慢性萎缩性胃炎中医证治规律探讨及临床疗效评价研究
|
摘要
【背景】
慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)是临床常见难治性胃病,发病率高,病情缠绵反复,伴肠化、异型增生时癌变危险性增加。迄今尚缺乏公认有效的干预措施,中医治疗本病的优势和特色已逐渐为人们所认识,但在辨证诊治及疗效评价上还存在一定问题,影响优势与特色的发挥,也阻碍临床和科研工作的开展。
【目的】
总结慢性萎缩性胃炎中医证候特征及辨证用药规律,为临床、科研提供参考;整理挖掘导师治疗CAG思维模式、用药经验等,有利于其学术思想推广;对中医治疗CAG临床疗效进行客观评价,分析活血化瘀治疗CAG的作用和疗效特点,探索形成符合疾病特点的综合疗效评价方法,分析当前疗效评价存在的问题。
【方法】
通过对中医辨证治疗CAG文献的收集整理和计量分析,对病机、证候要素、证候类型、用药及配伍规律等进行科学总结;秉承“人机结合、以人为本”的理念,运用“名老中医临床诊疗信息采集系统”、“名老中医经验智能分析平台”和关联规则等方法,结合导师本人指导,对其治疗CAG的思维模式、用药经验等进行总结;通过临床对照试验系统评价,与西医阳性药物、常规对症治疗等多种对照比较,客观评价中药治疗CAG临床疗效,通过文献筛选和质量评价明确当前疗效评价存在的问题;通过辨证治疗CAG65例临床观察,从病理组织学、胃镜下病变、症状、基于患者报告临床结局(PRO)评价量表四个方面客观评价疗效,并分析活血化瘀治疗CAG的作用,总结疗效优势和特点。
【结果】
(一)萎缩性胃炎中医证候特征及辨证用药规律分析
共纳入文献137篇。常见证型为脾胃虚弱(占34.2%)、肝胃不和(21.3%)、胃阴不足(18.6%)、胃络瘀血证(18.1%)和脾胃湿热(15.6%)证;证候要素分虚实两方面,虚以气虚(23.3%)、阴虚(23.5%)为主,多于阳虚(11.5%);实以气滞(26.7%)和血瘀(18.6%)为主,多于湿热(14.3%)及郁热(4.3%);常用药分为健脾、理气、化湿、清热、养阴、活血及消导7类,包括白芍、白术、半夏、陈皮、茯苓、丹参、黄芪、香附、枳壳、黄连等;脾胃虚弱证治以香砂六君子汤加减,以党参、白术、黄芪、茯苓等为主药,配桂枝、生姜、吴萸等温中阳,配砂仁、陈皮、木香等理气,配莪术、丹参等活血,配神曲、内金、麦芽、山楂等消导助运;肝胃不和证以四逆散、柴胡疏肝散合金铃子散加减,以柴胡、香附、枳壳为主疏肝理气,配元胡、香附、川芎等活血理气,配白芍等防辛燥伤阴;脾胃湿热证以黄芩滑石汤、藿朴夏苓汤或香砂平胃散加减,用药以半夏、黄连、黄芩、佩兰、苍术、蔻仁为主,配合芳香化湿和运脾化湿药,配厚朴、陈皮、苏梗、砂仁等调气机,配茯苓、炒白术等健脾促纳运;胃阴不足证以一贯煎、沙参麦冬汤加减,以沙参、麦冬、石斛、白芍等为主药,佐半夏、佛手、香附、陈皮、砂仁、枳壳、谷麦芽、内金等理气消导,佐黄芪、肉桂等从阳引阴;胃络瘀血证以丹参饮、失笑散加减,以丹参、元胡、当归、莪术、蒲黄、五灵脂等药为主,常与黄芪、白术、茯苓等健脾药及檀香、砂仁等理气药配伍。
(二)导师唐旭东教授治疗萎缩性胃炎经验总结与数据挖掘
共收集病例113人次,中医诊断为“痞满”和“胃脘痛”者各占40.70%和41.59%;治法以理气(131频次)、活血(56频次)、健脾(51频次)为主;常用香苏饮、四逆散、小陷胸汤理气通降(共计116频次),金铃子散、丹参饮、失笑散活血理气(125频次),半夏泻心汤、黄芩滑石汤、黄连温胆汤清化湿热(54频次),香砂六君子汤、四君子汤健脾扶中(33频次),左金丸清肝泄热(32频次),益胃汤或一贯煎养阴(4频次);共用药110味,常用黄连、陈皮、清半夏、苏梗、乌贼骨、元胡、砂仁、川楝子、炒白术、香附、枳壳、黄芩、滑石等;理气通降配合柔润之品防温燥伤阴,选用健脾理气之品或配合益气健脾药,攻补兼施,配伍活血药或选用理气活血药物气血同治;正确选用不同作用的活血化瘀药,配合其他治法保证疗效,注意顾护脾胃正气;化湿理气并用,化湿兼顾健脾;养阴配伍理气及健脾运脾药防滋腻碍胃。常用药对为川楝子=＞元胡、清半夏=＞黄连、苏梗&香附=＞陈皮、黄芩&清半夏=＞滑石等。
(三)中医辨证治疗萎缩性胃炎临床疗效评价研究
1中药治疗萎缩性胃炎临床疗效的系统评价:
(1)病理疗效:从病变例数和积分变化两方面比较,中药组与对照组萎缩改善有统计学差异(P=0.004和0.008),其中中药组优于维酶素、猴头菌和空白对照(P=0.0001、0.0002和0.01),西药对症治疗优于中药(P=0.03);中药组肠化改善优于对照组(P=0.02和P＜0.00001),其中与猴头菌、空白对照、西药常规比较(P=0.02、0.007和0.02),与维酶素比较(P=0.69)。中药组与对照组异型增生改善有统计学差异(P=0.006和0.004),其中与西药常规、空白对照比较(P=0.11和0.09),与维酶素比较(P=0.0004)。(2)胃镜疗效:中药组与对照组比较粘膜颗粒样、胆汁反流改善均有统计学差异(P=0.05和0.005),与维酶素、猴头菌比较血管透见改善均无差异(P=0.25和0.83),与维酶素比较粘膜白相改善有统计学差异(P=0.0002)。(3)Hp根除率:中药组与对照组Hp根除率有统计学差异(P=0.009),其中与维酶素、空白对照和枸橼酸铋钾颗粒比较(P=0.02、0.009和0.009),与猴头菌、西药常规比较(P=0.70和0.74)。(4)症状疗效:中药组与对照组总体症状改善有统计学差异(P=0.008),其中与枸橼酸铋钾颗粒、西药对症治疗比较(P=0.64和0.13),与维酶素、空白对照比较(P=0.04和0.008)。中药与对照组胃痛改善有统计学差异(P＜0.00001),其中与维酶素、猴头菌比较(P=0.0002和0.002);与维酶素比较胃痛积分改善有统计学差异(P＜0.00001,);中药与对照组胃胀痞闷改善有统计学差异(P＜0.00001),其中与维酶素和猴头菌比较(均P＜0.00001);中药与维酶素胃胀痞闷积分改善有统计学差异(P＜0.00001)。中药与维酶素比较嗳气改善无差异(P=0.18和0.22)。中药改善纳呆优于对照组(P=0.0007),其中与维酶素、猴头菌比较(P=0.03和0.02);与维酶素比较纳呆积分改善有统计学差异(P＜0.00001)。与维酶素、猴头菌比较大便异常改善均有统计学差异(P=0.002和0.03);与猴头菌比较嘈杂改善无差异(P=0.34);与维酶素比较嘈杂与反酸积分改善均有统计学差异(P＜0.00001)。
2辨证治疗慢性萎缩性胃炎65例临床观察:
(1)血瘀组患者较非血瘀组病程长(P=0.044)、病理组织学病变重(P=0.026),非血瘀组女性较多(P=0.013)、症状总分及PRO量表总分较血瘀组高(P=0.030和0.003);(2)PRO量表积分:治疗后消化不良、全身症状、心理、反流和排便异常5个维度及总分均有明显改善(P＜0.05),而社会功能无改善(P=0.089);各维度对总分贡献依次为消化不良(标化回归系数为0.423)＞全身症状(0.362)＞心理功能(0.353)＞反流(0.238)＞社会功能(0.141)＞排便异常(0.106)。各辨证组间各维度及总分改善无差异(P＞0.05);非血瘀组全身症状及总分改善优于血瘀组(P=0.002和0.004);(3)临床症状:治疗后各主症及总分均有明显改善(P＜0.05),总积分改善中以胃脘堵闷(0.397)和胀满(0.330)作用最大,其次为嘈杂(0.292)、胃痛(0.283)、纳差(0.273)、嗳气(0.189)。各辨证组间主症及总积分改善均无差异(P=0.113和0.150);血瘀组与非血瘀组主症及总积分改善有统计学差异(P=0.039和0.021)、纳差和嗳气改善有统计学差异(P=0.040和0.034);(4)胃镜病理:治疗后胃镜下主要病变积分、总积分和病理主要病变积分、总积分改善均有统计学差异(P＜0.05),各辨证组间以上各项改善均无差异(P＞0.05);血瘀组和非血瘀组病理主要病变及总积分改善有统计学差异(P=0.028和0.036),而胃镜主要病变及总积分改善无差异(P=0.387和0.207)。
【结论】
1慢性萎缩性胃炎中医证候特征及辨证用药规律
慢性萎缩性胃炎临床表现以胃脘胀满、疼痛、堵闷、嗳气、纳差等消化不良症状为主,伴疲乏、消瘦等全身症状以及紧张、焦虑、恐癌等心理症状。CAG病机为虚实夹杂,虚以气虚、阴虚为主,实以气滞、血瘀为主,常见证型为脾胃虚弱、肝胃不和、脾胃湿热、胃阴不足及胃络瘀血;治疗侧重健脾、理气、活血。常在主方基础上,综合本证型病机特点、药物间相互作用及胃腑喜润恶燥、喜通降恶郁滞的生理特性,适当佐用其他类药物,使兼顾病机更全面,提高主药疗效。脾胃虚弱证治以甘温补益、健脾扶中为法,以香砂六君子汤(脾胃虚寒用黄芪建中汤)加减,常配伍理气、活血及消导药;肝胃不和证以辛香理气、和胃通降为法,用四逆散或柴胡疏肝散合金铃子散加减,常与活血、健脾、清热、养阴药配伍。脾胃湿热证以清热化湿为法,以黄芩滑石汤或藿朴夏苓汤或香砂平胃散加减,佐以芳香化湿及健脾淡渗药,配伍理气药以疏理气机、健脾药以助纳运。胃阴不足证以甘凉濡润、滋养胃阴为法,以一贯煎或益胃汤加减,少佐理气、醒脾消导药,防呆滞气机,少佐黄芪、肉桂等甘温之品从阳引阴。胃络瘀血证以活血理气通络为法,丹参饮或失笑散加减,此法贯穿治疗始终,常配合其他方法使用。应用时须区别血瘀程度、病变趋势,酌情选用和血、活血或破血等不同活血化瘀药物。兼气血不足者,配合党参、当归、白芍等益气养血;配伍理气药,首选活血兼有理气作用的药物,以通利血分之滞。
2导师唐旭东教授治疗慢性萎缩性胃炎思维模式与用药经验
