中医药防治胃癌研究进展
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摘要
胃癌(gastric cancer, GC)是我国常见的上消化道恶性肿瘤之一,其早期缺乏特异性的症状和体征,发现时往往处于疾病终末期,严重威胁我国人民的生命健康.中医药(traditional chinese medicine, TCM)对GC的防治具有良好疗效,本文主要从GC的病因病机,辨证分型和TCM在GC癌前病变、术前新辅助化疗、术后化疗、延长患者生存期等方面的应用做一综述.
Gastric cancer(GC) is one of the most common malignant tumors of the upper digestive tract, threatening the health of Chinese people seriously. It is often diagnosed at the late stage of the disease because of the lack of specific symptoms and signs in the early stage. However,traditional Chinese medicine(TCM) has good effects in the prevention and treatment of GC. This article reviews the etiology, pathogenesis, syndrome differentiation, and classification of GC, as well as the application of TCM in precancerous lesions of GC, preoperative neoadjuvant chemotherapy of GC, postoperative chemotherapy, and prolonging the life span of GC patients.
Gastric cancer(GC) is one of the most common malignant tumors of the upper digestive tract, threatening the health of Chinese people seriously. It is often diagnosed at the late stage of the disease because of the lack of specific symptoms and signs in the early stage. However,traditional Chinese medicine(TCM) has good effects in the prevention and treatment of GC. This article reviews the etiology, pathogenesis, syndrome differentiation, and classification of GC, as well as the application of TCM in precancerous lesions of GC, preoperative neoadjuvant chemotherapy of GC, postoperative chemotherapy, and prolonging the life span of GC patients.
引文
1万德森.临床肿瘤学.北京:科学出版社2014;95
2刘炯,李兆申.幽门螺杆菌感染与胃癌发生.中国实用内科杂志2014;34:538-544[DOI:10.7504/nk2014041002]
3 Lin Y,Wolk A,Hakansson N,Lagergren J,Lu Y.Dietary intake of lignans and risk of esophageal and gastric adenocarcinoma:a cohort study in Sweden.Cancer Epidemiol Biomarkers Prev2013;22:308-312[PMID:23195991 DOI:10.1158/1055-9965.EPI-12-1138]
4 Ferlay J,Soerjomataram I,Dikshit R,Eser S,Mathers C,Rebelo M,Parkin DM,Forman D,Bray F.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012.Int J Cancer 2015;136:E359-E386[PMID:25220842 DOI:10.1002/ijc.29210]
5 Chen W,Zheng R,Baade PD,Zhang S,Zeng H,Bray F,Jemal A,Yu XQ,He J.Cancer statistics in China,2015.CA Cancer J Clin2016;66:115-132[PMID:26808342 DOI:10.3322/caac.21338]
