基于分子分型的乳腺癌中医精准辨治思路探讨  

Exploring traditional Chinese medicine-based diagnosis and treatment of breast cancer based on molecular typing

作　　者：张一鸣 田辛晨 王宇飞[1] 王浩辰 周河燃 王永宏 蒋树龙[1] ZHANG Yiming;TIAN Xinchen;WANG Yufei;WANG Haochen;ZHOU Heran;WANG Yonghong;JIANG Shulong(Jining First People's Hospital,Jining 272002,China;Qilu Medical College of Shandong University,Jinan 250012,China;Clinical Medical College of Jining Medical University,Jining 272067,China;Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310006,China;Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]济宁市第一人民医院,济宁272002 [2]山东大学齐鲁医学院 [3]济宁医学院临床医学院 [4]浙江中医药大学附属杭州市中医院 [5]北京中医药大学东直门医院

出　　处：《北京中医药大学学报》2023年第7期1025-1031,共7页Journal of Beijing University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(No.82074360);山东省泰山学者青年专家项目(No.tsqn201909200);济宁市重点研发项目(No.2022YXNS170);国家中医药管理局全国名老中医药专家传承工作室建设项目(国中医药人教函[2022]75号)。

摘　　要：乳腺癌根据内在基因表达分为管腔上皮A(Luminal A)型、管腔上皮B(Luminal B)型、人表皮生长因子受体2(HER-2)阳性型及三阴性4种分子分型。本文通过对近10年关于乳腺癌分子分型与中医证候、体质相关性的研究和不同分子分型乳腺癌临床特点研究进行归纳分析发现,不同分子分型的乳腺癌中医证候特点存在差异,其中,Luminal型乳腺癌侧重肝郁气滞、冲任失调,HER-2阳性型乳腺癌侧重风挟痰瘀流窜经络,三阴性乳腺癌侧重痰瘀毒胶结经络。因此,在乳腺癌的中医辨治中,应在疏肝健脾这一核心治则基础上,根据不同分子分型的病机特点进行针对性调整,重视平衡气血阴阳,形成乳腺癌辨病-辨型-辨证一体化的中医精准辨治思路。On the basis of the expression of specific genes,breast cancer is classified into four molecular types:Luminal A,Luminal B,human epidermal growth factor receptor 2(HER-2)-positive,and triple negative.By summarizing and analyzing the studies published in the past decade,including the correlation between molecular types of breast cancer and traditional Chinese medicine(TCM)patterns,as well as the connection between the TCM constitution and clinical characteristics of different molecular types of breast cancer,this study reveals that there are differences in TCM patterns between different types of breast cancer.Notably,the pattern of liver depression and qi stagnation and the pattern of thoroughfare-controlling vessel disharmony are common contributors to the development of Luminal A and B breast cancer.In patients with HER-2-positive breast cancer,the main pathogenic mechanism is that wind,an exterior pathogen in Chinese medicine,complicated with phlegm and static blood,flows through the channels.In patients with triple-negative breast cancer,toxin,phlegm,and static blood are cemented in the channels.Therefore,in TCM-based diagnosis and treatment of breast cancer,it is necessary to make targeted changes according to the pathogenesis characteristics of different molecular types based on the core treatment principle of soothing the liver and invigorating the spleen,paying attention to the balance of qi,blood,and yin and yang and achieving accurate TCM differentiation and treatment with the integration of disease differentiation,molecular typing,and pattern differentiation.

关 键 词：乳腺癌 分子分型 精准医疗 辨证 中医体质 

分 类 号：R273[医药卫生—中西医结合]