电子鼻咽镜联合窄带成像技术在鼻咽癌中医辨证中的应用

Application of electronic nasopharyngoscopy combined with narrow band imaging in traditional Chinese medicine syndrome differentiation of nasopharyngeal carcinoma

摘要

目的 探讨电子鼻咽镜联合窄带成像技术(narrow band imaging, NBI)下鼻咽癌的局部特征与其整体中医证型之间的相关性。方法 纳入2023年5月至2025年5月中山市中医院初治鼻咽癌患者197例，其中热邪犯肺证49例、血瘀阻络证48例、痰浊结聚证70例、正虚毒滞证30例。采用电子鼻咽镜联合NBI技术观察鼻咽部黏膜形态、颜色、完整性及微血管颜色、密度、形态等局部特征，分析其与中医证型的关联。结果 鼻咽癌中医证型与镜下病变区边界清晰度、黏膜颜色、黏膜完整性、出血倾向、分泌物性质及NBI下微血管形态、密度、颜色特征均显著相关(P<0.05)。各证型特征性表现如下:热邪犯肺证以黏膜明显充血、脓性分泌物为主；血瘀阻络证表现为边界清晰、无分泌物，NBI下微血管呈棕褐色并墨绿色、密集融合及扭曲蛇形；痰浊结聚证以黏膜颜色与周围相似、分泌物增多为特征；正虚毒滞证以边界不规则、黏膜颜色稍淡、分泌物清晰为特征。结论 电子鼻咽镜联合NBI技术可客观显示鼻咽部黏膜形态及微血管改变，为鼻咽癌中医辨证提供可视化依据，对临床精准辨证具有指导意义。

Abstract

Objective To investigate the correlation between local features of nasopharyngeal carcinoma (NPC) observed under electronic nasopharyngoscopy combined with narrow band imaging (NBI) and traditional Chinese medicine (TCM) syndrome patterns, providing objective imaging evidence for TCM syndrome differentiation. Methods A total of 197 patients with newly diagnosed NPC treated at Zhongshan Hospital of Traditional Chinese Medicine from May 2023 to May 2025 were enrolled and classified into four TCM syndrome types: ReXieFanFei syndrome (n=49), XueYuZuLuo syndrome (n=48), TanZhuoJieJu syndrome (n=70), and ZhengXuDuZhi syndrome (n=30). Electronic nasopharyngoscopy combined with NBI was used to observe local features including mucosal morphology, color, integrity, as well as microvascular color, density, and morphology. The correlation between these features and TCM syndrome types was analyzed. Results NPC TCM syndrome patterns showed significant associations (P<0.05) with endoscopic characteristics, including lesion border clarity, mucosal color, mucosal integrity, bleeding tendency, secretion properties, and NBI microvascular features (color, density, and morphology). Key manifestations for each syndrome type were as follows: ReXieFanFei syndrome was characterized by marked mucosal congestion and purulent secretions; XueYuZuLuo syndrome featured well-defined borders, absence of secretions, and NBI findings of brownish-green microvessels with dense fusion and serpentine tortuosity; TanZhuoJieJu syndrome presented with mucosal color similar to surrounding tissue and increased secretions; ZhengXuDuZhi syndrome was characterized by irregular borders, pale mucosa, and clear secretions. Conclusion Electronic nasopharyngoscopy combined with NBI technology can objectively reveal mucosal and microvascular alterations in NPC, providing a visual basis for TCM syndrome differentiation and guiding clinical precision treatment.

关键词

鼻咽癌 / 电子鼻咽镜 / 窄带成像技术 / 中医证型

Key words

Nasopharyngeal carcinoma / Electronic nasopharyngoscopy / Narrow band imaging / Traditional Chinese medicine syndrome patterns

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基金资助

中山市社会公益与基础研究专项资金(2024B1135)

广东省中医药局基金项目(20221427)

中山市社会公益科技研究项目(2023B1087)

中山市中医药传承创新发展科研专项重点项目(2024B3004)