小归芍化浊解毒方对胃癌前病变浊毒内蕴证患者血清胃蛋白酶原的影响
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摘要
目的观察小归芍化浊解毒方治疗胃癌前病变浊毒内蕴证的临床疗效及可能作用机制。方法将102例胃癌前病变浊毒内蕴证患者随机分为治疗组和对照组各51例。治疗组给予小归芍化浊解毒方口服,每日1剂;对照组给予口服胃复春片,每次4片,每日3次,疗程均为3个月。观察治疗前后患者临床症状积分、胃镜下黏膜病变积分及病理学积分,并检测治疗前后血清胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ及胃蛋白酶原比值(PGR)水平。结果治疗组治疗后临床症状积分均较治疗前降低(P <0. 05),且治疗组治疗后胃脘疼痛、胃脘胀闷、嗳气、嘈杂、寐差、胃凉积分较对照组降低更明显(P <0. 05)。治疗组治疗后黏膜病变积分均降低(P <0. 05),且治疗组在改善黏膜白或花斑、血管透见及隆起结节积分方面优于对照组(P <0. 05)。治疗组在改善萎缩、肠化积分及病理总积分方面优于对照组(P <0. 05)。治疗后两组血清胃蛋白酶原Ⅰ及PGR水平均较本组治疗前增加,且治疗组均优于对照组(P <0. 05)。结论小归芍化浊解毒方治疗胃癌前病变浊毒内蕴证不仅能缓解临床症状,还能改善患者病理组织学表现,调节血清胃蛋白酶原水平可能是其机制之一。
Objective To observe the clinical effect and possible mechanism of Xiaoguishao Huazhuo Jiedu Decoction( 小归芍化浊解毒方) on pepsinogen of the patients with gastric precancerous lesions and syndrome of interior retention of turbidity and toxin. Methods A total of 102 patients were randomly divided into a treatment group and a control group,with 51 patients in each group. The treatment group was given Xiaoguishao Huazhuo Jiedu Decoction,and the control group was given Weifuchun tablets both for 3 months. The changes of clinical symptoms,scores of mucosal lesion under gastroscopy,scores of pathology,were observed before and after the treatment. The levels of serum pepsinogen Ⅰ,pepsinogen Ⅱ and pepsinogen ratio( PGR) were examined. Results The scores of symptoms in the treatment group were reduced after treatment( P < 0. 05),and the reduciton of scores of gastric pain,stomach distention,belching,gastric discomfort,insomnia,and cool stomach was more significant than that of the control group( P < 0. 05). The score of mucosal lesions in the treatment group decreased( P < 0. 05). The changes of score of leukoplakia or versicolor mucosa,and the blood vessel penetration and the bulge nodules in the treatment group was superior to that in the control( P < 0. 05). The improvement of scores of atrophy and intestinal metaplasia in the treatment group was better than that of the control group( P < 0. 05). The levels of pepsinogenⅠ and PGR in both groups were higher than those before treatment,and the treatment group was superior to the control group( P < 0. 05).Conclusion Xiaoguishao Huazhuo Jiedu Decoction in the treatment of gastric precancerous lesions and syndrome of interior retention of turbidity and toxin,can not only improve clinical symptoms,but also improve pathological conditions,whose mechanism might be regulating pepsinogen levels.
