健脾活血法治疗慢性萎缩性胃炎的疗效观察及对转化生长因子（TGF-β1）、Smad3表达的影响

发布时间：2018-06-09 20:31

本文选题：CAG + 脾虚血瘀　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:采取随机、对照的方法,观察健脾活血法治疗慢性萎缩性胃炎(CAG)脾虚血瘀证的临床疗效及对转化生长因子(TGF-β1),Smad3表达的影响,探讨可能的作用机制。方法:根据本研究的纳入标准,收集就诊于江苏省中医院普内科门诊符合CAG脾虚血瘀证诊断标准的患者共78例。采用数字随机法将患者分为两组,治疗组40例,脱落2例,对照组38例,脱落3例,治疗组予口服健脾活血方(炙黄芪15克,炒白术10克,炒苡仁15克,莪术10克,炒枳壳10克,佛手10克,鸡内金10克,石见穿15克,每日1剂,水煎服,200ml,早晚各一次),共治疗3个月;对照组予口服胃复春片(每次4片,每天3次),共治疗3个月。观察两组患者治疗前后的临床症状、病理变化及治疗组治疗前后TGF-β1、Smad3表达的情况,进行统计学分析。结果:1.症候疗效比较:治疗组患者38例,其中临床治愈13例,显效10例,有效11例,无效4例,总有效率达89.50%;对照组患者35例,其中临床治愈2例,显效6例,有效14例,无效13例,总有效率为62.86%。经统计学分析P0.01,两组症候疗效之间存在高度显著性差异。说明治疗组疗效明显优于对照组。2.胃黏膜病理检查比较:在改善患者胃黏膜萎缩、肠上皮化生的程度上,两组治疗前后积分对比具有高度显著性差异(P0.01),且治疗后两组组间对比亦具有高度显著性差异(P0.01),说明两组均可以明显改善患者胃黏膜萎缩及肠上皮化生,治疗组明显优于对照组。3.治疗组治疗前后胃黏膜免疫组化病理比较:治疗后TGF-β1及Smad3的表达比治疗前显著下降,具有显著性差异(P0.05),且TGF-β1与Smad3的表达在治疗前(r=0.793)与治疗后的表达(r=0.735)均呈正相关(P0.05)。4.两组在治疗过程中,均无发现任何不良反应。结论:运用健脾活血法治疗CAG脾虚血疲证可显著改善患者的临床症状,减轻萎缩、肠化的程度,并可以降低患者TGF-β1及Smad3蛋白的表达,提示健脾活血法可能通过改善胃黏膜血流量、诱导细胞分化、调节细胞增殖与凋亡、调节细胞免疫等机制达到治疗CAG的目的。
[Abstract]:Objective: to observe the clinical effect of invigorating spleen and activating blood circulation in treating chronic atrophic gastritis with deficiency of spleen and blood stasis and its effect on the expression of TGF- 尾 1 and Smad3 in chronic atrophic gastritis (CAG). Methods: according to the inclusion criteria of this study, 78 patients with CAG spleen deficiency and blood stasis syndrome were collected from Department of General Medicine, Jiangsu Provincial Hospital of traditional Chinese Medicine. The patients were randomly divided into two groups with 40 cases in the treatment group, 2 cases in the control group and 38 cases in the control group. The treatment group was given orally the decoction of invigorating spleen and activating blood circulation (15 grams of Radix Astragali, 10 grams of Atractylodes macrocephala, 15 grams of fried lachrymine, 10 grams of zedoary curcuma, 10 grams of Rhizoma Curcumae). Fried Fructus Aurantii 10 grams, Buddhist hand 10 grams, chicken Neijin 10 grams, stone see wear 15 grams, daily 1 dose, decoction of water 200ml, morning and evening, once in the morning and evening, a total of 3 months, the control group was given oral Weifuchun tablet (4 tablets per day, 3 times a day, a total of 3 months). The clinical symptoms, pathological changes and the expression of TGF- 尾 1 Smad3 before and after treatment in two groups were observed and analyzed statistically. The result is 1: 1. There were 38 cases in the treatment group, including 13 cases of clinical cure, 10 cases of remarkable effect, 11 cases of effective and 4 cases of ineffectiveness, and the total effective rate was 89.50 cases, while in the control group, there were 2 cases of clinical cure, 6 cases of remarkable effect, 14 cases of effective and 13 cases of ineffectiveness. The total effective rate was 62.86. By statistical analysis P 0.01, there was a significant difference between the two groups. It shows that the curative effect of the treatment group is obviously superior to that of the control group. Comparison of pathological examination of gastric mucosa: in improving the degree of gastric mucosal atrophy and intestinal metaplasia in patients, The scores of the two groups were significantly different before and after treatment, and there was also a significant difference between the two groups after treatment, indicating that both groups could obviously improve the gastric mucosal atrophy and intestinal metaplasia, and the treatment group was obviously superior to the control group (.3). The expression of TGF- 尾 1 and Smad3 in the treatment group was significantly lower than that before and after treatment (P 0.05), and the expression of TGF- 尾 1 and Smad3 was positively correlated with the expression of TGF- 尾 1 and Smad3 before and after treatment. No adverse reactions were found in both groups during the course of treatment. Conclusion: the method of invigorating spleen and activating blood circulation can significantly improve the clinical symptoms, reduce the degree of atrophy and intestinal metaplasia, and decrease the expression of TGF- 尾 1 and Smad3 protein in patients with CAG. It is suggested that the method of invigorating spleen and activating blood circulation may be used to treat CAG by improving gastric mucosal blood flow, inducing cell differentiation, regulating cell proliferation and apoptosis, and regulating cellular immunity.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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