6 Shiraishi N,Yasuda K,Kitano S.Laparoscopic gastrectomy with lymph node dissection for gastric cancer.Gastric Cancer 2006;9:167-176[PMID:16952034 DOI:10.1007/s10120-006-0380-9]
7 Sugano H.Natural history of human cancer.Gan No Rinsho1983;29:475-482[PMID:6876413]
8 Saragoni L,Morgagni P,Gardini A,Marfisi C,Vittimberga G,Garcea D,Scarpi E.Early gastric cancer:diagnosis,staging,and clinical impact.Evaluation of 530 patients.New elements for an updated definition and classification.Gastric Cancer 2013;16:549-554[PMID:23423491 DOI:10.1007/s10120-013-0233-2]
9 Jiang L,Yang KH,Guan QL,Chen Y,Zhao P,Tian JH.Survival benefit of neoadjuvant chemotherapy for resectable cancer of the gastric and gastroesophageal junction:a meta-analysis.J Clin Gastroenterol 2015;49:387-394[PMID:25144898 DOI:10.1097/MCG.0000000000000212]
10车娟娟,王婧,曹邦伟.Claudin蛋白在胃癌种的研究进展.医学综述2017;23:3378-3382[DOI:10.3969/j.issn.10062084.2017.17.011]
11宋杰,陈凤格,赵伟,赵冬.胃癌的发病率现状与治疗研究进展.中国慢性病预防与控制2016;24:704-707[DOI:10.16386/j.cjpccd.issn.1004-6194.2016.09.019]
12何萍,沈克平,胡兵.中医药胃癌治疗研究进展.中华中医药学刊2012;30:280-282[DOI:10.13193/j.archtcm.2012.02.58.hep.013]
13李东垣.脾胃论.北京:北京人民卫生出版社2005;3-4
14江澄,林胜友,赵晶磊.胃癌中医证型动态演变的回顾性研究.中国中西医结合杂志2013;33:44-46[DOI:10.7661/CJIM.2013.1.44]
15刘苓霜.刘嘉湘.扶正治癌,人瘤共存.中国中医药报2018;4
16王雄文,林龙,李佩华,贺凡,周岱翰.周岱翰诊治肿瘤的中医学术思想探讨.广州中医药大学学2015;32:762-764[DOI:10.13359/j.cnki.gzxbtcm.2015.04.040]
17王永炎,严世芸.实用中医内科学.上海:上海科学技术出版社2009;686-688
18王程燕,谢长生.6970例胃癌辨证分型临床报道的统计分析.云南中医学院学报2015;38:58-61[DOI:10.19288/j.cnki.issn.1000-2723.2015.03.016]
19王克穷,于明洋.浅探队列研究在胃癌辨证标准研究中的运用.天津中医药2010;27:297-298
20林玲,韩涛,陆璐,孙倩倩,孙明瑜.慢性萎缩性胃炎及胃癌前病变动物模型的总结应用与评述.中国实验方剂学杂志2018;24:1-8[DOI:10.13422/j.cnki.syfjx.20182329]
21 Dinis-Ribeiro M,Areia M,de Vries AC,Marcos-Pinto R,Monteiro-Soares M,O'Connor A,Pereira C,Pimentel-Nunes P,Correia R,Ensari A,Dumonceau JM,Machado JC,Macedo G,Malfertheiner P,Matysiak-Budnik T,Megraud F,Miki K,O'Morain C,Peek RM,Ponchon T,Ristimaki A,Rembacken B,Carneiro F,Kuipers EJ;European Society of Gastrointestinal Endoscopy;European Helicobacter Study Group;European Society of Pathology;Sociedade Portuguesa de Endoscopia Digestiva.Management of precancerous conditions and lesions in the stomach(MAPS):guideline from the European Society of Gastrointestinal Endoscopy(ESGE),European Helicobacter Study Group(EHSG),European Society of Pathology(ESP),and the Sociedade Portuguesa de Endoscopia Digestiva(SPED).Endoscopy 2012;44:74-94[PMID:22198778DOI:10.1055/s-0031-1291491]