Objective To observe the clinical effect and possible mechanism of Xiaoguishao Huazhuo Jiedu Decoction( 小归芍化浊解毒方) on pepsinogen of the patients with gastric precancerous lesions and syndrome of interior retention of turbidity and toxin. Methods A total of 102 patients were randomly divided into a treatment group and a control group,with 51 patients in each group. The treatment group was given Xiaoguishao Huazhuo Jiedu Decoction,and the control group was given Weifuchun tablets both for 3 months. The changes of clinical symptoms,scores of mucosal lesion under gastroscopy,scores of pathology,were observed before and after the treatment. The levels of serum pepsinogen Ⅰ,pepsinogen Ⅱ and pepsinogen ratio( PGR) were examined. Results The scores of symptoms in the treatment group were reduced after treatment( P < 0. 05),and the reduciton of scores of gastric pain,stomach distention,belching,gastric discomfort,insomnia,and cool stomach was more significant than that of the control group( P < 0. 05). The score of mucosal lesions in the treatment group decreased( P < 0. 05). The changes of score of leukoplakia or versicolor mucosa,and the blood vessel penetration and the bulge nodules in the treatment group was superior to that in the control( P < 0. 05). The improvement of scores of atrophy and intestinal metaplasia in the treatment group was better than that of the control group( P < 0. 05). The levels of pepsinogenⅠ and PGR in both groups were higher than those before treatment,and the treatment group was superior to the control group( P < 0. 05).Conclusion Xiaoguishao Huazhuo Jiedu Decoction in the treatment of gastric precancerous lesions and syndrome of interior retention of turbidity and toxin,can not only improve clinical symptoms,but also improve pathological conditions,whose mechanism might be regulating pepsinogen levels.
引文
[1]TOMOHIRO KD. Analysis of ABC(D)stratification for screening patients with gastric cancer[J]. World J Gastroenterol,2011,17(43):4793-4798.
[2]MIKI K. Gastric cancer screening by combined assay for serum anti-Helicobacter pylori IgG antibody and serum pepsinogen levels-“ABC method”[J]. Proc Jpn Acad Ser B Phys Biol Sci,2011,87(7):405-414.
[3]SIPPONEN P,RANTA P,HELSKE T,et al. Serum levels of amidated gastrin-17 and pepsinogen I in atrophic gastritis:an observational case-control study[J]. Scand J Gastroenterol,2002,37(7):785-791.
[4]梁瑞威,侯俊良,廖江涛.不同胃黏膜病变患者的血清胃蛋白酶原变化[J].临床与病理杂志,2016,36(3):215-219.
[5]刘启泉,李博林,王志坤,等.小归芍化浊解毒方治疗胃癌前病变临床研究[J].四川中医,2014,32(6):90-92.
[6]王志坤,刘启泉,李博林,等.小归芍化浊解毒方治疗胃癌前病变的临床疗效及对患者生存质量的影响[J].四川中医,2014,32(1):91-93.
[7]中华医学会消化病学分会.中国慢性胃炎共识意见[J].胃肠病学,2013,18(1):24-36.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:124-129.
[9]中华中医药学会脾胃病分会.慢性萎缩性胃炎中医诊疗共识意见[J].中医杂志,2010,51(8):749-753.
[10]张澍田,程芮.胃癌前病变的内镜治疗进展[J].医学与哲学,2015,36(12):15-17.
[11]曹艳菊,屈昌民,吴继华,等.叶酸联合胃复春治疗萎缩性胃炎癌前病变的疗效[J].世界华人消化杂志,2013,21(30):3261-3264.
[12]冯瑞兵.叶酸对慢性萎缩性胃炎癌前病变的疗效观察[J].新医学,2011,42(5):312-314.
[13]薛辉,辛凤池,穆素恩,等.血清Hcy,叶酸和维生素B12在胃癌及其癌前疾病中的作用[J].现代生物医学进展,2017,17(15):2896-2899.
[14]詹继烈,罗靖,何萍,等.胃粘膜相微观辨证分型探讨:附2000例分析[J].中医杂志,1989,30(4):37-40.
[15]刘华一,张莎,杨阔,等.胃癌前病变中医证候分型与胃蛋白酶原的相关性研究[J].中国中西医结合消化杂志,2016,24(6):449-454.
[16]刘启泉,李佃贵,张纨,等.慢性胃炎从浊毒论治[J].北京中医药大学学报,2010,33(3):153-155.
[17]乔正梅,王登峰,赵秋剑,等.血清胃蛋白酶原、胃泌素-17在胃癌及胃癌前病变的诊断价值[J].中国卫生检验杂志,2017,27(2):198-200.
[18]熊文坚,陆思源,金惠,等.癌前病变及胃癌的有效血清学筛查方法研究[J].中国临床医学,2006,13(6):953-954.