(1)病机及辨证:认为CAG中医诊断以“痞满”、“胃脘痛”为宜;病机为虚实夹杂,脾胃虚弱是病理基础,气机阻滞、胃失和降是主要病机及重要环节,血瘀普遍存在,是疾病发生、发展甚至恶变的关键环节,单纯血瘀证并不多见,常伴发于其他证候,诊断时可不必拘泥于瘀血证的全部症状和体征。强调宏微观辨证结合、兼顾地域、气候、年龄等因素综合辨证。(2)治则治法:治疗重视调理气血,以气血为线贯穿各种治法。处方用药坚持攻补兼施,以补为主,寓通于补的原则,补,主要是补气、温阳,滋阴、补血;攻,重在理气活血通降导滞。(3)处方用药:理气通降常用香苏饮、四逆散、柴胡疏肝散、丹参饮等。常配伍滋阴柔和之品防温燥伤阴,理气兼顾健脾,理气配伍活血,气血同治;活血化瘀常用失笑散、丹参饮、金铃子散等,强调根据虚实主次、标本缓急选用不同作用程度的活血化瘀药,配合其他治法及药物,注意顾护脾胃正气;益气健脾常用四君子汤、香砂六君子汤,反对壅补,主张通补,即在运用理气、活血等药物保持脾胃通降功能基础上调补;清热化湿常用黄芩滑石汤、藿朴夏苓汤、半夏泻心汤及温胆汤等,常化湿理气并用,化湿兼顾健脾;养阴常用益胃汤或一贯煎,常配伍理气及健脾药防滋腻碍胃。此外,注意药物间配伍和对症治疗,调理大便以助通降。(4)强调用药平和、科学选择服药时间、足疗程治疗、强调应个人养生与药物治疗结合,强调长期随访、定期复查,强调定位活检和规范病理诊断;重视胃癌前病变,对肠化尤其异型增生进行针对性用药。
3中医治疗CAG临床疗效评价
中医治疗CAG在临床症状、基于患者报告临床结局(PRO)量表5个维度及总积分、胃镜下粘膜病变、病理组织学均有不同程度的改善。其中非血瘀组患者嗳气、纳差等消化不良症状改善优于血瘀组;血瘀组病理积分改善尤其肠化、萎缩优于非活血化瘀组,说明活血化瘀对于改善萎缩,防止病变进展具有重要作用。临床症状和PRO量表中,以消化不良、心理和全身症状改善最大,对社会功能影响尚待进一步研究验证。
当前中医治疗CAG疗效评价还存在很多问题,建议今后研究:(1)定位活检、规范病理诊断,加强质量控制。(2)严格科研设计,遵循随机化原则,做好分配方案隐藏,可实行盲态评价;选择空白对照或西药常规治疗对照,避免疗效不确定的中成药;保证足够样本量;采用新近公认的疾病诊断标准,保证病例的可比性。(3)疗效指标选择:避免将病理、胃镜、症状混淆,建议各指标采用积分方法做前后比较,合理划分主、次病变(症状),参考新的悉尼分类系统对病理组织学病变进行规范分级和赋分,对于癌变意义大的异型增生进行深入评价;合理而实用的镜下病变分级有待进一步研究;症状分级及赋分要统一,主症可从频率和程度两方面综合评价,并予以较高权重;进行长期随访和疗效观测,观察死亡率、癌变率等终点指标;重视生活质量及患者自我报告临床结局的评价。(4)疗程须3个月以上,做好辨证分型和症状、舌、脉等术语规范。
Chronic atrophic gastritis(CAG) as a commonest gastrointestinal disease, has higher prevalence and threatens healthy seriously. To date, general-accepted effective therapy remains absent. TCM may exert a promising option. But problems exist in therapeutic effect evaluation impair the progress of clinical research.
Aim To conclude and analyze the differentiation-prescription rules of CAG; to evaluate the therapeutic effect of TCM for the treatment of CAG, to explore the evaluating methods and raise current problems.
Method To analyze the rules of pathogenesis, differentiation and prescription of CAG, by literature analysis and dinning the experience of professor Tang ; to evaluate the therapeutic effect of CAG treated with TCM, and to address the characteristics, advantage and current problem by conducting systematic review and observing efficacy of 65 cases with CAG treated by TCM based on syndrome differentiation.
Result
1. Differentiation-prescription rules of CAG:
(1) Results from literatures analysis: Spleen-stomach deficiency (34.2%) , disharmony between liver and stomach (21.3 %) , stomach-yin deficiency (18.6%) , spleen-stomach damp-heat (15.6%) and blood stasis in stomach collaterals (18.1 %) are the commonest syndromes. Qi and yin deficiency (23.3 % VS 23.5 %) dominate at deficient aspect, qi stagnation and blood stasis (26.7 % VS 18.6%) dominate at excess aspect. Common-used drugs include invigorating spleen, regulating qi, eliminating damp, nourishing yin, promoting blood circulation and promoting digestion, including Bai-shao, Bai-zhu, Ban-xia, Chen-pi, Fu-ling, and etc. Spleen-stomach deficiency syndrome treated with Xiang-sha-liu-jun-zi-tang, combined with drugs of regulating qi, warming interior, promoting blood circulation and nourishing yin; disharmony between liver and stomach syndrome treated with Si-ni-san or Chai-hu-shu-gan-san and Jin-ling-zi-san, spleen-stomach damp-heat syndrome treated with Huang-qin-hua-shi-tang or Huang-lian-wen-dan-tang combined with drugs of regulating qi and invigorating spleen; stomach-yin deficiency treated with Yi-guan-jian or Yi-wei-tang, matched drugs of regulating qi, promoting blood circulation and promoting digestion; blood stasis in stomach collaterals syndrome treated with Shi-xiao-san or Dan-shen-yin, combinded with drugs of regulating qi, invigorating spleen and nourishing yin.
(2) Differentiation-prescription experience of professor Tang: Major treating method is regulating qi to promote stomach empting and descending, added drugs of promoting blood circulation, invigorating spleen, eliminating damp; common-used prescriptions includes Xiang-su-yin, Si-ni-san, Xiao-xian-xiong-tang, Jin-ling-zi-san, Dan-shen-yin,Shi-xiao-san and Zuo-jin-wan; drugs include Huang-lian, Chen-pi, Ban-xia, Su-geng, Wu-zei-gu, Yuan-hu, Chuang-lian-zi, and etc;common used drug pairs like Chuang-lian-zi=>Yuan-hu,Xiang-fu=>Chen-pi, Ban-xia=>Huang-lian, and etc.
