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頁籤選單縮合
題名 | 乳癌預後之中醫舌診指標=The TCM Indices of Tongue Diagnosis for the Prognosis of Breast Cancer |
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編 次 | (2-2) |
作 者 | 蔣依吾; | 書刊名 | 中醫藥年報 |
卷期 | 3 2014.12[民103.12] |
頁次 | 頁(84)1-(84)42 |
分類號 | 413.241 |
關鍵詞 | 乳癌預後; 自動化舌診系統; Logistic regression; p-value; The prognosis of breast cancer; TCM; |
語文 | 中文(Chinese) |
中文摘要 | 研究目的:於 90至 92年計畫主持人帶領下,已發展可自動分析舌部影像特徵之中醫舌診電腦化系統,並經中醫藥委員會申請專利,於 2008年 4月獲准發明專利( "舌診系統及其方法 ",中華民國專利證書發明第 I296110號),復於 98、99年進行自動化舌診系統與中醫師診斷一致性研究,證實中醫舌診電腦化系統具高度自身一致性及符合舌診專家判讀之外部一致性,可降低傳統舌診因環境及人為因素影響,一致性偏低之缺失,俾利對舌象進行大規模定性及定量分析,提供客觀穩定判讀結果。其系統發展日趨穩定,進程由被動傳承轉化為積極創新,透過大規模對各類舌頭證型進行影像擷取、分析、統計及歸納,提出針對特定疾病之中醫嶄新理論。本計畫旨透過中醫舌診電腦化系統對乳癌進行客觀評估,以非侵入拍攝方式取得乳癌病患和正常人舌頭影像,經自動化舌診系統分析後,統計乳癌病患與正常人舌象特徵差異,並以乳癌病患舌象特徵與院方提供之病患西醫檢驗資料進行交叉比對,以找出可評估患者病況之舌象特徵,其判別依據將可提供醫師於臨床診斷上之參考。 研究方法:本計劃執行工作概略為 3階段:資料收集與分類、自動化舌診系統分析、數據統計比對經彰化基督教醫院使用舌診儀以非侵入性方式取得乳癌患者 (為實驗組)和正常 人(對,照組)之舌頭影像 (第一期取得實驗組 60例,對照組 70例,第二期實驗組再擴增 122例),將所取得之影像透過自動化舌診系統並統計分析兩者舌頭之舌色、苔色、苔之程度、裂紋、朱點、瘀點、齒痕、津液、舌形九大項特徵,歸納乳癌病患者與正常人舌象顯著差異處,據以鑑別乳癌患者與正常人,於期中報告(102.7.24)後根據委員建議,進行乳癌第零期患者與正常人比對,因此另增收集 15例 0期患者,總計 0期者 20例。惟零期乳癌仍屬小樣本,於期中實地訪查點(102.9.27)後據委員建議進行將第 0期與第 1期之患者合併後與正常人比對之工作(0期與 1期計 67例),藉以初步評估乳癌發病初期之客觀判別指標,同時亦比較乳癌腫塊發病部位(於胸部左側或右側)、乳癌期數不同時其舌特徵達顯著差異項目。 結果與討論:全程計畫期間已共收集乳癌病患 177例,正常人 70例之舌頭影像,經自動化舌診系統之數據整合與各類組別間舌象特徵之統計歸納與比較,其中重要成果為:(1)乳癌病患與正常人舌象特徵以 Mann-Whitney檢定達顯著水準 (p<0.05)項目為舌苔整體 (p=0.0073)、舌苔脾胃區 (p=0.0203)、舌苔最大面積 (p=0.0015)、舌苔厚薄度_薄苔(p=0.0004)、齒痕數量 (p=0.0454)、朱點數量 (p=0.0000)、朱點脾胃區個數(p=0.0000)、朱點肝膽左區 (p=0.0014)、朱點肝膽右區 p=(0.0000)、朱點心肺區個數 p=(0.0032),並以達顯著特徵者作為 Logistic Regression之預測模型因子與公式推導,其乳癌預測可達 80%之準確率 [16]。(2) 比較乳癌 0期、1期患者與正常人舌象特徵顯著差異部份,兩者間以舌苔整體 (p=0.018)、舌苔最小面積 (p=0.047)、舌苔最大面積 (p=0.000)、舌苔厚薄 (薄苔) (p=0.007)、整體舌頭長寬比 (p=0.008)、裂紋數量 (p=0.006)、齒痕肝膽左區數量 (p= 0.000)、齒痕肝膽右區數量 (p= 0.014) 、朱點數量 (p= 0.000)、朱點最大面積 (p= 0.024)、朱點脾胃區個數 (p=0.000)與朱點心肺區個數 (p= 0.000)皆達顯著水準,上述舌象特徵表現會因有否罹患乳癌而有數據上之差別,可進一步藉此鑑別乳癌初期患者。本期計劃之第一項研究成果已於 Journal of Traditional and Complementary Medicine發表,為中醫舌診結合現代科學應用發展上一重大突破,亦初步提供中醫師對乳癌之客觀判別指標,期望未來可配合各院之合作,建立起中醫舌診資料庫,屆時必能使資料收集與分析更加完善與效率之提升。 |
英文摘要 | AIM: Led by project director from 1991 to 1993, it has developed a Tongue computerized system which analyzes the tongue characteristic automatically, and from 2009 to 2010, we did the research about The Study on the Agreement between Automatic Tongue Diagnosis System and Traditional Chinese Medicine Practitioners. We prove that the results of this study lead us to conclude that ATDS is effective in preventing influence of external factors and can provide TCM practitioners with objective and precise diagnostic data. This project aims to make an objective assessment about breast cancer through TCM tongue computerized system. To search the tongue characteristic which will be assessed the disease so that the doctors will refer the discrimination in the clinical diagnosis. RESEARCH METHODS: With the help of Changhua Christian Hospital, We use the non-invasive way to shoot the tongue image