中医药治疗胃癌前病变研究进展
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摘要
胃癌前病变(precancerous lesions of gastric cancer,PLGC)是正常胃黏膜向胃癌转化过程中的一个重要阶段,中医临床工作者可运用辨证论治的理论,采用经验方、中医外治法、中成药等治疗措施有效阻断或逆转PLGC,但由于PLGC病因繁多,发病机制十分复杂,故也存在一定的问题,主要体现在以下几个方面:(1)临床研究没有统一的诊断标准和详细的疗效判定标准,不同的研究者参考的胃镜和病理活检标准也不统一;(2)目前还没有制定统一的中医辨证标准,临床工作者对PLGC治疗疗程的长短也没有形成统一的认识;(3)目前中医药治疗PLGC的方法很多,如健脾和胃、调和肝脾、解毒化瘀、化湿泄浊、益气养阴,但没有一个主导原则;(4)大多数临床观察只重视近期疗效,对疾病动态变化及远期疗效的观察相对不足;(5)由于各医家对本病病因病机的认识尚不统一,在临床上进行多中心、大样本的随机对照研究十分困难;(6)中药在治疗本病的同时是否具有不良反应,中药在有效抑制胃癌组织基因表达的同时,对其他正常组织是否也有影响,鲜有报道。
Precancerous lesions of gastric cancer( PLGC) is an important stage in the progress of normal gastric mucosa to gastric carcinoma,and clinical practitioners of TCM can use the theory of syndrome differentiation and treatment,using experience,external treatment of Chinese medicine,Chinese patent medicine and other treatment measures to effectively block or reverse PLGC,however,because of the various etiology and complex pathogenesis of PLGC,there are some problems,which are mainly reflected in the following aspects:(1) there was no uniform diagnostic criteria and detailed evaluation criteria in clinical studies,and neither were the gastroscopy and pathological biopsy criteria referred to by different researchers;(2)because of the variety of etiology and complicated pathogenesis of PLGC,there is no unified standard of TCM syndrome differentiation at present,and the clinical workers have not formed a unified understanding of the duration of treatment for PLGC;(3)there are many methods of traditional Chinese medicine to treat PLGC,such as invigorating spleen and stomach,harmonizing liver and spleen,detoxifying and removing blood stasis,removing dampness and releasing turbidity,nourishing Qi and nourishing Yin,but there is not a leading principle;(4)most clinical observation only pay attention to the short-term curative effect,but the observation of the disease dynamic change and the longterm curative effect is relatively insufficient;(5)because the understanding of the etiology and pathogenesis of the disease is not uniform,it is very difficult to carry out a multicenter,large sample randomized controlled study in clinic;(6)it is seldom reported that whether traditional Chinese medicine has adverse reactions at the same time as treating this disease,and while effectively inhibiting gene expression in gastric cancer tissues,whether Chinese medicine also has an effect on other normal tissues.
Precancerous lesions of gastric cancer( PLGC) is an important stage in the progress of normal gastric mucosa to gastric carcinoma,and clinical practitioners of TCM can use the theory of syndrome differentiation and treatment,using experience,external treatment of Chinese medicine,Chinese patent medicine and other treatment measures to effectively block or reverse PLGC,however,because of the various etiology and complex pathogenesis of PLGC,there are some problems,which are mainly reflected in the following aspects:(1) there was no uniform diagnostic criteria and detailed evaluation criteria in clinical studies,and neither were the gastroscopy and pathological biopsy criteria referred to by different researchers;(2)because of the variety of etiology and complicated pathogenesis of PLGC,there is no unified standard of TCM syndrome differentiation at present,and the clinical workers have not formed a unified understanding of the duration of treatment for PLGC;(3)there are many methods of traditional Chinese medicine to treat PLGC,such as invigorating spleen and stomach,harmonizing liver and spleen,detoxifying and removing blood stasis,removing dampness and releasing turbidity,nourishing Qi and nourishing Yin,but there is not a leading principle;(4)most clinical observation only pay attention to the short-term curative effect,but the observation of the disease dynamic change and the longterm curative effect is relatively insufficient;(5)because the understanding of the etiology and pathogenesis of the disease is not uniform,it is very difficult to carry out a multicenter,large sample randomized controlled study in clinic;(6)it is seldom reported that whether traditional Chinese medicine has adverse reactions at the same time as treating this disease,and while effectively inhibiting gene expression in gastric cancer tissues,whether Chinese medicine also has an effect on other normal tissues.
