Study On Diagnosing Endometriosis By The Method Of Observing And Analyzing Sublingual Veins

The visual inspection of a patient' s sublingual veins mainly gauges the waxing and waning of qi and blood,offers more information for differentiation of syndromes and diseases.This study took women' s endometriosis as the research object,discussed the relationship between endometriosis and pathological variations of sublingual veins by the means of prospective study and by the methods of literature research,clinical research,experimental study,diagnostic tests and evaluation of clinical epidemiology and so on, in order to diagnose endometriosis early and exactly by observing and analyzing sublingual veins combining symptoms and signs,laid the foundation for further research of blood stasis diseases' diagnostic accuracy.The thesis is divided into five parts.Part 1 Literature ResearchReorganized and studied systematically the literatures which were correlated with sublingual veins of all times and in all countries.The original record of sublingual veins was seen in the book of The Yellow Emperor's Medicine Classic(Huang Di Nei Jing).As a diagnostic method,the visual inspection of a patient' s sublingual veins rose in dynasties Jin Sui Tang Song,paused after dynasty Ming,revitalized in new China.Ancient doctors had realized lots of viscera link sublingual veins by meridians and collaterals, the variations of sublingual veins connect with some diseases,and sublingual veins as a treatment site be wildly used in clinical.Modern doctors have researched sublingual veins in base and clinical.There have been major clinical researches concerned with relationships between sublingual veins and kinds of internal diseases,and relatively minor about the relationships between sublingual veins and endometriosis.A part of these researches discussed pathological sublingual veins of endometriosis and variations after treating with activating blood to resolve stasis.Most of them clarified the connection of endometriosis and blood stasis syndromes in etiology and pathogenesis.These results played positive roles on diagnosing and treating endometriosis.But there have no reports of systematic researches on relationship between endometriosis and pathological sublingual veins by the method of literature research,clinical research,experimental study and accuracy evaluation of diagnosis and so on.Part 2 Clinical Research1 Clinical Research on Sublingual Veins of EndometriosisObjective:to explore the clinical characteristics of endometriosis patients' tongue in blood stasis syndrome.Object:85 cases with endometriosis,85 cases with hysteromyoma,30 healthy cases as control.Method:The prospective study was made.The clinical observation and the automatic recognition and analysis of image by computer were combined.Results and Conclusions:Clinical observation showed that pathological variations on the back of tongue of endometriosis patients and hysteromyoma patients are similarly as general tongue of blood stasis.Just observing the tongue body is difficult to distinguish these two diseases.The variety of tongue coating relates closely to deputy syndrome of blood stasis and plays an important role in judging different syndrome of endometriosis.R,G,B values of the tongue body of endometriosis patients and hysteromyoma patients mainly performed as R values descending and B values ascending.Descending in R values and ascending in G values of the tongue body of endometriosis patients were much than hysteromyoma patients.There were serious pathological variations of sublingual veins in endometriosis patients.Total scores of pathological sublingual veins of endometriosis participants,there were 90.59%beyond 10 scores on average.The pathological rate was much than 68.24% of hysteromyoma participants.It was thought that comprehensively observing color,wild diameter,length,shape,filling and outer of sublingual veins is an important indicator in diagnosing endometriosis.2 Using Laparoscopy to Explore and Treat EndometriosisObjective:to explore using laparoscopy to diagnose and treat endometriosisObject:85 cases with endometriosis.Method:Operating in automatic and visualized system by laparoscopy. Results and Conclusions:85 cases finished surgery by laparoscopy,and 81 cases were confirmed as endometriosis.We thought that there were lots of benefits of surgery by laparoscopy,such as little traumas,much superiority to minute lesions,flexible operation,more effective and efficient in treating ovary cysts and peritoneal endometriosis lesions and make wound healing easily.But it is a traumatic means couldn't be a wellness check.It is expensive that many hospitals and patients couldn't afford.Laparoscopy surgery can not completely cure endometriosis that can not be universal.Applying no injuries about tongue diagnosis especially sublingual veins in TCM has significant practical values