理气活血解毒法对慢性萎缩性胃炎伴肠上皮化生的临床研究及机制探讨

发布时间：2018-01-18 00:19

本文关键词：理气活血解毒法对慢性萎缩性胃炎伴肠上皮化生的临床研究及机制探讨　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:慢性萎缩性胃炎伴肠上皮化生是一种胃癌前疾病。肠上皮化生是癌前病变的关键步骤,所以干预肠上皮化生是减少胃癌发病率的关键。现代医学对于慢性萎缩性胃炎伴肠上皮化生的治疗上主要采取目以根除Hp,促进胃动力,保护胃黏膜,抗氧化剂、叶酸等治疗手段。目前没有明确有效的手段。中医药在治疗、干预慢性萎缩性胃炎伴肠上皮化生的临床实践中有着突出的优势。中医各家在治疗本病时有着不同的认识及临证经验。我们通过前期对慢性萎缩性胃炎伴肠上皮化生进行的证候学调查结果,我们采用了理气活血解毒法治疗本病,有待于通过进一步研究证实其疗效,探索其机制。本研究观察分析了理气活血解毒法治疗慢性萎缩性胃炎伴肠上皮化生中肝胃郁热,气虚血瘀患者39例。根据其治疗前后的症状、病理、CDX2、MUC2、Ki-67、Bcl-2、Bax表达水平变化,评价理气活血解毒法治疗IM的疗效,尝试分析理气活血解毒法治疗慢性萎缩性胃炎伴肠上皮化生可能的作用机制,同时丰富本病的理论和临床诊疗基础及依据。本研究分两部分:第一部分总结撰写中西医综述,总结CAG伴IM的认识及研究进展。第一篇阐述慢性萎缩性胃炎伴肠上皮化生相关的中医学认识。第二篇总结现代医学对慢性萎缩性胃炎伴肠上皮化生的研究进展。第二部分临床研究通过观察慢性萎缩性胃炎临床治疗前后症状、组织病理、免疫组化等相关指标的变化,观察理气活血解毒法对CAG伴IM的疗效,探讨理气活血解毒法干预慢性萎缩性胃炎伴肠上皮化生的作用机制。方法:本课题观察来源于2014.09-2016.12就诊于北京中医药大学东直门医院的慢性萎缩性胃炎伴肠上皮化生,肝胃郁热,气虚血瘀患者39名。对于符合纳入标准的病例,予理气活血解毒法方药(醋柴胡10g、紫苏梗10g、白花蛇舌草10g、生薏苡仁30g、莪术10g、太子参10g)口服治疗,观察治疗前后症状、组织病理、CDX2、MUC2、Ki-67、Bcl-2、Bax表达水平变化,评价理气活血解毒法治疗IM的疗效,尝试分析理气活血解毒法治疗慢性萎缩性胃炎伴肠上皮化生可能的作用机制。结果:(1)中医症状积分疗效评价:痊愈7例,占17.95%,显效5例,占12.82%,有效22例,占56.41%,无效5例,占12.82%,总有效率87.18%。根据疗前疗后症状积分对比,发现胃痛、痞满、反酸症状差异具有显著统计学意义(P0.01)。暖气、食欲减退、乏力症状差异具有统计学意义(P0.05)。大便稀溏、口苦咽干、烧心、心烦易怒、呃逆、恶心呕吐等症状差异无统计学意义(P0.05)。(2)病理学疗效评价:痊愈9例,占23.08%,显效6例,占15.38%,有效16例,占41.03%,无效8例,占20.51%,总有效率=痊愈率+显效率+有效率=79.49%。疗前疗后肠上皮化生、异型增生的差异具有显著统计学意义(P0.01),腺体萎缩、慢性炎症没有明显差异(P0.05)。病理积分疗前疗后具有显著差异(P0.01)。(3)治疗前后 CDX2、MUC2、Ki67、Bcl-2、Bax表达差异治疗前CDX2中度表达比例较高(74.36%)。MUC2中轻、中度表达比例较高(35.90%、46.15%),治疗后CDX2轻、中度表达较高(46.15%、38.46%),MUC2阴性表达较高(43.59%)。治疗前后Ki-67、Bcl-2均为中度表达比例较高。治疗前后Bax均为阴性表达比例较高。在疗前和疗后进行比较,发现CDX2差异有统计学意义(P0.05);MUC2差异有显著统计学意义(P0.01)。Ki-67、Bcl-2、Bax差异无统计学意义(P0.05)。结论:(1)慢性萎缩性胃炎伴肠上皮化生收入病人年龄多在40-70岁之间,说明慢性萎缩性胃炎伴肠上皮化生多见于中老年人,符合对于慢性萎缩性胃炎的流行病学认识。(2)通过症状积分、胃镜及病理诊断,可证明理气活血解毒法治疗慢性萎缩性胃炎伴肠上皮化生疗效可靠。(3)理气活血解毒法可能是通过影响CDX2的表达,进而影响MUC2的表达,从而影响胃粘膜肠上皮化生的进程。
[Abstract]:Objective: Chronic Atrophic Gastritis with intestinal metaplasia is a precancerous disease. Intestinal metaplasia is a key step in precancerous lesions, so the intervention of intestinal metaplasia is the key to reduce the incidence of gastric cancer. The treatment of modern medicine for chronic atrophic gastritis with intestinal metaplasia and should be taken in order to the eradication of Hp, promote gastric motility, protect gastric mucosa, antioxidant and folic acid treatment. At present there is no clear and effective means. In the treatment of Chinese medicine, has a prominent advantage in clinical practice intervention of chronic atrophic gastritis with intestinal metaplasia. Various Chinese medicine have different understanding and clinical experience in the treatment of this when the disease investigation results. We through the early syndrome of chronic atrophic gastritis with intestinal metaplasia were, we adopt the method of regulating qi and activating blood in treating this disease detoxification, need to be further research confirmed its efficacy, to explore its mechanism. Study the Qi blood detoxification method with intestinal metaplasia in the liver and stomach syndrome in treatment of chronic atrophic gastritis, 39 cases of qi deficiency and blood stasis patients. According to their clinical symptoms, pathology, CDX2, MUC2, Ki-67, Bcl-2, the expression of Bax, evaluation of curative effect of Qi Huoxue Jiedu Decoction Treat IM, try to analyze the treatment of chronic atrophic gastritis with intestinal metaplasia of the possible mechanism of regulating qi and activating blood detoxification, and enrich the theory of disease and clinical basis. This research is divided into two parts: the first part summarizes the writing of Chinese and Western medicine review, summarize the progress of knowledge and research of CAG with IM. The first part of chronic atrophic gastritis intestinal metaplasia associated with TCM. The second article summarizes the research progress of modern medicine for chronic atrophic gastritis with intestinal metaplasia. The second part is clinical research through observation of clinical treatment of