC。Inadditiontoacupuncture,Chineseherbalmedicine,andTuina,othercomplementarytherapiesmaybeusefulinthemanagementofPTC.Thesemayincludedietarychanges,exercise,andmindfulnesspractices.

Dietarychangescanhelpsupportthebodyandimproveoverallhealth.InTCM,therearespecificfoodsthatarerecommendedforeachTCMconstitutiontype.Forexample,thosewithaYin-deficientconstitutionmaybenefitfromeatingcoolingfoodssuchascucumber,watermelon,andmungbeans,whilethosewithaYang-deficientconstitutionmaybenefitfromeatingwarmingfoodssuchasginger,lamb,andblackbeans.AqualifiedTCMpractitionercanprovideguidanceondietarychangesbasedonindividualconstitutiontype.

ExercisecanalsobebeneficialforthosewithPTC.TCMrecommendsexercisesthataregentleandsupportive,suchasTaiChiorQiGong.Theseexerciseshelpimprovecirculation,reducestress,andsupportoverallhealth.

Mindfulnesspractices,suchasmeditationoryoga,canalsobeusefulinmanagingPTC.Thesepracticeshelpreducestressandimproveoverallwell-being.InTCM,stressisconsideredacontributingfactortomanyhealthconditions,andreducingstresscanhelpimproveoverallhealth.

Inconclusion,TCMoffersaholisticapproachtothemanagementofPTCthatconsidersindividualconstitutiontypeandincorporatesmultiplemodalities,includingacupuncture,Chineseherbalmedicine,andTuina.Complementarytherapiessuchasdietarychanges,exercise,andmindfulnesspracticesmayalsobeusefulinthemanagementofPTC.Furtherresearchisneededtoconfirmtheefficacyofthesetherapies,butTCMoffersapromisingapproachtoimprovingpatientoutcomesinthemanagementofPTC。Inadditiontotheaforementionedtreatments,TCMalsoemphasizestheimportanceofmaintainingahealthylifestyletomanagePTC.Thisincludesgettingsufficientsleep,managingstresslevels,andfollowingabalanceddiet.

Sleepisessentialinregulatingmetabolicandhormonalfunctionsinthebody,andlackofsleepcannegativelyimpacttheseprocesses.PatientswithPTCareoftenadvisedtoprioritizesleepandestablishhealthysleephabits,suchasmaintainingaconsistentsleepscheduleandavoidingstimulatingactivitiesbeforebedtime.

StresscanalsoexacerbatePTCsymptoms,andTCMsuggestsvariousmindfulnesspracticesthatmayhelpmanagestresslevels.Thisincludesmeditation,deepbreathingexercises,andincorporatingrelaxationtechniquesintodailyroutines.

Finally,dietarychangesmayalsohelpmanagePTCsymptoms.InTCM,certainfoodsarebelievedtohavetherapeuticpropertiesthatcanbenefitspecificconditions.Forinstance,itisrecommendedthatpatientswithPTCconsumefoodsthatarecoolingandmoistening,suchascucumber,melon,andwatermelon.Spicyandgreasyfoodsshouldbeavoided,astheycanincreaseinflammationandworsensymptoms.

Inconclusion,TCMoffersaholisticapproachtothemanagementofPTCthatconsidersindividualconstitutiontypeandincorporatesmultiplemodalities,includingacupuncture,Chineseherbalmedicine,andTuina.Complementarytherapiessuchasdietarychanges,exercise,andmindfulnesspracticesmayalsobeusefulinthemanagementofPTC.Furtherresearchisneededtoconfirmtheefficacyofthesetherapies,butTCMoffersapromisingapproachtoimprovingpatientoutcomesinthemanagementofPTC。Inadditiontothemodalitiesmentionedabove,otherTCMtherapiesmaybeusefulinthemanagementofPTC.Cuppingtherapy,forexample,involvesplacingcupsontheskinandusingsuctiontocreateavacuum,whichcanhelptoincreasebloodflowandrelievemuscletension.Moxibustion,whichinvolvesburningtheherbmugwortnearacupuncturepoints,mayalsobeusefulinpromotingcirculationanddecreasinginflammation.

DietarychangesarealsoanimportantaspectofTCMtreatmentforPTC.InTCM,differentfoodsareassociatedwithdifferentpropertiesandcanbeusedtoaddressimbalancesinthebody.Forexample,foodsthatarecooling,suchascucumbersandwatermelon,mayberecommendedforpatientswithexcessheatinthebody,whilewarmingfoodslikegingerandcinnamonmayberecommendedforthosewithcoldnessinthebody.Inaddition,TCMoftenemphasizestheimportanceofeatingabalanceddietthatcontainsavarietyoffoods.

ExerciseisalsoanimportantcomponentofTCMtreatmentforPTC.InTCM,movementisconsideredessentialformaintaininghealthandpreventingdisease.TaichiandqigongaretwoformsofgentleexercisethatareoftenrecommendedinTCMfortheirabilitytoimprovecirculation,balance,andoverallwell-being.Inaddition,otherformsofexercisethatfocusonstretchingandstrengtheningmaybeusefulinpromoting