2. Evaluation of therapeutic effect of TCM for the treatment of CAG based on syndrome differentiation
(1) Systematic review on TCM for the treatment of CAG: The efficacy was evaluated from both number and score changes. The atrophy improvement of TCM group is more significant than controls (P=0.004 VS 0.008 ), compared with vitacoenzyme, hericium and blank control (P=0.0001, 0.0002 VS 0.01), while symptomatic treatment superior to TCM (P=0.03); For improving IM, TCM is superior to controls (P=0.02 VS P<0.00001), compared with hericium, blank and symptomatic medication (P=0.02, 0.007 VS 0.02), with vitacoenzyme (P=0.69) .For improvement DYS of TCM group is more significant than controls (P=0.006 VS 0.004), compared with symptomatic medication and blank control (P=0.11 VS 0.09), with vitacoenzyme (P=0.0004) .For improving granula-like mucosa and bile reflux, TCM is superior to controls (P=0.05 VS 0.005) ,compared with vitacoenzyme and hericium for visible vessel change (P=0.25 VS 0.83). For Hp eradicative rate, there are significance between TCM and control (P=0.009), with hericium, blank control and bismuth potassium citrate (P=0.02, 0.009 VS 0.009), with hericium and symptomatic medication (P=0.70 VS 0.74) ;for overall symptomatic improvement, TCM is more significant than control (P=0.008) ,for stomach pain (P<0.00001) , epigastric distension and fullness (P < 0.00001) ,belching (P=0.18 VS 0.22) , poor appetite (P=0.0007), for disordered stool (P=0.002 VS 0.03) , heart burn (P<0.00001) , acid reflux (P<0.00001).
(2) Clinical observation on 65 cases with CAG treated with TCM based on syndrome differentiation: patient of blood stasis with longer course (P=0.044) , more severe pathological lesions (P=0.026) ,non-blood stasis group with female dominance (P=0.013) ,more severe symptoms and PRO scores (P=0.030 VS 0.003) . After treatment the total symptom score, PRO score, endoscopic findings and pathological lesions were improved significantly (P<0.05); dimensions of PRO attribute to overall improvement as dyspepsia ( 0.423 ) >general symptoms (0.362)> Psychological function(0.353) >reflux (0.238) >social function (0.141)> disordered stool (0.106), the social status remains unchanged (P=0.089) .Total symptom scores improvement of non blood stasis group is superior (P=0.004) , especially belching and poor appetite(P=0.040 VS 0.034 ) ,symptoms attribute to overall improvement as gastric fullness (0.397) ,distention (0.330), heart bum (0.292), gastric pain (0.283) ,poor appetite (0.273) ,belching (0.189) . the pathological improvement of blood stasis group is superior (P=0.036) .
Conclusion
1. Differentiation-prescription rules:
CAG manifests as non-specific dyspeptic symptoms like gastric fullness and distention, pain, belching, poor appetite, disordered defecation, general symptoms like lassitude, anorexia and psychological ones like nervous, anxiety and fear of carcinogenesis. The pathogenesis characterized by qi and yin deficiency dominance in deficient aspect, with qi stagnation and blood stasis dominance in excess aspect. Spleen-stomach deficiency is the basic pathogenesis, qi stagnation and blood stasis play a key role in occurrence and development. Commonest syndromes include disharmony and stagnating heat of liver-stomach, spleen-stomach deficiency, damp-heat in middle-Jiao, stomach yin deficiency. Blood stasis of stomach collateral developed in the long course of the disease, accompanied with other syndrome. Main treating method is regulating qi to promoting stomach soothing and descending, matched promoting blood circulating, invigorating spleen, eliminating damp; Each syndrome treated by major prescription, which modified with drugs of other functions, to prevent intense function or adverse effect of major drugs, by comprehensively considering the pathogenic character of the syndrome, drug interaction and the physiological nature of stomach.
2. Therapeutic effect evaluation of TCM for the treatment of CAG
The TCM was superior to controls in improving symptoms, five dimensions of PRO scale, endoscopic findings and pathological changes. Non blood stasis group is superior t in improving dyspeptic symptoms like belching and poor appetite; blood stasis group has more severe pathological lesions and exhibits more significant improvement after treatment. It is concluded that promoting blood circulation plays an important role in improving atrophy, IM and preventing carcinogenesis, which should be used careful for patient with digestion disorder. The phenomena of no change in social status still need further research.
Some problems encountered in effect evaluation, which should be improved from following aspects: (1) Making biopsy from constant location, standardizing pathological operations, strengthening qualify control. (2) Strengthening research design, including randomization and allocation conceal, blind evaluation, choosing blank or conventional treatment as control, avoiding controls without recognized efficacy, sufficient sample size, applying recognized diagnostic criteria. (3) Selection of effect evaluating method: Intermingle of symptom, endoscopic and pathological changes should be avoided, scores of above items of pre and after treatment is recommended, differentiate the major and other lesion. The grade and scoring of pathological lesions should refer to updated Sydney system, and make further evaluation for DYS; rational and practical grading method still need further study. The classification and scoring of symptoms should be unify, the major ones should be evaluated from both frequency and intensity, longer duration and follow-up study to observe mortality and gastric cancer incidence rate, pay more attention to evaluation of the health related quality of life and patient reported outcome. (4) Treatment duration should be longer than 3 months, standardizing the Traditional Chinese Medicine Terms of CAG.
慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)是临床常见难治性胃病,发病率高,病情缠绵反复,伴肠化、异型增生时癌变危险性增加。迄今尚缺乏公认有效的干预措施,中医治疗本病的优势和特色已逐渐为人们所认识,但在辨证诊治及疗效评价上还存在一定问题,影响优势与特色的发挥,也阻碍临床和科研工作的开展。
【目的】
总结慢性萎缩性胃炎中医证候特征及辨证用药规律,为临床、科研提供参考;整理挖掘导师治疗CAG思维模式、用药经验等,有利于其学术思想推广;对中医治疗CAG临床疗效进行客观评价,分析活血化瘀治疗CAG的作用和疗效特点,探索形成符合疾病特点的综合疗效评价方法,分析当前疗效评价存在的问题。
【方法】
通过对中医辨证治疗CAG文献的收集整理和计量分析,对病机、证候要素、证候类型、用药及配伍规律等进行科学总结;秉承“人机结合、以人为本”的理念,运用“名老中医临床诊疗信息采集系统”、“名老中医经验智能分析平台”和关联规则等方法,结合导师本人指导,对其治疗CAG的思维模式、用药经验等进行总结;通过临床对照试验系统评价,与西医阳性药物、常规对症治疗等多种对照比较,客观评价中药治疗CAG临床疗效,通过文献筛选和质量评价明确当前疗效评价存在的问题;通过辨证治疗CAG65例临床观察,从病理组织学、胃镜下病变、症状、基于患者报告临床结局(PRO)评价量表四个方面客观评价疗效,并分析活血化瘀治疗CAG的作用,总结疗效优势和特点。
【结果】
(一)萎缩性胃炎中医证候特征及辨证用药规律分析
共纳入文献137篇。常见证型为脾胃虚弱(占34.2%)、肝胃不和(21.3%)、胃阴不足(18.6%)、胃络瘀血证(18.1%)和脾胃湿热(15.6%)证;证候要素分虚实两方面,虚以气虚(23.3%)、阴虚(23.5%)为主,多于阳虚(11.5%);实以气滞(26.7%)和血瘀(18.6%)为主,多于湿热(14.3%)及郁热(4.3%);常用药分为健脾、理气、化湿、清热、养阴、活血及消导7类,包括白芍、白术、半夏、陈皮、茯苓、丹参、黄芪、香附、枳壳、黄连等;脾胃虚弱证治以香砂六君子汤加减,以党参、白术、黄芪、茯苓等为主药,配桂枝、生姜、吴萸等温中阳,配砂仁、陈皮、木香等理气,配莪术、丹参等活血,配神曲、内金、麦芽、山楂等消导助运;肝胃不和证以四逆散、柴胡疏肝散合金铃子散加减,以柴胡、香附、枳壳为主疏肝理气,配元胡、香附、川芎等活血理气,配白芍等防辛燥伤阴;脾胃湿热证以黄芩滑石汤、藿朴夏苓汤或香砂平胃散加减,用药以半夏、黄连、黄芩、佩兰、苍术、蔻仁为主,配合芳香化湿和运脾化湿药,配厚朴、陈皮、苏梗、砂仁等调气机,配茯苓、炒白术等健脾促纳运;胃阴不足证以一贯煎、沙参麦冬汤加减,以沙参、麦冬、石斛、白芍等为主药,佐半夏、佛手、香附、陈皮、砂仁、枳壳、谷麦芽、内金等理气消导,佐黄芪、肉桂等从阳引阴;胃络瘀血证以丹参饮、失笑散加减,以丹参、元胡、当归、莪术、蒲黄、五灵脂等药为主,常与黄芪、白术、茯苓等健脾药及檀香、砂仁等理气药配伍。
(二)导师唐旭东教授治疗萎缩性胃炎经验总结与数据挖掘
共收集病例113人次,中医诊断为“痞满”和“胃脘痛”者各占40.70%和41.59%;治法以理气(131频次)、活血(56频次)、健脾(51频次)为主;常用香苏饮、四逆散、小陷胸汤理气通降(共计116频次),金铃子散、丹参饮、失笑散活血理气(125频次),半夏泻心汤、黄芩滑石汤、黄连温胆汤清化湿热(54频次),香砂六君子汤、四君子汤健脾扶中(33频次),左金丸清肝泄热(32频次),益胃汤或一贯煎养阴(4频次);共用药110味,常用黄连、陈皮、清半夏、苏梗、乌贼骨、元胡、砂仁、川楝子、炒白术、香附、枳壳、黄芩、滑石等;理气通降配合柔润之品防温燥伤阴,选用健脾理气之品或配合益气健脾药,攻补兼施,配伍活血药或选用理气活血药物气血同治;正确选用不同作用的活血化瘀药,配合其他治法保证疗效,注意顾护脾胃正气;化湿理气并用,化湿兼顾健脾;养阴配伍理气及健脾运脾药防滋腻碍胃。常用药对为川楝子=＞元胡、清半夏=＞黄连、苏梗&香附=＞陈皮、黄芩&清半夏=＞滑石等。
(三)中医辨证治疗萎缩性胃炎临床疗效评价研究
1中药治疗萎缩性胃炎临床疗效的系统评价:
(1)病理疗效:从病变例数和积分变化两方面比较,中药组与对照组萎缩改善有统计学差异(P=0.004和0.008),其中中药组优于维酶素、猴头菌和空白对照(P=0.0001、0.0002和0.01),西药对症治疗优于中药(P=0.03);中药组肠化改善优于对照组(P=0.02和P＜0.00001),其中与猴头菌、空白对照、西药常规比较(P=0.02、0.007和0.02),与维酶素比较(P=0.69)。中药组与对照组异型增生改善有统计学差异(P=0.006和0.004),其中与西药常规、空白对照比较(P=0.11和0.09),与维酶素比较(P=0.0004)。(2)胃镜疗效:中药组与对照组比较粘膜颗粒样、胆汁反流改善均有统计学差异(P=0.05和0.005),与维酶素、猴头菌比较血管透见改善均无差异(P=0.25和0.83),与维酶素比较粘膜白相改善有统计学差异(P=0.0002)。(3)Hp根除率:中药组与对照组Hp根除率有统计学差异(P=0.009),其中与维酶素、空白对照和枸橼酸铋钾颗粒比较(P=0.02、0.009和0.009),与猴头菌、西药常规比较(P=0.70和0.74)。(4)症状疗效:中药组与对照组总体症状改善有统计学差异(P=0.008),其中与枸橼酸铋钾颗粒、西药对症治疗比较(P=0.64和0.13),与维酶素、空白对照比较(P=0.04和0.008)。中药与对照组胃痛改善有统计学差异(P＜0.00001),其中与维酶素、猴头菌比较(P=0.0002和0.002);与维酶素比较胃痛积分改善有统计学差异(P＜0.00001,);中药与对照组胃胀痞闷改善有统计学差异(P＜0.00001),其中与维酶素和猴头菌比较(均P＜0.00001);中药与维酶素胃胀痞闷积分改善有统计学差异(P＜0.00001)。中药与维酶素比较嗳气改善无差异(P=0.18和0.22)。中药改善纳呆优于对照组(P=0.0007),其中与维酶素、猴头菌比较(P=0.03和0.02);与维酶素比较纳呆积分改善有统计学差异(P＜0.00001)。与维酶素、猴头菌比较大便异常改善均有统计学差异(P=0.002和0.03);与猴头菌比较嘈杂改善无差异(P=0.34);与维酶素比较嘈杂与反酸积分改善均有统计学差异(P＜0.00001)。
2辨证治疗慢性萎缩性胃炎65例临床观察:
(1)血瘀组患者较非血瘀组病程长(P=0.044)、病理组织学病变重(P=0.026),非血瘀组女性较多(P=0.013)、症状总分及PRO量表总分较血瘀组高(P=0.030和0.003);(2)PRO量表积分:治疗后消化不良、全身症状、心理、反流和排便异常5个维度及总分均有明显改善(P＜0.05),而社会功能无改善(P=0.089);各维度对总分贡献依次为消化不良(标化回归系数为0.423)＞全身症状(0.362)＞心理功能(0.353)＞反流(0.238)＞社会功能(0.141)＞排便异常(0.106)。各辨证组间各维度及总分改善无差异(P＞0.05);非血瘀组全身症状及总分改善优于血瘀组(P=0.002和0.004);(3)临床症状:治疗后各主症及总分均有明显改善(P＜0.05),总积分改善中以胃脘堵闷(0.397)和胀满(0.330)作用最大,其次为嘈杂(0.292)、胃痛(0.283)、纳差(0.273)、嗳气(0.189)。各辨证组间主症及总积分改善均无差异(P=0.113和0.150);血瘀组与非血瘀组主症及总积分改善有统计学差异(P=0.039和0.021)、纳差和嗳气改善有统计学差异(P=0.040和0.034);(4)胃镜病理:治疗后胃镜下主要病变积分、总积分和病理主要病变积分、总积分改善均有统计学差异(P＜0.05),各辨证组间以上各项改善均无差异(P＞0.05);血瘀组和非血瘀组病理主要病变及总积分改善有统计学差异(P=0.028和0.036),而胃镜主要病变及总积分改善无差异(P=0.387和0.207)。
【结论】
1慢性萎缩性胃炎中医证候特征及辨证用药规律
慢性萎缩性胃炎临床表现以胃脘胀满、疼痛、堵闷、嗳气、纳差等消化不良症状为主,伴疲乏、消瘦等全身症状以及紧张、焦虑、恐癌等心理症状。CAG病机为虚实夹杂,虚以气虚、阴虚为主,实以气滞、血瘀为主,常见证型为脾胃虚弱、肝胃不和、脾胃湿热、胃阴不足及胃络瘀血;治疗侧重健脾、理气、活血。常在主方基础上,综合本证型病机特点、药物间相互作用及胃腑喜润恶燥、喜通降恶郁滞的生理特性,适当佐用其他类药物,使兼顾病机更全面,提高主药疗效。脾胃虚弱证治以甘温补益、健脾扶中为法,以香砂六君子汤(脾胃虚寒用黄芪建中汤)加减,常配伍理气、活血及消导药;肝胃不和证以辛香理气、和胃通降为法,用四逆散或柴胡疏肝散合金铃子散加减,常与活血、健脾、清热、养阴药配伍。脾胃湿热证以清热化湿为法,以黄芩滑石汤或藿朴夏苓汤或香砂平胃散加减,佐以芳香化湿及健脾淡渗药,配伍理气药以疏理气机、健脾药以助纳运。胃阴不足证以甘凉濡润、滋养胃阴为法,以一贯煎或益胃汤加减,少佐理气、醒脾消导药,防呆滞气机,少佐黄芪、肉桂等甘温之品从阳引阴。胃络瘀血证以活血理气通络为法,丹参饮或失笑散加减,此法贯穿治疗始终,常配合其他方法使用。应用时须区别血瘀程度、病变趋势,酌情选用和血、活血或破血等不同活血化瘀药物。兼气血不足者,配合党参、当归、白芍等益气养血;配伍理气药,首选活血兼有理气作用的药物,以通利血分之滞。
2导师唐旭东教授治疗慢性萎缩性胃炎思维模式与用药经验
(1)病机及辨证:认为CAG中医诊断以“痞满”、“胃脘痛”为宜;病机为虚实夹杂,脾胃虚弱是病理基础,气机阻滞、胃失和降是主要病机及重要环节,血瘀普遍存在,是疾病发生、发展甚至恶变的关键环节,单纯血瘀证并不多见,常伴发于其他证候,诊断时可不必拘泥于瘀血证的全部症状和体征。强调宏微观辨证结合、兼顾地域、气候、年龄等因素综合辨证。(2)治则治法:治疗重视调理气血,以气血为线贯穿各种治法。处方用药坚持攻补兼施,以补为主,寓通于补的原则,补,主要是补气、温阳,滋阴、补血;攻,重在理气活血通降导滞。(3)处方用药:理气通降常用香苏饮、四逆散、柴胡疏肝散、丹参饮等。常配伍滋阴柔和之品防温燥伤阴,理气兼顾健脾,理气配伍活血,气血同治;活血化瘀常用失笑散、丹参饮、金铃子散等,强调根据虚实主次、标本缓急选用不同作用程度的活血化瘀药,配合其他治法及药物,注意顾护脾胃正气;益气健脾常用四君子汤、香砂六君子汤,反对壅补,主张通补,即在运用理气、活血等药物保持脾胃通降功能基础上调补;清热化湿常用黄芩滑石汤、藿朴夏苓汤、半夏泻心汤及温胆汤等,常化湿理气并用,化湿兼顾健脾;养阴常用益胃汤或一贯煎,常配伍理气及健脾药防滋腻碍胃。此外,注意药物间配伍和对症治疗,调理大便以助通降。(4)强调用药平和、科学选择服药时间、足疗程治疗、强调应个人养生与药物治疗结合,强调长期随访、定期复查,强调定位活检和规范病理诊断;重视胃癌前病变,对肠化尤其异型增生进行针对性用药。
3中医治疗CAG临床疗效评价
中医治疗CAG在临床症状、基于患者报告临床结局(PRO)量表5个维度及总积分、胃镜下粘膜病变、病理组织学均有不同程度的改善。其中非血瘀组患者嗳气、纳差等消化不良症状改善优于血瘀组;血瘀组病理积分改善尤其肠化、萎缩优于非活血化瘀组,说明活血化瘀对于改善萎缩,防止病变进展具有重要作用。临床症状和PRO量表中,以消化不良、心理和全身症状改善最大,对社会功能影响尚待进一步研究验证。
当前中医治疗CAG疗效评价还存在很多问题,建议今后研究:(1)定位活检、规范病理诊断,加强质量控制。(2)严格科研设计,遵循随机化原则,做好分配方案隐藏,可实行盲态评价;选择空白对照或西药常规治疗对照,避免疗效不确定的中成药;保证足够样本量;采用新近公认的疾病诊断标准,保证病例的可比性。(3)疗效指标选择:避免将病理、胃镜、症状混淆,建议各指标采用积分方法做前后比较,合理划分主、次病变(症状),参考新的悉尼分类系统对病理组织学病变进行规范分级和赋分,对于癌变意义大的异型增生进行深入评价;合理而实用的镜下病变分级有待进一步研究;症状分级及赋分要统一,主症可从频率和程度两方面综合评价,并予以较高权重;进行长期随访和疗效观测,观察死亡率、癌变率等终点指标;重视生活质量及患者自我报告临床结局的评价。(4)疗程须3个月以上,做好辨证分型和症状、舌、脉等术语规范。
Chronic atrophic gastritis(CAG) as a commonest gastrointestinal disease, has higher prevalence and threatens healthy seriously. To date, general-accepted effective therapy remains absent. TCM may exert a promising option. But problems exist in therapeutic effect evaluation impair the progress of clinical research.