22 Correa P,Piazuelo MB.Natural history of Helicobacter pylori infection.Dig Liver Dis 2008;40:490-496[PMID:18396115 DOI:10.1016/j.dld.2008.02.035]
23陈曦,孙明瑜,刘宁宁,叶冠,赵亚红,张也青,朱梅萍.胃癌癌前病变分子遗传学改变研究进展.中国医刊2018;53:477-481[DOI:10.3969/j.issn.1008-1070.2018.05.004]
24郭亚云,冷秀梅,魏睦新.化痰消瘀方用于胃癌癌前病变的疗效观察.现代中西医结合杂志2013;22:3663-3665[DOI:10.3969/j.issn.1008-8849.2013.33.006]
25吴红苗.养胃消瘀汤治疗慢性萎缩性胃炎癌前病变的疗效观察及HP相关性的研究.中医临床研究2016;8:136-137[DOI:10.3969/j.issn.1674-7860.2016.15.066]
26杨建东.中医辨证治疗胃癌癌前病变临床观察.亚太传统医药2014;10:54-55
27 Frei E 3rd.Clinical cancer research:an embattled species.Cancer 1982;50:1979-1992[PMID:7127245]
28崔勇,张荣香,王福立,魏本尊,张建东.新辅助化疗联合术后同步放化疗治疗Ⅲ期胃癌的疗效分析.中国肿瘤临床2016;43:747-752[DOI:10.3969/j.issn.1000-8179.2016.17.389]
29赵国栋,王绥能,谢权,彭勃.进展期胃癌患者新辅助化疗及术后血清Her-2/neu ECD水平变化.中国现代医学杂志2013;23:70-72[DOI:10.3969/j.issn.1005-8982.2013.15.016]
30 Wilke H,Preusser P,Fink U,Gunzer U,Meyer HJ,Meyer J,Siewert JR,Achterrath W,Lenaz L,Knipp H.Preoperative chemotherapy in locally advanced and nonresectable gastric cancer:a phase II study with etoposide,doxorubicin,and cisplatin.J Clin Oncol 1989;7:1318-1326[PMID:2769330 DOI:10.1200/JCO.1989.7.9.1318]
31朱旭升.进展期胃癌新辅助化疗后超微结构的改变及健脾养胃方防治术后化疗不良反应的研究.南京:南京中医药大学2015
32周莲清.益气活血方对新辅助化疗胃癌围手术期的影响.湖南:湖南中医药大学2009
33曹超,黄秋林.扶正抑瘤方联合新辅助化疗、腹腔镜辅助胃癌根治术治疗进展期胃癌痰瘀毒结证患者的疗效观察.中国实验方剂学杂志2018;24:176-178[DOI:10.13422/j.cnki.syfjx.20180622]
34林明生,王常松.中医药对胃癌术后化疗患者的辨治思路.长春中医药大学学报2015;31:278-280[DOI:10.13463/j.cnki.cczyy.2015.02.021]
35薛兴存,郭锐.健脾益气化瘀方配合西药治疗早期胃癌术后疗效观察.陕西中医2012;33:843-844[DOI:10.3969/j.issn.1000-7369.2012.07.051]
36叶昀旖.益气健脾化积方对胃癌化疗患者免疫调控作用的临床研究.南京中医药大学2017
37陆任理.中医药联合化疗治疗进展期胃癌疗效的Meta分析.浙江中医药大学2014
38费燕华,王南瑶.参苓白术散对胃癌术后患者化疗药物副作用和生活质量的影响.浙江中医杂志2009;44:208[DOI:10.3969/j.issn.0411-8421.2009.03.036]
39刘昱.自拟理气和胃汤联合XELOX方案对胃癌术后患者的临床疗效观察.黑龙江中医药大学2017
40修丽娟.魏品康治疗胃癌特点.中国中医药信息杂志2006;13:87
41周珂,刘伟胜.晚期肺癌“带瘤生存的中西医结合调治思路”.新中医2011;43:1-3[DOI:10.13457/j.cnki.jncm.2011.05.062]
42丁忠阳,唐建东,李淦,蒋盘强,吴昊天,唐张峰.三维放化疗结合中医药治疗对胃癌远期及近期的影响.中国中医基础医学杂志2017;23:1731-1733
2刘炯,李兆申.幽门螺杆菌感染与胃癌发生.中国实用内科杂志2014;34:538-544[DOI:10.7504/nk2014041002]
3 Lin Y,Wolk A,Hakansson N,Lagergren J,Lu Y.Dietary intake of lignans and risk of esophageal and gastric adenocarcinoma:a cohort study in Sweden.Cancer Epidemiol Biomarkers Prev2013;22:308-312[PMID:23195991 DOI:10.1158/1055-9965.EPI-12-1138]
