| ObjectiveThe clinical information of colorectal adenomatous polyps with different stages of intraepithelial neoplasia in Guangdong Hospital of traditional Chinese medicine was analyzed retrospectively.The database of clinical information was established.The investigation contents were arranged by Microsoft Excel software,spss20.0 and statistical methods were used.The age distribution,sex ratio,polyp location,length,size,number and pathological classification were analyzed.The distribution of TCM syndrome factors was based on the correlation of clinical symptoms.MethodsFrom January 2013 to January 2019,288 patients in the high-level group and 347 patients in the low-level group were analyzed retrospectively.The clinical information of patients was collected and the clinical information database was established by Microsoft The investigation contents were arranged by Excel software.Spss20.0 software was used to compare the differences of age,polyp size,polyp pathological type,polyp quantity,polyp shape,polyp surface congestion,polyp surface shape,TCM syndrome distribution between the two groups.Cluster analysis method was used to analyze the common TCM syndrome elements of the two groups of patients,and common syndrome types were developed IBM modeler 18.0 software analyzed the association rules of disease location and disease syndrome elements of the two groups of patients,and explored the evolution rules of TCM syndrome elements in the development of colorectal adenomatous polyposis.Results1.635 cases of colorectal adenoma with intraepithelial neoplasia were included in this study.There were 354 male patients and 281 female patients.The age range was 19-87 years old.The ratio of male to female was 1.3:1.There was significant difference between male and female(P<0.05).Among them,there were 194 males(55.9%)and 153 females(44.1%)in the low-level group,160 males(55.6%)and 128 females(44.4%)in the high-level group.There was no significant difference in gender distribution between the two groups(P=0.929>0.05).The difference between the two groups was statistically significant(z=2.295,P=0.022<0.05).The median age of the low-level group was 59,and that of the high-level group was 62.There were 347 low-grade patients with age distribution of 6(1.7%)in the<30-year-old range,17(4.9%)in the 30-40-year-old range,54(15.6%)in the 40-50-year-old range,103(29.70%)in the 50-60-year-old range,93(26.8%)in the 60-70-year-old range,62(17.9%)in the 70-80-year-old range,12(3.5%)in the>80-year range,288(1.4%)in the high-grade group,8(2.8%)in the 30-40-year-old range,31(10.8%)in the 40-50-year-old range,50-60 There were 74 cases(25.7%)in the age range,104 cases(36.1%)in the 60-70 age range,57 cases(19.8%)in the 70-80 age range and 10 cases(3.5%)in the>80 age range.There was no significant difference in the age distribution between the two groups(P=0.112>0.5).2.Physiological characteristics of polyps:There were 347 patients in the low-level group,the median size of polyp was 10 mm,288 patients in the high-level group,the median size of polyp was 18 mm,the difference between the two groups was statistically significant(z=14.602,P=0.000<0.05).In the low-level group,there were 4 cases(1.2%),165 cases(47.6%),134 cases(38.6%)and 44 cases(12.7%)with polyp size less than 5mm,134 cases(10-20mm)and>20mm in the low-level group,288 cases(1.0%),9 cases(3.1%),147 cases(51.0%)and 129 cases(44.8%)with polyp size less than 5mm in the high-level group,the difference was statistically significant(P=0.000).In the low-level group,66 cases(19.0%)of the polyps occurred in ascending colon,57 cases(16.4%)in transverse colon,116 cases(33.4%)in sigmoid colon,39 cases(11.2%)in descending colon,69 cases(19.9%)in rectum,38 cases(13.2%)in ascending colon,29 cases(10.1%)in transverse colon,113 cases(39.2%)in sigmoid colon,29 cases(10.1%)in descending colon and 79 cases(27.4%)in rectum,with statistical differences Significance(P=0.009<0.05).There were 291 cases of tubular adenoma(83.9%),18 cases of serrated adenoma(5.2%),32 cases of tubular villous adenoma(9.2%),6 cases of villous adenoma(1.7%);163 cases of tubular adenoma(56.6%),4 cases of serrated adenoma(1.4%),116 cases of tubular villous adenoma(40.3%),5 cases of villous adenoma(1.7%)in the advanced group,and the distribution of pathological types was different between the two groups There was statistical significance(P=0.000).There were 127 cases(36.6%)with single polyp and 220 cases(63.4%)with multiple polyps in the low-level group,3 cases(1.0%)with single polyp and 285 cases(99.0%)with multiple polyps in the high-level group,so the difference between the two groups was statistically significant(P=0.000).In the low-grade group,71(20.5%)had a pedicle,70(20.2%)had a pedicle,196(56.5%)had a wide base,and 10(2.9%)had a laterally developed polyp.In the high-grade group,106(36.8%)had a pedicle,40(13.9%),116(40.3%)had a wide base,and 26(9.0%)had a laterally developed polyp.The morphological distribution of the two groups was statistically significant(P=0.000).There were 307 cases(88.5%)without hyperemia,32 cases(9.2%)with hyperemia,8 cases(2.3%)with slight hyperemia and 0 case(0.0%)with obvious hyperemia in the low-level group,119 cases(41.3%),79 cases(27.4%),85 cases(29.5%)with slight hyperemia and 5 cases(1.7%)with obvious hyperemia in the high-level group.In the low-grade group,296(85.3%)had smooth surface,0(0.0%)had vegetable pattern,0(0.0%)had erosion,and 51(14.7%)had lobular changes.In the high-grade group,233(80.9%)had smooth surface,1(0.3%)had vegetable pattern,2(0.7%)had erosion,and 52(18.1%)had lobular changes.There was no significant difference between the two groups(P=0.166>0.05).3.TCM syndrome element distribution:A total of 134 patients with low-level