chronic atrophic gastritis Before and after the symptoms, pathological changes, immunohistochemistry and other related indicators, to observe the curative effect of Qi blood detoxification method on CAG with IM, and explore mechanisms of Liqi Huoxue Jiedu therapy in the treatment of chronic atrophic gastritis with intestinal metaplasia. Methods: This study observed the chronic atrophic gastritis from 2014.09-2016.12 treated at the Beijing University of Chinese Medicine hospital in Dongzhimen with intestinal metaplasia, liver stomach heat, Qi deficiency and blood stasis patients 39. For the cases that meet the inclusion criteria, to Qi Huoxue Jiedu prescription (vinegar Bupleurum 10g, perilla 10g, Oldenlandia 10g, raw coix seed 30g, Rhizoma Curcumae 10g, Radix Pseudostellariae 10g) oral treatment, observation of symptoms before and after treatment, the organization CDX2, MUC2, pathology, Ki-67, Bcl-2, the expression of Bax, evaluation of curative effect of Qi Huoxue Jiedu Decoction Treat IM, try to analyze with intestinal metaplasia may be the treatment of chronic atrophic gastritis Qi and activating blood detoxification Mechanism. Results: (1) the curative effect evaluation of TCM symptom score: 7 cases were cured, accounting for 17.95%, effective in 5 cases, accounting for 12.82%, effective 22 cases, invalid 5 cases, accounting for 56.41%, accounting for 12.82%, the total efficiency of 87.18%. according to the symptoms before and after treatment the integral comparison, found a stomachache, fullness, was statistically significant the significance of differences in symptoms of acid reflux (P0.01). The heating, loss of appetite, fatigue symptoms were statistically significant difference (P0.05). Loose stool, throat pain, heartburn, irritability, hiccups, nausea and vomiting and other symptoms had no significant difference (P0.05). (2) the pathological evaluation of curative effect: 9 cases were cured, accounted for 23.08%. Effective in 6 cases, accounting for 15.38%, effective 16 cases, invalid 8 cases, accounting for 41.03%, accounting for 20.51%, the total effective rate = ofabove remarkable rate + efficiency of =79.49%. before therapy of intestinal metaplasia, there was a statistically significant difference (P0.01), dysplasia of glandular atrophy, there was no significant difference between chronic inflammation (P0.05) the pathological scores of treatment. Before and after treatment with significant difference (P0.01). (3) before and after treatment, CDX2, MUC2, Ki67, Bcl-2, Bax expression of CDX2 before the treatment of moderate expression of a higher proportion (74.36%) in.MUC2 light, a higher proportion of moderate expression (35.90%, 46.15%), after treatment of CDX2 light, moderate high expression (46.15%, 38.46%). The negative expression of MUC2 was higher (43.59%). Before and after treatment Ki-67, Bcl-2 were moderate expression. A higher proportion of Bax before and after treatment were negative expression. A higher proportion in comparison before treatment and after treatment, found that there were significant differences in CDX2 (P0.05 MUC2); statistically significant (P0.01).Ki-67, Bcl-2, no significant differences in Bax (P0.05). Conclusion: (1) chronic atrophic gastritis with intestinal metaplasia patient income over the age between 40-70 years old, chronic atrophic gastritis with intestinal metaplasia is more common in the elderly, in conformity with the epidemiology of chronic atrophic gastritis (2) through the understanding. Symptoms, gastroscopy and pathological diagnosis, that Qi and activating blood detoxification in treatment of chronic atrophic gastritis with intestinal metaplasia (3). The curative effect is reliable Qi blood detoxification method may be affected by the expression of CDX2, thereby affecting the expression of MUC2, thus affecting the intestinal metaplasia of gastric mucosa in the process.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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