4 Ferlay J,Soerjomataram I,Dikshit R,Eser S,Mathers C,Rebelo M,Parkin DM,Forman D,Bray F.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012.Int J Cancer 2015;136:E359-E386[PMID:25220842 DOI:10.1002/ijc.29210]
5 Chen W,Zheng R,Baade PD,Zhang S,Zeng H,Bray F,Jemal A,Yu XQ,He J.Cancer statistics in China,2015.CA Cancer J Clin2016;66:115-132[PMID:26808342 DOI:10.3322/caac.21338]
6 Shiraishi N,Yasuda K,Kitano S.Laparoscopic gastrectomy with lymph node dissection for gastric cancer.Gastric Cancer 2006;9:167-176[PMID:16952034 DOI:10.1007/s10120-006-0380-9]
7 Sugano H.Natural history of human cancer.Gan No Rinsho1983;29:475-482[PMID:6876413]
8 Saragoni L,Morgagni P,Gardini A,Marfisi C,Vittimberga G,Garcea D,Scarpi E.Early gastric cancer:diagnosis,staging,and clinical impact.Evaluation of 530 patients.New elements for an updated definition and classification.Gastric Cancer 2013;16:549-554[PMID:23423491 DOI:10.1007/s10120-013-0233-2]
9 Jiang L,Yang KH,Guan QL,Chen Y,Zhao P,Tian JH.Survival benefit of neoadjuvant chemotherapy for resectable cancer of the gastric and gastroesophageal junction:a meta-analysis.J Clin Gastroenterol 2015;49:387-394[PMID:25144898 DOI:10.1097/MCG.0000000000000212]
10车娟娟,王婧,曹邦伟.Claudin蛋白在胃癌种的研究进展.医学综述2017;23:3378-3382[DOI:10.3969/j.issn.10062084.2017.17.011]
11宋杰,陈凤格,赵伟,赵冬.胃癌的发病率现状与治疗研究进展.中国慢性病预防与控制2016;24:704-707[DOI:10.16386/j.cjpccd.issn.1004-6194.2016.09.019]
12何萍,沈克平,胡兵.中医药胃癌治疗研究进展.中华中医药学刊2012;30:280-282[DOI:10.13193/j.archtcm.2012.02.58.hep.013]
13李东垣.脾胃论.北京:北京人民卫生出版社2005;3-4
14江澄,林胜友,赵晶磊.胃癌中医证型动态演变的回顾性研究.中国中西医结合杂志2013;33:44-46[DOI:10.7661/CJIM.2013.1.44]
15刘苓霜.刘嘉湘.扶正治癌,人瘤共存.中国中医药报2018;4
16王雄文,林龙,李佩华,贺凡,周岱翰.周岱翰诊治肿瘤的中医学术思想探讨.广州中医药大学学2015;32:762-764[DOI:10.13359/j.cnki.gzxbtcm.2015.04.040]
17王永炎,严世芸.实用中医内科学.上海:上海科学技术出版社2009;686-688
18王程燕,谢长生.6970例胃癌辨证分型临床报道的统计分析.云南中医学院学报2015;38:58-61[DOI:10.19288/j.cnki.issn.1000-2723.2015.03.016]
19王克穷,于明洋.浅探队列研究在胃癌辨证标准研究中的运用.天津中医药2010;27:297-298
20林玲,韩涛,陆璐,孙倩倩,孙明瑜.慢性萎缩性胃炎及胃癌前病变动物模型的总结应用与评述.中国实验方剂学杂志2018;24:1-8[DOI:10.13422/j.cnki.syfjx.20182329]
21 Dinis-Ribeiro M,Areia M,de Vries AC,Marcos-Pinto R,Monteiro-Soares M,O'Connor A,Pereira C,Pimentel-Nunes P,Correia R,Ensari A,Dumonceau JM,Machado JC,Macedo G,Malfertheiner P,Matysiak-Budnik T,Megraud F,Miki K,O'Morain C,Peek RM,Ponchon T,Ristimaki A,Rembacken B,Carneiro F,Kuipers EJ;European Society of Gastrointestinal Endoscopy;European Helicobacter Study Group;European Society of