胃炎系列方治疗胃癌前病变的临床与病理研究

作者	单位
徐进康	南京中医药大学附属昆山中医医院消化科
陆喜荣	南京中医药大学附属昆山中医医院消化科
李岩	南京中医药大学附属昆山中医医院消化科

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中文摘要:

目的研究胃炎系列方治疗慢性萎缩性胃炎(chronic atrophic gastritis,CAG)伴肠上皮化生(in-testinal metaplasia,IM)和(或)异型增生(dysplasia,Dys)的临床疗效,并探讨其逆转胃癌前期病变的分子机制。方法将确诊为CAG伴IM和(或)轻度Dys的患者150例随机分为治疗组(120例)和对照组(30例)。治疗组根据中医辨证分型分为肝胃不和型(32例)、脾胃虚弱型(35例)、胃阴不足型(28例)及胃络瘀阻型(25例)4个证型,分别给予胃炎系列方Ⅰ～Ⅳ号方口服;对照组给予胃复春片口服,均以3个月为1个疗程,共治疗2个疗程。比较两组治疗前后临床疗效、胃镜下改变、病理改变以及胃黏膜缺氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)、血管内皮生长因子(vascular endothelial growth factor,VEGF)蛋白表达。结果治疗组临床疗效总有效率(86.7%)及胃镜改善总有效率(78.3%)均高于对照组(分别为56.7%、40.0%),差异有统计学意义(P<0.01,P<0.05);治疗组临床症状总有效率及病理学变化总有效率亦高于对照组,差异有统计学意义(P<0.05)。对照组治疗前后HIF-1α及VEGF蛋白表达比较,差异均无统计学意义(P>0.05)。治疗组治疗后HIF-1α及VEGF蛋白表达均较本组治疗前明显减少(P<0.01),且明显低于对照组治疗后(P<0.05)。结论胃炎系列方治疗胃癌前病变有较好的临床疗效,并能显著改善萎缩、IM及Dys,促进病变胃黏膜的逆转,其作用机制可能与抑制胃癌前期病变时胃黏膜HIF-1α和VEGF的过度表达有关。

英文摘要:

Objective To study the therapeutic effect of Weiyan serial recipes(WYSR) in treatment of chronic atrophic gastritis(CAG) accompanied with intestinal metaplasia(IM) and/or dysplasia(Dys) and to explore its molecular mechanisms for reversing the gastric precancerous lesions.Methods One hundred and fifty patients with confirmed diagnosis of CAG accompanied with IM and/or mild Dys were randomly assigned to the treatment group(120 cases) and the control group(30 cases).Patients in the treatment group were respectively treated with WYSR Ⅰ-Ⅳ according to Chinese medicine syndrome typing as incoordination of Gan and Wei syndrome(32 cases),deficiency of Pi and Wei syndrome(35 cases),insufficient Wei-yin syndrome(28 cases),and stasis stagnation in Wei-channel syndrome(25 cases).Patients in the control group orally took Weifuchun Pill.The therapeutic course for all was 3 months,and totally 2 courses.The clinical effects,changes under the gastroscope,the pathological changes,and expressions of gastric mucosal hypoxia-inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF) protein were compared between the two groups before and after treatment.Results The total effective rate of the treatment group was 86.7% and the total effective rate of the gastroscopic changes was 78.3%,which was higher than those of the control group(56.7% and 40.0%),showing significant difference(P<0.01,P<0.05).The total effective rate of clinical symptoms and that of the pathological changes were higher in the treatment group than in the control group with statistical significance shown(P<0.05).There was no statistical difference in the expressions of HIF-1α and VEGF protein of the control group between before and after treatment(P>0.05).Compared with before treatment,the post-treatment expressions of HIF-1α and VEGF protein both obviously decreased in the treatment group(P<0.01),and were lower than those in the control group(P<0.05).Conclusions WYSR showed better effects on treating gastric precancerous lesions.It could significantly improve the atrophy,IM,and Dys,and promote the reversal of gastric precancerous lesions.Its mechanisms might possibly be correlated with inhibiting the over-expressions of HIF-1α and VEGF protein.

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