目的:通过分析健康女性乳腺BI-RADS分类与其可能影响因素的关系,以更早期通过干预达到一级预防。方法:以我院近5年7 204例健康体检女性作为研究对象,分析其乳腺超声与年龄、BMI、甘油三酯、总胆固醇、高密度胆固醇(HDL-C)、葡萄糖、子宫状态的关联,乳腺报告采用美国放射学会乳腺影像学报告和数据系统(Breast Imaging Reporting and Data System,BI-RADS)判读结果,对各项数据进行卡方检验与Logistic多因素分析。结果:年龄、甘油三酯、总胆固醇、HDL-C、葡萄糖对乳腺BI-RADS分类没有影响(P>0.05);BMI(P=0.004)与子宫状态(P=0.000)是BI-RADS分类的独立影响因素;低体质(OR=0.696,95%CI=0.502~0.966)、超重(OR=0.217,95%CI=0.142~0.333)、肥胖(OR=0.123,95%CI=0.066~0.231)与BI-RADS分类呈负相关,子宫缺失(OR=19.189,95%CI=14.055~26.198)、子宫肌瘤(OR=4.384,95%CI=3.499~5.492)、绝经期子宫(OR=3.283,95%CI=2.374~4.541)是BI-RADS高分类的危险因素。结论:BMI与子宫状态是BI-RADS高分类的独立危险因素,这种关联不依赖于其他因素独立存在。子宫状态与乳腺BI-RADS关联,发现子宫缺失对乳腺BI-RADS分类极具影响。
Cancer immunoediting consists of three sequential phases： elimination, equilibdum, and escape. For colorectal adenoma-carcinoma sequence, the adenoma dysplastic progression may represent an equilibdum phase and the cancer stage as escape phase. Immune system eliminates transformed enterocytes by destroying them at first, sculpts them at the same time and selects the variants subsequently that are no longer recognized and insensitive to immune effectors, and finally induces immunosuppressive state within the tumor microenvironment that facilitates immune escape and tumor outgrowth. Immunosuppression and inflammation are the two crucial features of Pi （Spteen）-deficiency. Ctassic quotations, immune evidence and ctinicat observations suggest that Spleen （but not other organs） deficiency is the key pathogenesis of colorectal cancer （CRC） microenvironment. Weakness of old age, immunosuppressive cytokines from chronic inflammation, tumor-dedved immunosuppressive factors and surrendered immune cells--regulatory T cells, myeloid-derived suppressor cells and tumor associated macrophages （TAMs） constitutes CRC microenvironment of Pi-deficiency. Furthermore, excess in superficiality, such as phlegm stagnation, blood stasis and toxin accumulation are induced by chronic inflammation on the basis of asthenia in origin, an immunosuppressive state. Great masters of Chinese medicine emphasize that strengthen Pi is the chief therapeutic principle for CRC which receives good therapeutic effects. So, Pi-deficiency based syndrome is the pivotal pathogenesis of tumor microenvironment. The immunosuppressive microenvironment facilitates immune escape which play an important role in the transition from adenoma to adenocarcinoma. There are some signs that strengthen Pi based treatment has potential capacity to ameliorate tumor environment. It might be a novel starting point to explore the mechanism of strengthen Pi based therapy in the prevention and treatment of CRC through regulation of tumor environment and immunoedit