[19]刘丹,吴瑾. PG,MG-7与胃癌关系的研究现状与进展[J].实用肿瘤学杂志,2006,20(6):558-560.
[20]陈智周,范振符.胃蛋白酶原Ⅰ、Ⅱ在早期胃癌普查中的意义[J].中华肿瘤杂志,2002,24(1):1-3.
[21]鲁品,马颖才.血清胃蛋白酶原在胃癌癌前病变、筛查及预后应用中的研究进展[J].中华胃肠内镜电子杂志,2016,3(2):79-82.
[2]MIKI K. Gastric cancer screening by combined assay for serum anti-Helicobacter pylori IgG antibody and serum pepsinogen levels-“ABC method”[J]. Proc Jpn Acad Ser B Phys Biol Sci,2011,87(7):405-414.
[3]SIPPONEN P,RANTA P,HELSKE T,et al. Serum levels of amidated gastrin-17 and pepsinogen I in atrophic gastritis:an observational case-control study[J]. Scand J Gastroenterol,2002,37(7):785-791.
[4]梁瑞威,侯俊良,廖江涛.不同胃黏膜病变患者的血清胃蛋白酶原变化[J].临床与病理杂志,2016,36(3):215-219.
[5]刘启泉,李博林,王志坤,等.小归芍化浊解毒方治疗胃癌前病变临床研究[J].四川中医,2014,32(6):90-92.
[6]王志坤,刘启泉,李博林,等.小归芍化浊解毒方治疗胃癌前病变的临床疗效及对患者生存质量的影响[J].四川中医,2014,32(1):91-93.
[7]中华医学会消化病学分会.中国慢性胃炎共识意见[J].胃肠病学,2013,18(1):24-36.
[8]郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:124-129.
[9]中华中医药学会脾胃病分会.慢性萎缩性胃炎中医诊疗共识意见[J].中医杂志,2010,51(8):749-753.
[10]张澍田,程芮.胃癌前病变的内镜治疗进展[J].医学与哲学,2015,36(12):15-17.
[11]曹艳菊,屈昌民,吴继华,等.叶酸联合胃复春治疗萎缩性胃炎癌前病变的疗效[J].世界华人消化杂志,2013,21(30):3261-3264.
[12]冯瑞兵.叶酸对慢性萎缩性胃炎癌前病变的疗效观察[J].新医学,2011,42(5):312-314.
[13]薛辉,辛凤池,穆素恩,等.血清Hcy,叶酸和维生素B12在胃癌及其癌前疾病中的作用[J].现代生物医学进展,2017,17(15):2896-2899.
[14]詹继烈,罗靖,何萍,等.胃粘膜相微观辨证分型探讨:附2000例分析[J].中医杂志,1989,30(4):37-40.
[15]刘华一,张莎,杨阔,等.胃癌前病变中医证候分型与胃蛋白酶原的相关性研究[J].中国中西医结合消化杂志,2016,24(6):449-454.
[16]刘启泉,李佃贵,张纨,等.慢性胃炎从浊毒论治[J].北京中医药大学学报,2010,33(3):153-155.
[17]乔正梅,王登峰,赵秋剑,等.血清胃蛋白酶原、胃泌素-17在胃癌及胃癌前病变的诊断价值[J].中国卫生检验杂志,2017,27(2):198-200.
[18]熊文坚,陆思源,金惠,等.癌前病变及胃癌的有效血清学筛查方法研究[J].中国临床医学,2006,13(6):953-954.
[19]刘丹,吴瑾. PG,MG-7与胃癌关系的研究现状与进展[J].实用肿瘤学杂志,2006,20(6):558-560.
[20]陈智周,范振符.胃蛋白酶原Ⅰ、Ⅱ在早期胃癌普查中的意义[J].中华肿瘤杂志,2002,24(1):1-3.
[21]鲁品,马颖才.血清胃蛋白酶原在胃癌癌前病变、筛查及预后应用中的研究进展[J].中华胃肠内镜电子杂志,2016,3(2):79-82.