Aim To conclude and analyze the differentiation-prescription rules of CAG; to evaluate the therapeutic effect of TCM for the treatment of CAG, to explore the evaluating methods and raise current problems.
Method To analyze the rules of pathogenesis, differentiation and prescription of CAG, by literature analysis and dinning the experience of professor Tang ; to evaluate the therapeutic effect of CAG treated with TCM, and to address the characteristics, advantage and current problem by conducting systematic review and observing efficacy of 65 cases with CAG treated by TCM based on syndrome differentiation.
Result
1. Differentiation-prescription rules of CAG:
(1) Results from literatures analysis: Spleen-stomach deficiency (34.2%) , disharmony between liver and stomach (21.3 %) , stomach-yin deficiency (18.6%) , spleen-stomach damp-heat (15.6%) and blood stasis in stomach collaterals (18.1 %) are the commonest syndromes. Qi and yin deficiency (23.3 % VS 23.5 %) dominate at deficient aspect, qi stagnation and blood stasis (26.7 % VS 18.6%) dominate at excess aspect. Common-used drugs include invigorating spleen, regulating qi, eliminating damp, nourishing yin, promoting blood circulation and promoting digestion, including Bai-shao, Bai-zhu, Ban-xia, Chen-pi, Fu-ling, and etc. Spleen-stomach deficiency syndrome treated with Xiang-sha-liu-jun-zi-tang, combined with drugs of regulating qi, warming interior, promoting blood circulation and nourishing yin; disharmony between liver and stomach syndrome treated with Si-ni-san or Chai-hu-shu-gan-san and Jin-ling-zi-san, spleen-stomach damp-heat syndrome treated with Huang-qin-hua-shi-tang or Huang-lian-wen-dan-tang combined with drugs of regulating qi and invigorating spleen; stomach-yin deficiency treated with Yi-guan-jian or Yi-wei-tang, matched drugs of regulating qi, promoting blood circulation and promoting digestion; blood stasis in stomach collaterals syndrome treated with Shi-xiao-san or Dan-shen-yin, combinded with drugs of regulating qi, invigorating spleen and nourishing yin.
(2) Differentiation-prescription experience of professor Tang: Major treating method is regulating qi to promote stomach empting and descending, added drugs of promoting blood circulation, invigorating spleen, eliminating damp; common-used prescriptions includes Xiang-su-yin, Si-ni-san, Xiao-xian-xiong-tang, Jin-ling-zi-san, Dan-shen-yin,Shi-xiao-san and Zuo-jin-wan; drugs include Huang-lian, Chen-pi, Ban-xia, Su-geng, Wu-zei-gu, Yuan-hu, Chuang-lian-zi, and etc;common used drug pairs like Chuang-lian-zi=>Yuan-hu,Xiang-fu=>Chen-pi, Ban-xia=>Huang-lian, and etc.
2. Evaluation of therapeutic effect of TCM for the treatment of CAG based on syndrome differentiation
(1) Systematic review on TCM for the treatment of CAG: The efficacy was evaluated from both number and score changes. The atrophy improvement of TCM group is more significant than controls (P=0.004 VS 0.008 ), compared with vitacoenzyme, hericium and blank control (P=0.0001, 0.0002 VS 0.01), while symptomatic treatment superior to TCM (P=0.03); For improving IM, TCM is superior to controls (P=0.02 VS P<0.00001), compared with hericium, blank and symptomatic medication (P=0.02, 0.007 VS 0.02), with vitacoenzyme (P=0.69) .For improvement DYS of TCM group is more significant than controls (P=0.006 VS 0.004), compared with symptomatic medication and blank control (P=0.11 VS 0.09), with vitacoenzyme (P=0.0004) .For improving granula-like mucosa and bile reflux, TCM is superior to controls (P=0.05 VS 0.005) ,compared with vitacoenzyme and hericium for visible vessel change (P=0.25 VS 0.83). For Hp eradicative rate, there are significance between TCM and control (P=0.009), with hericium, blank control and bismuth potassium citrate (P=0.02, 0.009 VS 0.009), with hericium and symptomatic medication (P=0.70 VS 0.74) ;for overall symptomatic improvement, TCM is more significant than control (P=0.008) ,for stomach pain (P<0.00001) , epigastric distension and fullness (P < 0.00001) ,belching (P=0.18 VS 0.22) , poor appetite (P=0.0007), for disordered stool (P=0.002 VS 0.03) , heart burn (P<0.00001) , acid reflux (P<0.00001).
(2) Clinical observation on 65 cases with CAG treated with TCM based on syndrome differentiation: patient of blood stasis with longer course (P=0.044) , more severe pathological lesions (P=0.026) ,non-blood stasis group with female dominance (P=0.013) ,more severe symptoms and PRO scores (P=0.030 VS 0.003) . After treatment the total symptom score, PRO score, endoscopic findings and pathological lesions were improved significantly (P<0.05); dimensions of PRO attribute to overall improvement as dyspepsia ( 0.423 ) >general symptoms (0.362)> Psychological function(0.353) >reflux (0.238) >social function (0.141)> disordered stool (0.106), the social status remains unchanged (P=0.089) .Total symptom scores improvement of non blood stasis group is superior (P=0.004) , especially belching and poor appetite(P=0.040 VS 0.034 ) ,symptoms attribute to overall improvement as gastric fullness (0.397) ,distention (0.330), heart bum (0.292), gastric pain (0.283) ,poor appetite (0.273) ,belching (0.189) . the pathological improvement of blood stasis group is superior (P=0.036) .
Conclusion
1. Differentiation-prescription rules:
CAG manifests as non-specific dyspeptic symptoms like gastric fullness and distention, pain, belching, poor appetite, disordered defecation, general symptoms like lassitude, anorexia and psychological ones like nervous, anxiety and fear of carcinogenesis. The pathogenesis characterized by qi and yin deficiency dominance in deficient aspect, with qi stagnation and blood stasis dominance in excess aspect. Spleen-stomach deficiency is the basic pathogenesis, qi stagnation and blood stasis play a key role in occurrence and development. Commonest syndromes include disharmony and stagnating heat of liver-stomach, spleen-stomach deficiency, damp-heat in middle-Jiao, stomach yin deficiency. Blood stasis of stomach collateral developed in the long course of the disease, accompanied with other syndrome. Main treating method is regulating qi to promoting stomach soothing and descending, matched promoting blood circulating, invigorating spleen, eliminating damp; Each syndrome treated by major prescription, which modified with drugs of other functions, to prevent intense function or adverse effect of major drugs, by comprehensively considering the pathogenic character of the syndrome, drug interaction and the physiological nature of stomach.
2. Therapeutic effect evaluation of TCM for the treatment of CAG
The TCM was superior to controls in improving symptoms, five dimensions of PRO scale, endoscopic findings and pathological changes. Non blood stasis group is superior t in improving dyspeptic symptoms like belching and poor appetite; blood stasis group has more severe pathological lesions and exhibits more significant improvement after treatment. It is concluded that promoting blood circulation plays an important role in improving atrophy, IM and preventing carcinogenesis, which should be used careful for patient with digestion disorder. The phenomena of no change in social status still need further research.
Some problems encountered in effect evaluation, which should be improved from following aspects: (1) Making biopsy from constant location, standardizing pathological operations, strengthening qualify control. (2) Strengthening research design, including randomization and allocation conceal, blind evaluation, choosing blank or conventional treatment as control, avoiding controls without recognized efficacy, sufficient sample size, applying recognized diagnostic criteria. (3) Selection of effect evaluating method: Intermingle of symptom, endoscopic and pathological changes should be avoided, scores of above items of pre and after treatment is recommended, differentiate the major and other lesion. The grade and scoring of pathological lesions should refer to updated Sydney system, and make further evaluation for DYS; rational and practical grading method still need further study. The classification and scoring of symptoms should be unify, the major ones should be evaluated from both frequency and intensity, longer duration and follow-up study to observe mortality and gastric cancer incidence rate, pay more attention to evaluation of the health related quality of life and patient reported outcome. (4) Treatment duration should be longer than 3 months, standardizing the Traditional Chinese Medicine Terms of CAG.
