| Research purposeIn order to obtain the treatment distribution of Polypoid lesions of the gallbladder(PLG)and non-human supervision syndromes,there are valuable references for clinical differentiation and treatment of PLG.Improve the level of treatment and clinical diagnosis of PLG in TCM treatment,and study the law of medication as well as the characteristics of TCM syndrome.At the same time,in order to timely instruct patients to actively prevent and treat PLG and change their living habits,so as to reduce the occurrence and slow down the development of PLG,clinical studies on PLG risk factors were conducted.At the same time,systematic quantitative analysis was conducted on the incidence of gallbladder cancer in PLG larger than 10 mm in order to determine whether 10 mm is a reasonable limit for the removal of gallbladder polyps.As evidence-based medical evidence to guide the patient’s examination,guide clinicians reasonable treatment.Research method1.Literature research on medication rules of traditional Chinese medicine in the treatment of gallbladder polyps based on data miningSearch CNKI,VIP,CBM,PubMed,EMBASE,Cochrane and other databases from the establishment of the database to February 2023 on Chinese medicine treatment of PLG literature,establish Chinese medicine treatment of PLG database.Traditional Chinese Medicine Inheritance Assistance System(V2.5)software was used to analyze the drug frequency and drug combination of prescriptions.2.Meta-analysis and pathologic classification of gallbladder polyps larger than 10 mmBy searching the English literature database,the Chinese literature database and tracking the references included in the relevant review.The literatures related to the occurrence of PLG canceration since the establishment of the database were selected as clinical studies,retrospective studies or cohort studies.Patients diagnosed with PLG diameter greater than 10 mm received cholecystectomy and had pathological specimens.OneNote was used to manage the literatures obtained in the initial detection,and literature screening and data extraction were carried out.Excel database was established to organize and extract the contents.Statistical analysis was conducted by STATA 14.0 software and subgroup analysis was used to explore the differences in gallbladder cancer incidence among different ages and regions.Publication bias was evaluated by funnel plot and Egger’s test.3.Clinical studies on risk factorsA total of 200 patients diagnosed with PLG through B-ultrasound were selected from the outpatient and inpatient departments of Dongzhimen Hospital of Beijing from January 2022 to December 2022 according to the unified protocol,and 200 non-PLG patients with similar general conditions were selected from the above sites as the control group.SPSS25.0 software was used for analysis,counting data were expressed in frequency and rate,and chi-square test was used.In the analysis of correlation factors,univariate analysis was carried out first,and factors with statistical significance(P<0.05)were selected,and then multivariate logistic regression analysis was carried out.After logistic regression analysis,model evaluation should be carried out,including model validity test and goodness of fit.4.Clinical study of TCM syndrome lawA total of 200 patients diagnosed as PLG by B-ultrasound were selected from the outpatient department and inpatient department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2022 to December 2022 according to the unified protocol.The TCM clinical symptoms of PLG patients were recorded,including tongue,pulse and TCM syndrome manifestations.Symptom distribution was represented by frequency,and syndrome distribution characteristics were analyzed by SPSS25.0 statistical software for factor analysis and PLG syndrome cluster distribution analysis based on Jaccard similarity index and R language.Research results1.Literature research on medication rules of traditional Chinese medicine in the treatment of gallbladder polyps based on data miningAmong the 84 prescriptions for treating PLG,231 TCM were involved,and the drugs that appeared more than 15 times were curcuma,Bupleurum bupleurum,Radix simplex,rhubarb,curcuma zedoary,glycyrrhiza,wormwood,Radix auriculae,scutellaria,etc.In the four Qi and five flavors,the four Qi and five flavors,cold,warm,bitter and occinative,and the Guigan and spleen and stomach channels were the most.According to the analysis of association rules,the common associated drugs were mainly associated drugs with turmeric,bupleurum and C.mongolicum.Two new prescription drug combinations were obtained through