引文
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[4]史佳宁,郝微微.慢性萎缩性胃炎癌前病变中医治疗研究进展[J].辽宁中医药大学学报,2015,17(9):95-98.
[5]徐娟,黄华,李霞,等.胃癌前病变逆转的中医药研究进展[J].中医临床研究,2015,7(32):144-147.
[6]张德英,侯卓成,李卫强.中医药治疗胃癌前病变研究进展[J].辽宁中医杂志,2016,43(1):207-210.
[7]王捷虹,沈舒文,刘力,等.中医辨证治疗胃癌前期病变的临床观察与体会[J].辽宁中医杂志,2013,40(1):105-107.
[8]沈舒文,惠建萍,宇文亚,等.基于中医证候的胃黏膜异型增生癌变规律324例临床跟踪研究[C].深圳:中华中医药学会第二十一届全国脾胃病学术交流会暨2009年脾胃病诊疗新进展学习班论文汇编,2009.
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[10]朱瑜瑜.朱曙东结合内镜辨证论治慢性萎缩性胃炎之经验[J].辽宁中医药大学学报,2011,13(1):149-150.
[11]黄雅慧,刘越洋,孙洁,等.慢性萎缩性胃炎胃黏膜癌前病变病理变化与中医证型及Hp的相关性研究[J].中华中医药学刊,2014,32(6):1381-1383.
[12]张东兴,卢宜民.清热除湿活血方治疗胃癌前病变36例[J].浙江中医杂志,2011,46(6):427-428.
[13]李卫强,朱西杰,魏雪红.复方蜥蜴散不同微粒组合剂治疗胃癌前病变阴虚络瘀证120临床观察[C].昆明:中华中医药学会脾胃病分会第二十四次全国脾胃病学术交流会论文汇编,2012.
[14]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[J].现代中西医结合杂志,2013,22(33):3663-3665.
[15]饶晶,杨晓军,樊冬梅,等.健脾清热化瘀方治疗胃癌前病变的疗效及对胃黏膜黏蛋白5AC表达的影响[J].中国实验方剂学杂志,2014,20(4):183-187.
[16]张纨,张卫华,黄云曼,等.冬雪消解毒活血汤治疗胃癌前病变患者63例临床观察[J].光明中医,2015,12(30):2575-2577.
[17]谢晶日,孙涛,张杨,等.中医药治疗胃癌前病变的研究进展及相关问题分析[J].中华中医药学刊,2015,33(7):1545-1547.
[18]姚娜,孟宪鑫,李玲玲,等.中医综合疗法治疗慢性萎缩性胃炎癌前病变疗效观察[J].中国中医基础医学杂志,2013,19(6):674-678.
[19]朱海涛.穴位埋线治疗慢性萎缩性胃炎疗效观察[J].上海针灸杂志,2008,27(12):11-12.
[20]金建军,芦兰,邢鲁奇,等.胃复春对胃癌前病变中C-erb B-2表达的影响[J].医学信息,2011,24(8):3924-3925.
[21]唐芳.摩罗丹治疗慢性萎缩性胃炎260例临床分析[J].内蒙古中医药,2014,33(32):18.
[22]杨少军,汪龙德,张晶,等.平胃胶囊治疗慢性萎缩性胃炎癌前病变45例临床研究[J].中医杂志,2014,50(20):1745-1749.
[23]夏李明,曾光,陈国忠,等.七方胃痛颗粒对胃癌前病变TFF1基因DNA甲基化影响[J].现代中西医结合杂志,2014,23(21):2289-2291.
[24]朱萱萱,王海丹,周继发,等.仁术健胃颗粒对慢性萎缩性胃炎脾气虚证大鼠血清MTL、SS和GAS水平的实验研究[J].中华中医药学刊,2012,30(7):1459-1461.
[25]胡运莲,姜楠,谭大琦.加味左金丸对大鼠胃癌前病变胃黏膜EGFR、VEGF、C-met、Bcl-2、P53表达的影响[J].世界华人消化杂志,2006,14(7):650-654.
[26]谢晶日,孙涛,张杨.欣胃颗粒治疗胃癌前病变的临床研究[J].中医药导报,2015,21(18):48-50.
[27]张国新,党旖旎,严谨.胃癌前病变的治疗[J].医学与哲学(B),2015,36(11):19-21,87.
[2]房殿春,夏雨亭,吴云林.胃黏膜癌前病变和癌前疾病[M].成都:四川科学技术出版社,2006:189.
[3]张颜伟,郭喜军,赵见文.胃癌前病变的中医药研究进展[J].中医学报,2012,27(1):11-14.