引文
[1]Rugge M,Correa P,Dixon MF,et al.Gastric mucosal atrophy:interobserver consistency using new criteria for classification and grading.Aliment Pharmacol Ther,2002,16:1249-59.
[2]Brenner H,Rothenbacher D,Weck MN.Epidemiologic findings on serologically defined chronic atrophic gastritis strongly depend on the choice of the cutoff-value.Int J Cancer,2007,121(12):2782-6.
[3]Weck MN,Stegmaier C,Rothenbacher D,Brenner H.Epidemiology of chronic atrophic gastritis:population-based study among 9444 older adults from Germany.Aliment Pharmacol Ther,2007,26(6):879-87.
[4]Ferlay J,Bray F,Pisani P,et al.GLOBOCAN 2002:Cancer Incidence,Mortality and Prevalence Worldwide.IARC CancerBase No 5 version 2.0.Lyon:IARCPress,2004.
[5]Laimas J,Audrius I,Dainius J,Konrads F,Agnese S,IvarsT,et al.Precancerous gastric conditions in high Helicobacter pylori prevalence areas:comparison between Eastern European(Lithuanian,Latvian)and Asian(Taiwanese) patients.Medicina(Kaunas),2007,43(8):623-9.
[6]Melanie NW,Hermann B.Prevalence of Chronic Atrophic Gastritis in Different Parts of the World.Cancer Epidemiol Biomarkers Prev,2006,15(6):1083-94.
[7]De Vries AC,Meijer GA,Looman CW,Casparie MK,Hansen BE,van Grieken NC,et al.Epidemiological trends ofpre-malignant gastric lesions:a long-term nationwide study in the Netherlands.Gut,2007,56(12):1665-70.
[8]Dimitrov G,Gottrand F.Does gastric atrophy exist in children? World J Gastroenterol.2006.12(39):6274-9.
[9]陈灏珠,李宗明主编.内科学.第4版.北京:人民卫生出社,1996:360-366.
[10]J L Whiting,A Sigurdsson,D C Rowlands,M T Hallissey,J W L Fielding.The long term results of endoscopic surveillance of premalignant gastric lesions.Gut,2002,50(3):378-381.
[11]The Eurohepygast Study Group.Risk factors for atrophic chronic gastritis in a European population:results of the Eurohepygast study.Gut,2002,50(6):779-785.
[12]Uemura N,Okamoto S,Yamamoto S,et,al.Helicobacter pylori infection and the development of gastric cancer.N Engl J Med,2001,345:784-789.
[13]Yokata S,Amano K,Fujii N,Comparison of serum antibody to Helicobacter pylori lipopolysaccharides,CagA,VacA and partially purified cellular extracts in a Japenese population.FEMS Microbio Lett,2000,185:193-198.
[14]Sanduleanu S,Hameeteman W,etal.Double infection of the stomach with hlicobacter pylori and non-Helicobacter pylori bacteria a cause for the development of atrophic gastritis during acid-suppressive therapy.European Journal of Gastroenterology and Hepatology,2001,13(12):A1-A2.
[15]Hirano,Atsuyoshi,Yanai,etal.Evaluation of Epstein-Barr Virus DNA load in Gastric Mucosa with Chronic Atrophic Gastritis Usinga Real-Time Quantitative PCRA ssay.International Journal of Gastrointestinal Cancer,2003,34(223):87-94.
[16]郭昱,郭霞.慢性萎缩性胃炎胃泌素,生长抑素、表皮生长因子血管性肠肽的测定及临床意义.中华消化杂志,2003,11:531-534.
[17]Si JM,CA OQ,Gao M,Expression of growth hormone and it receptor in choric atrophic gastritis and its clilnical significance.World J Gastroenterol,2004,10(19):2908-2910.
[18]Green TJ,Venn BJ,Skeaff CM,et al.Serum Vitamine B12 concentrations and atrophic gastritis in older New Zealanders.Eur J Clin Nutr,2004,13:113-115.
[19]Possible means of blocking the formation of carcinogeni N-nitroso compounds. Science.1992,177:65-68.
[20]张沥,张冷霞,徐俊荣,等.热盐水致胃粘膜细胞凋亡及对热休克蛋白表达影响.世界华人消化杂志,2003,11(12):2038-2041.
[21]Lucy S,ItoSueli M,Obashinjo,Suely K.N,etal.Lifesty factors associated with atrophic gastritis among Helicobacter pylori seropositive Japanese Brazilians in Sao Paulo.Int Clinoncol,2003,8:362-368
[22]中华医学会消化病学分会.中国慢性胃炎共识意见(2006,上海).中华消化杂志,2007,27(1):45-49.
[23]Kim S,Harum K,Ito M,et al.Magnifying gastroendoscopy for diagnosis of histologic gastritis in the gastric antrum.Dig Liver Dis,2004,36:286-291.
[24]Kaminishi M,Yamaguchi H,Nomura S,et al.Endoscoic classification of chronic gastritis based on a pilot study by the research society for gastritis.Dig Endosc,2002,14:138-151.
[25]陈磊,杨建民,李向红,等.放大内镜下胃病患者胃粘膜微细结构改变及其临床病理意义.中华消化内镜杂志,2003,20(2):83-87.
[26]范玉林,杨建民,刘海峰,等.放大内镜对萎缩性胃炎诊断价值的前瞻性研究.中国内镜杂志,2004,10(2):41-44.
[27]Dixon MF,Genta RM,Yardley JH,et al.Classification and grading of gastritis.The updated Sydney system.Am J Surg Pathol,1996,20:1161-81.
[28]李鹏,张澍田.慢性胃炎的内镜诊断标准及评价.临床消化病杂志,200618(3):136-138.
[29]姚永莉,张万岱.慢性萎缩性胃炎的诊断和治疗.新医学,2005,36(12):720-721.
[30]施尧.慢性胃炎的萎缩诊断标准和分期分级.胃肠病学,2006,11(4):195-7.
[31]王国祥,祝旭清,缪扬德,王宏刚.美蓝染色在胃癌前病变和早期胃癌中的应用.胃肠病学和肝病学杂志,2006,15(5)460-462.
[32]周晶,沈志祥,沈磊.慢性萎缩性胃炎内镜与病理结果对照分析.中华消化萨科杂志,2004,21(4):84-88.
[33]李红涛,吴开春,李彩宁.血清胃泌素对老年性萎缩性胃炎的诊断.中华老年医杂志,2004,23(4):238-240.
[34]Ortner MA,Dorta G,Blum AL,Michetti P.Endoscopic interventions for preneoplastic and neoplastic lesions:mucosectomy,argon plasma coagulation,and photodynamic therapy.Digestive Diseases,2002,20(2):167-72.
[35]Rugge M,Leandro G,Farinati F,Di Mario F,Sonego F,Cassaro M.Gastric epithelial dysplasia.How clinicopathologic background relates to management.Cancer,1995,76:376-382.
[36]J L Whiting,A Sigurdsson,D C Rowlands,M T Hallissey,J W L Fielding.The long term results of endoscopic surveillance of premalignant gastric lesions.Gut,2002,50(3):378-381.
[37]Mario DR,Altamiro CP,Carlos L,Luis MD.Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia.Journal of Gastroenterology and Hepatology,2007,22(10):1594-1604.
[38]萧树东.江绍基胃肠病学[M].上海:上海科学技术出版社,2001.364.
[39]Wu KC,Li HT,Qiao TD,et al.Diagnosis of atrophic holygastritis in Chinese patients by measuring serum pepsinogen.Chin J Dig Dis,2004,5:22-27.
[40]中华医学会消化病学分会.幽门螺杆菌共识意见(2003·安徽桐城),中华消化杂志,2004,24:126-127.
[41]Malfertheiner P,Megraud F,O'Morain C,et al.European Helicobacter Pylori Study Group(EHPSG).Current concepts in the management of Helicobacter pylori infection the Maastricht 2-2000 Consensus Report.Aliment Pharmacol Ther,2002,16:167-180.
[42]Tucci A,Biasco G,Paparo GF,et al.Effect of eradication ofhelicobacter pylori in patients with fundic atrophic gastritis.New Engl J Med,1997,336(3):957-958.
[43]Heu BS,Yang HB,Wang YL,et al.Pretreatment gastric histology is helpful to predict the symptomatic response after H.pylori eradication in patients with non-ulcer dyspepsia.Dig Dis Sci,2001,46:2700-2707.
[44]Zhou L,Sung JJ,Lin S,et al.A five-year follow-up study on the pathological changes of gastric mucosa after H.pylori eradicanon.Chin Med J,2003,116:11-14.
[45]吴本俨,王孟薇.慢性萎缩性胃炎的现代观点.解放军保健医学杂志,2004,6(1):14-16.
[46]许国铭,李兆申,周多武.铝碳酸镁对胆汁反流性胃炎疗效及胃内24小时胆汁的影响.中华内科杂志,1998,37(11):598-599.
[47]朱舜时,胡运彪,施尧,李蓉蓉,房静远,等.维生素逆转胃癌的癌前病变-初期临床干预试验.胃肠病学,1996,1(2):70-74.
