Study On The Characteristics Of TCM Syndrome Elements Of Breast Cancer And Its Estrogen Metabonomics

Objective:Through literature and clinical research,the distribution law and mixed characteristics of TCM syndrome elements of breast cancer were clarified,and the metabolomics exploratory experiment of serum estrogen metabolites was carried out on the main syndrome elements,in order to enrich the content of TCM syndrome differentiation of breast cancer and micro syndrome differentiation index,and provide theoretical basis for TCM clinical differentiation and treatment of breast cancer.Methods:This study is divided into three parts:literature research,clinical research and metabolomics research.1.Literature research:The literatures related to traditional Chinese medicine for breast cancer published on CNKI,Wanfang Data Knowledge Service Platform,VIP Chinese Science and Technology Journal Database and Pub Med from 2012 to 2022 were searched.The Chinese search terms were“breast cancer,breast rock,breast cancer,breast tumor and TCM syndrome,syndrome type,syndrome differentiation,syndrome”,and the English search terms corresponded to the Chinese search terms.According to different database retrieval requirements,the retrieval formula is formulated.According to the strict literature inclusion and exclusion criteria,the included literature was extracted and statistically analyzed for TCM syndromes and syndromes,and the distribution of common TCM syndromes and syndromes of breast cancer was summarized.2.Clinical research:According to the diagnosis of breast cancer and the inclusion and exclusion criteria of the subject,the research object was determined.The standardized four diagnostic information collection table of traditional Chinese medicine was used to collect the four diagnostic information of the research object.According to Professor Zhu Wenfeng’s syndrome differentiation method,combined with the traditional Chinese medicine health status identification system,the distribution of clinical TCM disease location and disease nature syndrome elements of breast cancer was obtained.By applying the combination method of syndrome elements and association rule analysis method,the main mixed characteristics of TCM syndrome elements of breast cancer were obtained.3.Metabonomics research:Using targeted metabolomics method,LC-MS/MS techno logy was used to compare the estrogen metabolites of breast cancer patients with liver-qi stagnation,breast cancer patients without liver-qi stagnation and healthy women,an d try to find the microscopic syndrome differentiation index of breast cancer liver-qi s tagnation syndrome in estrogen metabolism.Results:1.Literature research results(1)A total of 909 articles were retrieved and 72 articles were included.(2)There are 50 kinds of TCM syndromes of breast cancer,mainly including Chongren imbalance syndrome,liver depression and phlegm coagulation syndrome,liver depression and qi stagnation syndrome,qi and blood deficiency syndrome,phlegm and blood stasis syndrome,accounting for 59.35%of all syndromes.(3)The TCM syndrome elements of breast cancer include 15 disease location syndrome elements and 26 disease nature syndrome elements.Among them,the top 10 disease location syndrome elements are liver,spleen,kidney,uterus,bones,stomach,heart,mind(brain),lung and table.The top 15 disease syndromes were qi stagnation,qi deficiency,phlegm,yin deficiency,yang deficiency,blood deficiency,blood stasis,toxin,dampness,heat(fire),essence deficiency,cold,yang hyperactivity,blood heat and qi depression.2.Clinical research results(1)General information:120 patients with breast cancer were included,with an average age of(48.25±8.83)years old,and 54 patients(45.00%)were 45-54 years old,accounting for the highest proportion.The average BMI was(23.60±3.45)kg/m~2.There were 46 cases of overweight and obesity,accounting for 38.33%.(2)Distribution of TCM syndrome elements of breast cancer:the distribution of disease location syndrome elements from high to low is liver,spleen,kidney,mind(brain),heart,stomach,gallbladder,uterus,bones and lungs.The average score of liver syndrome was the highest.There were differences in the scores of liver,spleen,kidney,mind and gallbladder(P<0.01).The distribution of disease syndrome elements from high to low was qi stagnation,qi deficiency,yin deficiency,yang deficiency,blood stasis,dampness,blood deficiency,heat,phlegm and yang hyperactivity.The average score of qi stagnation syndrome is the highest.There were differences in the scores of qi stagnation,heat and qi deficiency(P<0.01).(3)Breast cancer TCM syndrome elements mixed:the combination of disease location syndrome elements is mainly single disease location(liver,spleen),double disease location(liver+kidney,spleen+kidney).The combination of disease syndrome elements is mainly single disease(qi stagnation,yin deficiency)and double disease(qi deficiency+yang deficiency,qi stagnation+blood stasis).The association analysis results of Apriori algorithm showed that“liver-qi stagnation”was the strongest link,and“qi stagnation-liver and blood stasis”had the highest association confidence.(4)The yin deficiency syndrome elements of breast cancer were related to molecular typing:in the comparison of yin deficiency syndrome elements of each molecular typing,the yin deficiency score of HER2 overexpression type was higher than that of Luminal B type and basal type,and the difference was statistically significant(P<0.05).3.Metabolomics research resultsThree estrogen metabolites:E1,E2 and 2-Me OE1 were detected in the serum of breast cancer patients with liver-qi stagnation group,non-liver-qi stagnation group and healthy group.The concentrations of E1 and E2 in the liver-qi stagnation group were higher than those in the healthy group(P<0.01)and(P<0.05).The E1 in the non-liver-qi stagnation group was higher than that in the healthy group(P<0.05).There was no significant difference in 2-Me OE1between the groups(P<0.05).Conclusions:1.From literature research and clinical research,the distribution characteristics of TCM syndrome elements of breast cancer are obtained:the disease location is mainly in liver,spleen and kidney;disease is mainly qi stagnation,qi deficiency,yin deficiency,yang deficiency,blood stasis,phlegm.2.From the clinical research,the characteristics of TCM syndrome elements of breast cancer are obtained:multi-visceral distribution(liver,spleen and kidney),deficiency and excess(qi deficiency,yin deficiency,yang deficiency,qi stagnation,blood stasis,phlegm dampness);liver and qi stagnation are the most common.HER2 overexpression in breast cancer is related to yin deficiency,which may be one of the main pathogenesis of HER2overexpression.3.From the research of estrogen metabolomics,it is concluded that the concentration of E1 and E2 in postmenopausal breast cancer patients will increase,and the disorder of estrogen metabolism is related to the occurrence and development of breast cancer.E1 and E2 may be used as the microscopic syndrome differentiation indexes of liver-qi stagnation and miscellaneous syndrome elements of breast cancer.