cluster analysis algorithm and entropy clustering,which can be used to treat PLG in different syndromes and stages,and has great guiding significance for clinical practice.2.Meta-analysis and pathologic classification of gallbladder polyps larger than 10 mmA total of 769 literatures were retrieved according to the retrieval strategy,and a total of 12 studies were included in this meta-analysis.A total of 3818 patients were included.The combined effect size of the cancer rate of the included PLG was 19.1%,95%CI(0.111-0.270).Subgroup analysis shows that:by region:The combined effect size was 19.3%,95%CI(0.111,0.275)in Korea,27.1%,95%CI(0.000,0.548)in other countries,and 9.4%,95%CI(0.000,0.209)in Europe and other countries.Asian countries are higher than European ones.Mean age:the combined effect size of cancer rate in 40-49 years old group was 9.9%,95%CI(0.001,0.197).The combined effect size of cancer rate in 50-59 years old group was 16.2%,95%CI(0.043,0.281).The combined effect size of cancer rate was 36.7%,95%CI(0.308,0.425).The cancer rate of 50-59 years old group was higher than that of 40-49 years old group,and the cancer rate of over 60 years old group was significantly increased.The pathological classification results of PLG showed that the proportion of PLG with cholesterol properties greater than 10 mm was the highest,55.517%.The proportion of adenomatous polyps was 23.621%.The proportion of malignant polyps was 13.966%,and adenocarcinoma was the highest(13.793%).The bias assessment suggests that the literature included in this study is basically reliable,but there may be publication bias.A total of 6 studies suggested the optimal excision limit,ranging from 9 mm to 15 mm,and most supported the excision limit of 12 mmor more.3.Clinical study of risk factorsRisk factors:① Age:30-39 years old,60-69 years old,>70 years old in the three age stages,there were significant differences between the two groups,with statistical significance(P<0.01).② Sex:The sex ratio of male to female was 1.08:1.The baseline sex of healthy control group was the same,which could be compared.③BMI index:The PLG group and the healthy group had similar distribution of BMI index,but there was no statistical significance between the polyp group and the control group.④Emotion and diet:abnormal emotion was significantly correlated with the occurrence of PLG(P<0.05).There was a significant correlation between smoking and cold food and PLG occurrence(P<0.05).There was a significant correlation between PLG formation and non-eating breakfast,eating at night and hunger and satiety disorder(P<0.05).Alcohol consumption promoted PLG formation(P<0.05).⑤ Family history:Family history of PLG and malignant tumor were important genetic factors for the formation of PLG,with statistical significance(P<0.01).⑥Other digestive diseases:liver cysts,gallstones,and other digestive tract polyps(gastric polyps or intestinal polyps)were significantly associated with PLG(P<0.05).⑦ Other chronic diseases:thyroid nodule is one of the risk factors for PLG(P<0.05).Type 2 diabetes mellitus,hypertension,coronary heart disease and stroke were negatively correlated with the occurrence of PLG(P<0.05).logistic regression analysis showed that night eating,irregular rest and rest,family history of PLG disease,family history of malignant tumor,pylori infection,inflammatory bowel disease,gallstones,diabetes and other factors were significantly correlated with the occurrence of PLG(P<0.05).⑨ From the results of B ultrasound:From the PLG size,the maximum PLG diameter is 5-10 mm.Number of PLG:93 people were single,accounting for 46.5%;There were 107 cases,accounting for 53.5%.According to the morphology of PLG base,only 1 case was widened.The location of PLG was basically described as the capsule wall,and was clearly described as the bottom,neck and body of 4 patients each.Gallbladder wall thickening was divided into localized bottom thickening and diffuse thickening in 12 and 9 patients,respectively,accounting for 6.0%and 4.5%.There were 110 patients with rough gallbladder wall,accounting for 55.0%,and 90 patients with smooth wall accounted for 45.0%.There were 48 patients with gallstones,accounting for 24%of the total.There were 118 cases(59.0%)of PLG rear echogenic polyps,82 cases(41.0%)of hyperechogenic polyps,and 5 cases(41.0%)of PLG rear echogenic polyps.4.Clinical study on TCM syndrome ruleAmong the 200 patients with PLG,41 had symptoms with a frequency greater than 40(frequency greater than 20%).In factor analysis,principal component method was used to extract factors,and 15 factors had characteristic roots greater than 