Pathology;Sociedade Portuguesa de Endoscopia Digestiva.Management of precancerous conditions and lesions in the stomach(MAPS):guideline from the European Society of Gastrointestinal Endoscopy(ESGE),European Helicobacter Study Group(EHSG),European Society of Pathology(ESP),and the Sociedade Portuguesa de Endoscopia Digestiva(SPED).Endoscopy 2012;44:74-94[PMID:22198778DOI:10.1055/s-0031-1291491]
22 Correa P,Piazuelo MB.Natural history of Helicobacter pylori infection.Dig Liver Dis 2008;40:490-496[PMID:18396115 DOI:10.1016/j.dld.2008.02.035]
23陈曦,孙明瑜,刘宁宁,叶冠,赵亚红,张也青,朱梅萍.胃癌癌前病变分子遗传学改变研究进展.中国医刊2018;53:477-481[DOI:10.3969/j.issn.1008-1070.2018.05.004]
24郭亚云,冷秀梅,魏睦新.化痰消瘀方用于胃癌癌前病变的疗效观察.现代中西医结合杂志2013;22:3663-3665[DOI:10.3969/j.issn.1008-8849.2013.33.006]
25吴红苗.养胃消瘀汤治疗慢性萎缩性胃炎癌前病变的疗效观察及HP相关性的研究.中医临床研究2016;8:136-137[DOI:10.3969/j.issn.1674-7860.2016.15.066]
26杨建东.中医辨证治疗胃癌癌前病变临床观察.亚太传统医药2014;10:54-55
27 Frei E 3rd.Clinical cancer research:an embattled species.Cancer 1982;50:1979-1992[PMID:7127245]
28崔勇,张荣香,王福立,魏本尊,张建东.新辅助化疗联合术后同步放化疗治疗Ⅲ期胃癌的疗效分析.中国肿瘤临床2016;43:747-752[DOI:10.3969/j.issn.1000-8179.2016.17.389]
29赵国栋,王绥能,谢权,彭勃.进展期胃癌患者新辅助化疗及术后血清Her-2/neu ECD水平变化.中国现代医学杂志2013;23:70-72[DOI:10.3969/j.issn.1005-8982.2013.15.016]
30 Wilke H,Preusser P,Fink U,Gunzer U,Meyer HJ,Meyer J,Siewert JR,Achterrath W,Lenaz L,Knipp H.Preoperative chemotherapy in locally advanced and nonresectable gastric cancer:a phase II study with etoposide,doxorubicin,and cisplatin.J Clin Oncol 1989;7:1318-1326[PMID:2769330 DOI:10.1200/JCO.1989.7.9.1318]
31朱旭升.进展期胃癌新辅助化疗后超微结构的改变及健脾养胃方防治术后化疗不良反应的研究.南京:南京中医药大学2015
32周莲清.益气活血方对新辅助化疗胃癌围手术期的影响.湖南:湖南中医药大学2009
33曹超,黄秋林.扶正抑瘤方联合新辅助化疗、腹腔镜辅助胃癌根治术治疗进展期胃癌痰瘀毒结证患者的疗效观察.中国实验方剂学杂志2018;24:176-178[DOI:10.13422/j.cnki.syfjx.20180622]
34林明生,王常松.中医药对胃癌术后化疗患者的辨治思路.长春中医药大学学报2015;31:278-280[DOI:10.13463/j.cnki.cczyy.2015.02.021]
35薛兴存,郭锐.健脾益气化瘀方配合西药治疗早期胃癌术后疗效观察.陕西中医2012;33:843-844[DOI:10.3969/j.issn.1000-7369.2012.07.051]
36叶昀旖.益气健脾化积方对胃癌化疗患者免疫调控作用的临床研究.南京中医药大学2017
37陆任理.中医药联合化疗治疗进展期胃癌疗效的Meta分析.浙江中医药大学2014
38费燕华,王南瑶.参苓白术散对胃癌术后患者化疗药物副作用和生活质量的影响.浙江中医杂志2009;44:208[DOI:10.3969/j.issn.0411-8421.2009.03.036]
39刘昱.自拟理气和胃汤联合XELOX方案对胃癌术后患者的临床疗效观察.黑龙江中医药大学2017
40修丽娟.魏品康治疗胃癌特点.中国中医药信息杂志2006;13:87
41周珂,刘伟胜.晚期肺癌“带瘤生存的中西医结合调治思路”.新中医2011;43:1-3[DOI:10.13457/j.cnki.jncm.2011.05.062]
42丁忠阳,唐建东,李淦,蒋盘强,吴昊天,唐张峰.三维放化疗结合中医药治疗对胃癌远期及近期的影响.中国中医基础医学杂志2017;23:1731-1733