in screening and guiding clinical diagnosis of endometriosis.Part 3 Clinical Experimental StudyObjective:to explore the pathologic mechanism of sublingual veins changes of endometriosis patients and hysteromyoma patients.Object:85 cases with endometriosis,85 cases with hysteromyoma,30 healthy cases as control.Method:hemospasia venous blood on fasting to examine the following indexes:(1)Fibrinogen(FIB):Clauss;(2)Estrodial(E₂),Prolactin(PRL):Micro particle of immunoassay chemiluminescence;(3)Carbohydrate Antigen 125(CA125),Carbohydrate Antigen 19-9(CA19-9): Micro particle of immunoassay chemiluminescence;(4)Endometrial Antibody(EmAb):ELISA.Results and Conclusions:1 The FIB,E₂ and PRL of the endometriosis group are higher than the normal range,and FIB notable higher than the control group and the hysteromyoma group. These showed endometriosis patients' blood being hypercoagulability. Increasing of FIB is an important factor in the formation of endometriosis blood stasis,which reflecting on tongue is the tongue of blood stasis and pathologic variations of sublingual veins.E₂ level of endometriosis group and hysteromyoma group were higher than the normal range,proofing that either of them are belong to estrogen-dependence-disease.There was no statistics difference of their estrogen increasing.PRL level of endometriosis group was much higher than the control group and the hysteromyoma group.It is thought that E₂ infecting PRL and combined working of them made a significant role in promoting the occurrence and development of endometriosis.Otherwise,the changes making or promoting by PRL are likely as the performance of blood stasis of TCM.It confirmed endometriosis being blood stasis syndromes as TCM sees, and its main treatment must be activating blood to resolve stasis.PRL level of the hysteromyoma group was in normal range but higher than the control group, being thought infected by high E₂ level.Therefore,high E₂ and PRL level was an important feature of endometriosis.2 CA125,CA19-9 and EmAb levels in serum of endometriosis participants in this study were not too high,were only 63.5%,50.6%and 51.8%.Average level of CA125 and CA19-9 of mild patients in stageⅠ～Ⅱwas still in normal range and their positive rate was low.It could say that the expression of CA125 and CA19-9 can not judge endometriosis accurately.With illness increasing,CA125,CA19-9 and EmAb expressed higher and higher.It is thought that three of them had much value in forecasting the extent of illness than diagnosing endometriosis.Combining detection two of them or three of them in clinical can improve accuracy of endometriosis diagnosis.Part 4 Accuracy Estimate of Applying Sublingual Veins to Diagnose EndometriosisObjective:to explore the degree of accuracy of applying sublingual veins to diagnose endometriosis.Object:85 cases with endometriosis.Method:following the diagnostic test method of DME,making laparoscopy results as gold standard,comparing clinical results with variations of sublingual veins,estimating diagnostic indexes of sublingual veins such as sensitivity,specificity,misdiagnosis rate,missed diagnosis rate,accuracy, likelihood ratio and so on.Results and Conclusions:Calculated the indexes above,the results of diagnostic sensitivity, specificity,and positive likelihood ratio were relatively high and misdiagnosis rate,missed diagnosis rate,negative likelihood ratio were relatively low by applying sublingual veins to diagnose endometriosis.It conformed that,as an endometriosis diagnosis index,applying sublingual veins is significant.Compared with laparoscopy results,the accuracy of sublingual veins diagnosis was 92.94%,reflected that sublingual veins diagnosis is high match with laparoscopy diagnosis.In this stud,the accuracy of sublingual veins diagnosis in endometriosis diagnosis was better than in hysteromyoma diagnosis.Part 5 SummaryThe innovation in this study is:(1)This study took tongue back and sublingual veins of endometriosis patients as the research object for the first time,explored the clinical characteristic and the mechanism of formation of endometriosis patients' tongue from different levels of entirety,molecule and so on,and provided the objective basis for the diagnosis,treatment, prognosis analysis of endometriosis.It could be a screening for specific group of people,and could decline trauma and economical burden.(2)Appling clinical epidemiological diagnosis tests method to design and research could maximum decline infection of bias and opportunities.It was initial proofed tongue diagnosis,especially sublingual veins diagnosis of TCM can feasible and accurately be used in diagnosing modern diseases.(3)The study opens up the thought of research on tongue of blood stasis and blood stasis syndrome,and also explores an important method of establishing diagnostic standard of tongue of blood stasis and carrying out the standard successfully.