1,with a cumulative contribution rate of 63.387%.There were 11 syndromic elements,among which the pathogenic syndromes were dampness-heat,blood stasis,qi stagnation,spleen deficiency,Yin deficiency and phlegm,and the pathogenic location syndromes were liver,gallbladder,spleen,stomach and intestine.Factor analysis was used to cluster the four diagnosis information for dimensionality reduction,which could be divided into four syndromes:Yin deficiency and dampness-heat syndrome,liver and stomach depression of heat,qi stagnation and blood stasis syndrome,liver and gallbladder dampness-heat syndrome,and liver depression and spleen deficiency syndrome.In order to increase the rigor of the obtained syndrome types,the Jaccard similarity index was used in this study for unsupervised cluster analysis of all the syndrome types,which could be divided into 5 types,including the syndrome of heat stagnation of the liver and stomach,the syndrome of spleen-kidney Yang deficiency,the syndrome of qi stagnation and blood stasis with fire,the syndrome of dampness-heat of the liver and gallbladder,and the syndrome of liver stagnation and spleen deficiency with blood stasis.Through two kinds of cluster analysis,based on the research results and consultation with the research group and experts,the PLG TCM syndroms in this study were finally classified as five syndroms:liver depression and spleen deficiency,qi stagnation and blood stasis,liver-gallbladder dampness-heat syndrome,Yin deficiency and dampness-heat syndrome,spleen deficiency and phlegm-dampness syndrome.Dampness and heat of liver and gallbladder are the most common.Research conclusion1.Literature research on medication rules of traditional Chinese medicine in the treatment of gallbladder polyps based on data miningThe treatment of PLG by traditional Chinese medicine is mainly based on heat,dampness,depression,stasis,phlegm and other factors.The treatment is mainly based on promoting blood circulation,dispelling dampness,clearing heat,regulating qi and phlegm dispersing.2.Meta-analysis and pathologic classification of gallbladder polyps larger than 10 mmThe combined effect size of PLG cancer rate greater than 10 mmwas 19.1%.The polyp cancer rate gradually increased with the increase of age,and the cancer rate increased significantly when the age was over 60.The polyp cancer rate in Asia was significantly higher than that in European countries.In terms of pathological classification,more than half of PLG>10 mm were cholesterol polyps,and the proportion of adenomatous polyps was 23.621%.The proportion of malignant polyps was 13.966%,and adenocarcinoma was the highest(13.793%).The proportion of hyperplastic polyps and inflammatory polyps was small.The optimal excision limit was proposed in 6 literatures,most of which supported the excision limit of 12 mm or above.Preoperative imaging examination was emphasized to distinguish benign and malignant polyps,so as to reduce the proportion of gallbladder cholesterol polyps and increase the proportion of gallbladder adenoma and gallbladder cancer.3.Clinical study on risk factorsMultivariate logistic regression results showed that thyroid disease,inflammatory bowel disease,liver cyst,family history of malignant tumor,nocturnal eating,irregular work and rest schedule,and pylori infection were independent risk factors for PLG.Gallstone,diabetes,alcohol consumption,polyps of digestive tract were significantly correlated with PLG.4.Clinical study on TCM syndrome ruleThe basic syndromes of gallbladder polyps are as follows:the main syndromes are dampness-heat,blood stasis,qi stagnation,spleen deficiency,Yin deficiency and phlegm,and the syndromes of disease location are liver,gallbladder,spleen,stomach and intestine.The main syndrome types are liver depression and spleen deficiency syndrome,qi stagnation and blood stasis syndrome,liver and gallbladder dampness-heat syndrome,Yin deficiency and dampness-heat syndrome,spleen deficiency and phlegm-dampness syndrome.The frequency of dampness-heat syndrome of liver and gallbladder is the highest.The treatment can be through the liver and spleen accumulation,qi and blood elimination,clearing heat and dampness dispersing,Yin and removing excess,spleen warming Yang and phlegm treatment program,can be treated in the gallbladder before,during and after each stage is conducive to improving the diagnosis and treatment plan of traditional Chinese medicine prevention and treatment of gallbladder polyps,at the same time to strengthen the spirit and diet adjustment,is the top priority among the non-drug treatment of gallbladder polyps. |
PDF Full Text Request