of breast cancer patients and normal people. Tongue images through automated tongue diagnosis system and statistical analysis of both tongue Feature, summarized in breast cancer patients with normal tongueas significant difference to identify breast cancer patients and healthy subjects. And we combined both Chinese and Western medical knowledge to show the tongue differences between healthy people and early-stage (stage 0) breast cancer patients. Due to the few samples of early-stage patients (20 persons), here we further added in samples with patients at stage 1 condition to work on our research to help us observe and develop some objective tongue signals of early-stage breast cancer. We also compare significant difference items of tongues images from different breast cancer stages and tumor positions (in left/right breasts). RESULTS and DISCUSSION: The project gets 177 in experimental group and 70 in control group , a total of 247 tongue diagnosis image. We get important results: (1) The features of breast cancer patients and healthy subjects which use by Mann-Whitney test. The Mann–Whitney test showed that the amount of tongue fur, tongue fur in the spleen-stomach area, maximum covering area of tongue fur, thin tongue fur, the number of tooth marks, the number of red dots, red dot in the spleen-stomach area, red dot in the liver-gall-left area, red dot in the liver-gall-right area, and red dot in the heart-lung area demonstrated significant differences ( p<0.05). The tongue features of the testing group were employed to test the power of significant tongue features identified in predicting breast cancer. An accuracy of 80% was reached by applying the seven significant tongue features obtained through Mann–Whitney test.[16] (2) We found the outstanding differences of tongue image situation between stage 0 and 1 breast cancer patient and normal people. The main differences are tongue fur (p=0.018), minimum covering area of tongue fur (p=0.047), maximum covering area of tongue fur (p= 0. 003), thin tongue fur (p= 0.007), the aspect ratio of tongue (p= 0.008), the number of tongue fissure (p= 0.006), the number of tooth mark in the liver‑gall‑left(p= 0.000), the number of tooth mark in the liver‑gall‑right(p= 0.014), the number of red dots (p= 0.000), maximum area of red dots (p= 0.024), red dot in the spleen-stomach area (p=0.000) and red dot in the heart lung area demonstrated (p= 0.000).The primary result of this research project is already published in the journal of Traditional and Complementary Medicine, which indicates a great step in the field of scientific software applied in Chinese tongue diagnosis. This project also provides Chinese medicine doctors with objective signals to define breast cancer and going forward we expect more chances to corporate with Chinese medicine colleges to build up tongue image diagnosis database and further improve the efficiency and accuracy on this research and medical application. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。