[4]史佳宁,郝微微.慢性萎缩性胃炎癌前病变中医治疗研究进展[J].辽宁中医药大学学报,2015,17(9):95-98.
[5]徐娟,黄华,李霞,等.胃癌前病变逆转的中医药研究进展[J].中医临床研究,2015,7(32):144-147.
[6]张德英,侯卓成,李卫强.中医药治疗胃癌前病变研究进展[J].辽宁中医杂志,2016,43(1):207-210.
[7]王捷虹,沈舒文,刘力,等.中医辨证治疗胃癌前期病变的临床观察与体会[J].辽宁中医杂志,2013,40(1):105-107.
[8]沈舒文,惠建萍,宇文亚,等.基于中医证候的胃黏膜异型增生癌变规律324例临床跟踪研究[C].深圳:中华中医药学会第二十一届全国脾胃病学术交流会暨2009年脾胃病诊疗新进展学习班论文汇编,2009.
[9]李岩,徐进康,陆喜荣.胃炎系列方治疗胃癌前病变的临床与病理研究[J].中国中西医结合杂志,2011,31(12):1635-1638.
[10]朱瑜瑜.朱曙东结合内镜辨证论治慢性萎缩性胃炎之经验[J].辽宁中医药大学学报,2011,13(1):149-150.
[11]黄雅慧,刘越洋,孙洁,等.慢性萎缩性胃炎胃黏膜癌前病变病理变化与中医证型及Hp的相关性研究[J].中华中医药学刊,2014,32(6):1381-1383.
[12]张东兴,卢宜民.清热除湿活血方治疗胃癌前病变36例[J].浙江中医杂志,2011,46(6):427-428.
[13]李卫强,朱西杰,魏雪红.复方蜥蜴散不同微粒组合剂治疗胃癌前病变阴虚络瘀证120临床观察[C].昆明:中华中医药学会脾胃病分会第二十四次全国脾胃病学术交流会论文汇编,2012.
[14]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[J].现代中西医结合杂志,2013,22(33):3663-3665.
[15]饶晶,杨晓军,樊冬梅,等.健脾清热化瘀方治疗胃癌前病变的疗效及对胃黏膜黏蛋白5AC表达的影响[J].中国实验方剂学杂志,2014,20(4):183-187.
[16]张纨,张卫华,黄云曼,等.冬雪消解毒活血汤治疗胃癌前病变患者63例临床观察[J].光明中医,2015,12(30):2575-2577.
[17]谢晶日,孙涛,张杨,等.中医药治疗胃癌前病变的研究进展及相关问题分析[J].中华中医药学刊,2015,33(7):1545-1547.
[18]姚娜,孟宪鑫,李玲玲,等.中医综合疗法治疗慢性萎缩性胃炎癌前病变疗效观察[J].中国中医基础医学杂志,2013,19(6):674-678.
[19]朱海涛.穴位埋线治疗慢性萎缩性胃炎疗效观察[J].上海针灸杂志,2008,27(12):11-12.
[20]金建军,芦兰,邢鲁奇,等.胃复春对胃癌前病变中C-erb B-2表达的影响[J].医学信息,2011,24(8):3924-3925.
[21]唐芳.摩罗丹治疗慢性萎缩性胃炎260例临床分析[J].内蒙古中医药,2014,33(32):18.
[22]杨少军,汪龙德,张晶,等.平胃胶囊治疗慢性萎缩性胃炎癌前病变45例临床研究[J].中医杂志,2014,50(20):1745-1749.
[23]夏李明,曾光,陈国忠,等.七方胃痛颗粒对胃癌前病变TFF1基因DNA甲基化影响[J].现代中西医结合杂志,2014,23(21):2289-2291.
[24]朱萱萱,王海丹,周继发,等.仁术健胃颗粒对慢性萎缩性胃炎脾气虚证大鼠血清MTL、SS和GAS水平的实验研究[J].中华中医药学刊,2012,30(7):1459-1461.
[25]胡运莲,姜楠,谭大琦.加味左金丸对大鼠胃癌前病变胃黏膜EGFR、VEGF、C-met、Bcl-2、P53表达的影响[J].世界华人消化杂志,2006,14(7):650-654.
[26]谢晶日,孙涛,张杨.欣胃颗粒治疗胃癌前病变的临床研究[J].中医药导报,2015,21(18):48-50.
[27]张国新,党旖旎,严谨.胃癌前病变的治疗[J].医学与哲学(B),2015,36(11):19-21,87.