[48]宋海连,周宗骏,蒋锡琪,张国瑛.叶酸及维生素B12治疗慢性萎缩性胃炎的临床观察.上海医药,2000,21(9):27-28.
[49]萧树东.消化病学新理论与新技术.上海:上海科技教育出版社,1999.89-95.
[50]陈淑萍.β-胡萝卜素治疗慢性萎缩性胃炎.中国中西医结合消化杂志,2003,11(2):105-106.
[51]刘文忠.重视对胃粘膜萎缩和肠化生的研究.中华消化杂志,2003,23(3):1-2.
[52]赵丽琴.Celecoxib用于治疗息肉在美国批准上市.国外医学药学分册,2000,27(5):319-320.
[53]Sung JJ,Leung W K,Go M Y,et al.Cyclooxygenase-2 expression in Helicobacter pylori-associated premalignant and Malignant gastric lesions.Am J Pathol,2000,157(3):729-735.
[54]Akre K,Ekstrom A M,Signorello LB,et al.Aspirin and risk for gastric cancer a population-based case-control study in Sweden.Br J Cancer,2001,84(7):965-968.
[55]唐保东,曾志荣,胡品津.选择性COX-2抑制剂塞来昔布预防胃癌前病变发生及其机制的研究。 《癌症》Chinese Joumal of Cancer,2006,25(10):1205-1209.
[56]李春启,刘为纹,房殿春.实验动物胃粘膜癌前病变的模型建立、发生机理及其逆转治疗的研究.第三军医大学学报,1994,16(1):5-9,
[57]瞿尔鑫,朱斌.全反式维甲酸对胃粘膜肠上皮化生和异型增生逆转作用的临床观察.安徽医学,1997,18(4):1-2.
[58]石雪迎,赵凤志,戴欣,方杰,杨会敏.三七对大鼠实验性慢性萎缩性胃炎癌前病变作用的形态学观察.北京中医药大学学报.1999,22(6):45-7.
[59]陈建慧.微生态制剂享寿口服液治疗慢性萎缩性胃炎的疗效观察.江苏医药杂志,2002,28(11):864-865.
[60]Di Gregorio C,Morandi P,Fante R,De Gaetani C.Gastric dysplasia.A follow-up study.American Journal of Gastroenterology 1993;88(10):1714-9.
[61]Zhou L,Lin S,Ye S.Endoscopic mucosectomy for resection of early gastric cancer and precancerous lesions.Zhonghua Nei Ke Za Zhi,1995,34(7):443-5.
[62]Hamada T,Kondo K,Itagaki Y,Nishida J.Endoscopic mucosal resection for early gastric cancer.Nippon Rinsho,1996,54(5):1292-7.
[63]Ortner MA,Dorta G,Blum AL,Michetti P.Endoscopic interventions for preneoplastic and neoplastic lesions:mucosectomy,argon plasma coagulation,and photodynamic therapy.Digestive Diseases,2002,20(2):167-72.
[64]Hojo M,Miwa H,et al.Alteration of histological gastritis after cure of Helicobacter pylori infection.Aliment Pharmacother,2002,16:1923-1932.
[65]Sung JY,Lin SR,Leung WK,et al.Does eradication of H.pylori prevent deterioration of gastric atrophy and intestinal metaplasia? A 52 year follow-up.Gastroenterology,2002,122:Abstract.
[66]李春启,刘为纹.胃癌前病变研究的进展及展望.胃肠病学和肝病学杂志,1996,5(1):1-3.
[67]劳绍贤.胃癌癌前病变的现代医学与中医学研究近况.广州中医学院学报,1995,55-59.
[1]李益民,李纪云.“脏腑一体”气血并调谈慢性萎缩性胃炎的中医整体治疗.河北中医药学报,1998,13(2):20-22.
[2]李汉文,周继友.陈伯咸教授从肝论治萎缩性胃炎.山东中医杂志,1995,14(11):512-513.
[3]张效科,王国栋.慢性胃痛从肝论治的立论依据及意义.四川中医,2006,24(9):30-31.
[4]余恒先.试论调肝法治疗慢性萎缩性胃炎.新疆中医药,2005,23(2):4-6.
[5]于世良,韩继春。慢性萎缩性胃炎从肝论治.辽宁中医学院学报,2005,7(4):328.
[6]张德贵,贺建丽.肝脾同调法治疗慢性萎缩性胃炎68例.山西中医,2000,16(6):11.
[7]高捷.萎缩性胃炎从肝论治举隅.甘肃中医,2000,(5):23-25.
[8]冯心爱,阎双印,赵伟丽.柔肝滋胃汤.治疗慢性萎缩性胃炎56例.中日友好医院学报,2001,15(3):185.
[9]温佰胜.慢性胃炎从“脏腑”论治.中华中医药杂志,2005,20(2):107-108.
[10]唐旭东.董建华“通降论”学术思想整理.北京中医药大学学报,1995,18(2):45-48.
[11]傅志泉,金亚城,黄谦.萎缩性胃炎肝胃不和症辨识.实用中医内科杂志,2004,18(5):400-401.
[12]李文艳.慢性萎缩性胃炎中医治疗七法.甘肃科技,20,03,19(5):83-84.
[13]刘冬梅.治痿独取阳明。与慢性萎缩性胃炎的健脾治疗.山东中医药大学学报,2002,26(1):7-9.
[14]刘元周,姚央,辛勇,李国民.消导健脾法治疗慢性萎缩性胃炎疗效观察.北京军区医药,1994,6(1):25-26.
[15]董可宝,项华美,王丽云,等.论理肺以治胃肠病.安徽中医临床杂志,2002,6(14):208.
[16]邹立华,廖志锋.慢性胃炎从肺论治探析.湖北中医杂志,2002,24(10):22.
[17]张培彤.论慢性萎缩性胃炎从肾论治.山东中医药杂志,1996,15(6):245-246
[18]刘浙伟.从命门学说论治慢性萎缩性胃炎探析.浙江中医杂志,1998,152.
[19]刘庆华.温胃运脾益肾法治疗慢性萎缩性胃炎61例.天津中医,1995,12(5):15
[20]李胜.从脾肾论治慢性萎缩性胃炎虚寒证38例.中国中西医结合脾胃杂志,2000,8(2):117.
[21]陈小忆,邱志楠.“补肾调胃”法治慢性萎缩性胃炎46例的体会.广州医学院学报,1999,27(1):76-7.
[22]张玉波.浅谈对萎缩性胃炎的认识与治疗.中医函投通讯,1996,(5):28-9.
[23]李培英,孙寒光,王桂英.调节心肾法治疗萎缩性胃炎64例.河南中医,1997,17(3):169,146.
[24]杨容青.调和气血法治疗慢性萎缩性胃炎思考.辽宁中医杂志,2005,32(6):551-552.
[25]赵卫红,裴正义.行气化湿治疗慢性萎缩性胃炎.武汉市职工医学院学报第,2000,28(1):35-36.
[26]郝俊良.从湿论治慢性萎缩性胃炎.河北中医,2003,25(2):115-116.
[27]张宏,马华.散寒除湿法治疗慢性萎缩性胃炎的体会.山西医科大学学报,2006,37(8):883-884.
[28]李淑英,吴彩娥.清热燥湿法治疗萎缩性胃炎188例.山西中医,2001,17(1):15-16.
[29]顾庆华.清热化湿法治疗慢性萎缩性胃炎60例浅议.实用中医药杂志,2003,19(4):175-176.
[30]罗珠林.胃脘痛与瘀血的临床研究.实用中西医结合杂志,1991,4(5):302.
[31]潘秀珍,等.慢性胃病的血液流变学研究.中华消化杂志,1984,4(4):260.
[32]危北海.慢性胃炎诊治.中西医结合杂志,1990,10(5):265.
[33]马静.活血化瘀法治疗萎缩性胃炎探析。中医药管理杂志,2006,14(8):60-1.
[34]吴伯聪.活血化瘀法治疗萎缩性胃炎当议.山西中医,1995,11(3):27,40.
[35]吴红梅,崔濡涛.活血化瘀是治疗慢性萎缩性胃炎的重要法则.国医论坛,1997,12(2):20-21.
[36]刘迎.慢性萎缩性胃炎从瘀论治80例疗效观察.北京中医,2001,(4):17-18.
[37]赵进明.从血瘀论治慢性萎缩性胃炎.山东中医杂志,1999,18(3):107-108.
[38]喜新,单兆伟.益气活血方治疗慢性萎缩性胃炎气虚血瘀证36例.南京中医 药大学学报,1998,14(3):177-178.
[39]瞿绪军.健脾生津法治疗慢性萎缩性胃炎62例.华夏医学,2005,18(4):608-609.
[40]马贵同,张万贷,陈泽民,等.中医药治疗慢性萎缩性胃炎专家经验谈.中医杂志,1992,33(3):49-52.
[41]鲁香凤,赵凤志,戴欣,等.中药治疗实验性慢性萎缩性胃炎的酶组化及电镜观察.中国中西医结合脾胃杂志,2000,8(5):257.
[42]任宏义,牛灵地,郝万青,等.慢性萎缩性胃炎脾虚证的病理组织学与超微结构观察.中国中西医结合杂志,1992,12(10):593.