polyps and 165 patients with high-level polyps were extracted for analysis.There was no significant difference between the two groups(P=0.137>0.05).In the two groups,the disease location and syndrome element were mainly large intestine,followed by oligoabdomen,stomach,spleen,liver and kidney.A total of 244 patients in the low-level group and 233 patients in the high-level group were extracted for analysis.There was a significant difference between the two groups(P=0.000).In the low-level group,dampness was the most,followed by blood stasis and qi stagnation,while in the high-level group,dampness was the most,followed by blood stasis,pus,qi stagnation and toxin.A total of 41 patients in the low-level group and 77 patients in the high-level group were analyzed.There was no significant difference between the two groups(P=0.147>0.05).The main syndrome elements of asthenia and venereal disease in low-level group and high-level group were Qi deficiency,followed by Yin deficiency and qi depression,and those with Yang deficiency were the least.4.TCM syndrome element association analysis:there are 62 rules in the low-level group,among which the minimum support is 10.068%,the maximum support is 65.130%,the minimum confidence is 10.000%,and the maximum confidence is 86.567%.The relationship between spleen,stomach,large intestine and pathogenic syndrome element damp,qi stagnation,blood stasis is relatively large.There are 42 second-order association rules between disease location and syndrome factors in the low-level group,among which the highest support is large intestine→dampness,with a support of 65.130%and a confidence of 25.664%.Secondly,stomach→dampness,spleen →dampness,large intestine→qi stagnation,large intestine→blood stasis,large intestine→ Yin deficiency,etc.There are 21 third-order association rules between disease location and two disease syndrome factors in the low-level group,among which the highest support is large intestine→qi stagnation+dampness,the support is 16.715%,and the confidence is 43.103%.Secondly,large intestine→blood stasis+dampness,large intestine→Yin deficiency+dampness,large intestine→heat + dampness,etc.In the high-level group,152 rules were generated from the correlation analysis between disease location and disease syndrome factors,among which the minimum support degree was 10.417%,the maximum support degree was 73.658%,the minimum confidence degree was 10.000%,and the maximum confidence degree was 93.750%.The lines between spleen and large intestine of disease location syndrome and syndrome of disease type are relatively thick and have a great correlation with dampness,Qi deficiency and blood stasis.There are 67 second-order association rules between disease location and disease syndrome factors in the high-level group,among them,the highest support is large intestine→wet,the support is 73.958%,the confidence is 39.906%.Secondly,spleen→dampness,stomach→dampness,less abdomen→dampness,large intestine→blood stasis,large intestine→Qi deficiency,large intestine→qi stagnation,etc.There are 72 third-order association analysis rules between disease location and two disease syndrome factors in the high-level group,the highest support is large intestine→blood stasis+dampness,the support is 29.514%,the confidence is 43.529%.Secondly,large intestine→pus + dampness,large intestine→Qi deficiency+dampness,large intestine→qi stagnation+dampness,etc.5.Cluster analysis of syndrome elements in the two groups:TCM syndrome elements in the low-level group can be divided into the following two types:① syndrome element qi stagnation and syndrome element large intestine;②syndrome element spleen and syndrome element Qi deficiency.According to the clustering phenomenon,the following syndromes can be formulated:① qi stagnation in large intestine;②weak temper.There are three kinds of clustering phenomena in TCM syndrome elements of high-level group:①deficiency of syndrome elements in disease location and qi stagnation of syndrome elements in disease location;②large intestine and pus of syndrome elements in disease location;③ deficiency of syndrome elements in spleen and Qi in disease location.According to the clustering phenomenon,the following syndromes can be formulated:① Qi Stagnation with little abdomen;②large intestine with pus;③weak temper.Conclusion1.There are more men than women in colorectal adenomatous polyps,and the median age of patients in high-level group is higher than that in low-level group.Compared with the low-grade group,the high-grade group has a larger median polyp size,and the incidence of the disease is in the sigmoid colon or rectum,the pathological nature is tubular villous adenoma,the number is multiple,the shape is pedunculated polyp or laterally developed polyp,and the proportion of polyp surface congestion is higher.2.The position of colorectal polyposis is mainly in the large intestine,and also in the oligoabdomen and spleen stomach,which is mainly related to dampness.Deficiency syndrome is mostly Qi deficiency,but also Yin deficiency and qi depression.The pathogenesis of the patients with high-grade intraepithelial neoplasia is different from that of the patients with low-grade neoplasia.Dampness is the main cause of colorectal polyp and the root of the disease.3.According to the results of cluster analysis,the following syndromes can be formulated in the low-level group:① qi stagnation in large intestine;② weak temper.The high-level group can draw up the following syndromes:① Qi Stagnation with little abdomen;②large intestine with pus;③ weak temper.It is suggested that with the development of the disease,the disease location and the severity of the disease are increasing. |
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