[43]孙梅,詹小萍,金晨宇,杜勤.重用补托方治疗慢性萎缩性胃炎80例临床观察.中国中药杂志,2005,30(12):952-953.
[44]阚士宇,田德茂,陈如芳,林美娟,孙秀峰,马岚.养阴荣胃丸治疗萎缩性胃炎癌前病变临床研究.山东中医杂志,2006,25(2):94-95
[45]刘晴生,阮新华.养胃阴法治疗萎缩性胃炎.湖北中医杂志,2000,22(8):36.
[46]唐志英,曹光誉.养阴法为主治疗慢性萎缩性胃炎86例.实用中医内科杂志,2001,15(1):26.
[47]宫宪文.养阴法治疗萎缩性胃炎30例疗效观察.中医药信息,2002,19(3):57.
[48]杨锦侠,张升良,杨小丽.滋阴益气法治疗慢性萎缩性胃炎103例.现代中医药,2006,26(3):11-12.
[1]瞿绪军.健脾生津法治疗慢性萎缩性胃炎62例.华夏医学,2005,18(4):608-609.
[2]马贵同,张万贷,陈泽民,等.中医药治疗慢性萎缩性胃炎专家经验谈.中医杂志,1992,33(3):49-52.
[3]刘冬梅.“治痿独取阳明”与慢性萎缩性胃炎的健脾治疗.山东中医药大学学报,2002,26(1):7-9.
[4]李连英.浅述脾胃病用药规律.黑龙江中医药,2005,5:58-59.
[5]徐江雁,李郑生,刘文礼.李振华教授调理脾胃用药规律探讨.河南中医,2006, 26(1):27-29.
[6]傅志泉,金亚城,黄谦.萎缩性胃炎肝胃不和症辨识.实用中医内科杂志,2004,18(5):400-401.
[7]储浩然,张闻东.马骏治疗慢性萎缩性胃炎的用药经验.安徽中医临床杂志,2000,12(3):215-216.
[8]吴红梅,崔濡涛.活血化瘀是治疗慢性萎缩性胃炎的重要法则.国医论坛,1997,12(2):20-21.
[9]赵清.单兆伟治疗慢性萎缩性胃炎的处方用药特点.辽宁中医杂志,2002,29(9):524.
[10]杨晋翔.老年萎缩性胃炎的治疗特点.中医函授通讯,1996,(3):26-27.
[1]董建华(唐旭东整理).对治疗慢性萎缩性胃炎的看法.中国医药学报,1993,8(2):57-60.
[2]苏新宁,杨新林,邓三鸿,等.数据挖掘理论与技术.北京:北京科学技术文献出版社,2003.P6.
[1]Deeks JJ,Dinnes J,D'Amico R,et al.Evaluating non-randomized intervention studies.Health Technol assess,2003,7(27):iii-x,1-173.
[2]倪克中,秦岚.益气化淤法治疗萎缩性胃炎伴不典型增生肠上皮化生72例.中国中西医结合脾胃杂志,1996,4(4):236.
[3]邱志楠,潘俊辉,梁淑仪.健胃汤治疗慢性萎缩性胃炎96例疗效观察.新中医,1998,30(2):25-26.
[4]黄晋红,张仲海,罗红,于海英.消萎灵Ⅰ号胶囊治疗慢性萎缩性胃炎及胃癌前病变52例临床研究.武警医学,2004,15(11):815-817.
[5]刘远林.活血化瘀法治疗慢性萎缩性胃炎的疗效及对血液流变学的影响.中国中西医结合消化杂志,2005,13(2):127-128.
[6]阚士宇,田德茂,陈如芳,林美娟,孙秀峰,马岚.养阴荣胃丸治疗萎缩性胃炎癌前病变临床研究.山东中医杂志,2006,25(2):94-95.
[7]彭国英.自拟益胃消萎汤治疗慢性萎缩性胃炎58例.陕西中医,2007,28(1):40-42.
[8]袁红霞,黄文政,陈通,方桢,代二庆,于强,等.善胃号方对血瘀热毒型胃粘膜异型增生P21蛋白的影响.天津中医药,2003,20(1):16-18.
[9]杨莉莉,杨薇薇,姚强.胃复春对萎缩性胃炎胃粘膜病理组织学变化的影响.新疆中医药,2006,24(1)13-15.
[10]李恺.健脾泻胃汤治疗慢性萎缩性胃炎60例.陕西中医学院学报,2007,30(4):21-22.
[11]路文军,孙成栋,于大猛.夏连杞贞胶囊治疗胃阴亏损型慢性萎缩性胃炎癌前病变临床研究.中国中西医结合消化杂志,2007,15(4):224-226.
[12]田晶晶,陈桂芳,袁红霞.善胃Ⅲ号方治疗气阴两虚型慢性萎缩性胃炎的疗效观察.辽宁中医杂志,2006,33(11):1437-1438.
[13]陈欣童,蒋红玉,陈李华,李小球,匡忠生,谢宇辉,方永奇.胃炎康加维酶素对胃癌前病变的作用及其机理研究.中医药学刊,2004,22(9):1703-1704.
[14]刘重阳,陈东风,王军,彭安国.猴头菌提取物颗粒治疗慢性萎缩性胃炎30例.中国临床保健杂志,2007,10(3):290-291.
[15]曹志群.芪莲舒痞颗粒治疗慢性萎缩性胃炎癌前病变61例.山东中医药大学学报,2003,27(5):346-347.
[16]杨幼新,袁红霞,杨曼,代二庆,赵强.善胃方对气阴两虚型萎缩性胃炎癌前病变患者p16的影响.天津中医学院学报,2006,25(1):15-17.
[17]李宪禄,苗华军.胃得安与猴菇片治疗慢性萎缩性胃炎的比较.泰山医学院学报,2001,22(3):242-243.
[18]覃业姣.健胃汤治疗慢性萎缩性胃炎53例临床观察.广西医学,1997,19(2):300-301.
[19]罗宪津.养胃汤治疗慢性萎缩性胃炎.天津中医,2000,17(5):15-16.
[20]高望望,朱振华.萎胃消合剂治疗萎缩性胃炎癌前病变.现代实用医学,2003,15(8):503.
[21]赵红,周学锋.胃复春治疗慢性萎缩性胃炎癌前病变144例.临床药学,2004,13(8):70-71.
[22]莫天栩.益气养阴化瘀汤治疗慢性萎缩性胃炎癌前病变临床观察.中国中医急症,2005,14(6):523-524.
[23]李景巍.参苓蚤休汤为主治疗慢性萎缩性胃炎68例.中医杂志,2007,48(10):909-910.
[24]余道兵.当归补血口服液对慢性萎缩性胃炎伴型增生的逆转治疗(附50例临床分析).咸宁学院学报(医学版),2005,19(2):113-114.
[25]李恺.健脾泻胃汤治疗慢性萎缩性胃炎60例.陕西中医学院学报,2007,30(4):21-22.
[26]李兴锋.建中调胃汤治疗慢性萎缩性胃炎60例.中医研究,2003,16(6):30-31.
[27]胡蔚.健脾和胃法治疗脾胃虚弱型慢性萎缩性胃炎疗效观察.河北中医,2007,29(11):983-984.
[28]陈之光,张梅芬.中西医结合治疗慢性萎缩性胃炎68例疗效观察.浙江中医学院学报,2000,24(4):28.
[29]杨大昭.中西医结合治疗慢性萎缩性胃炎胃癌前期病变48例.中国中西医结合消化杂志,2003,11(4):236-237.
[30]郑镇雄.加味一贯煎治疗慢性萎缩性胃炎35例.湖北中医杂志,2000, 22(2):36.
[31]韩守信.消萎散治疗慢性萎缩性胃炎126例临床观察.河北中医,2006,28(9):667.
[32]卓玉珍,袁红霞,袁红梅,王学.善胃系列方治疗胃癌前病变的相关基因蛋白表达试验研究.天津中医学院学报,2006,25(1)18-21.
[33]中华医学会消化病学分会.中国慢性胃炎共识意见(2006,上海).中华消化杂志,2007,27(1):45-49.
[34]米庆海.影响萎缩性胃炎中医疗效的因素探讨.中国民间疗法,2008,(1):6
[1]董建华(唐旭东整理).对治疗慢性萎缩性胃炎的看法.中国医药学报,1993,8(2):57-60.
[2]罗珠林.胃脘痛与瘀血的临床研究.实用中西医结合杂志,1991,4(5):302.
[3]潘秀珍,林才经,等.慢性胃病的血液流变学研究.中华消化杂志.1984:4(4):260.
[4]戴晓玲,张庚良,海滨,滕玲,程丽娜.从血液流变学探讨萎缩性胃炎的血瘀改变.辽宁中医杂志,1994,21(1):10-11.
[5]张玉,林庚金,金惠铭,钱睿哲,张国平.慢性萎缩性胃炎胃粘膜血流量的研究.中华消化内镜杂志,1997,14(2):101-102.
[6]葛文松,刘杰民,安祯祥,王 敏.中医药对逆转慢性萎缩性胃炎病理变化的探讨.四川中医,2004,22(1):19-20.
[7]危北海.慢性胃炎诊治.中西医结合杂志,1990,10(5):265.
[8]樊群.活血化瘀是治疗胃癌前病变的关键环节.中国中医基础医学杂志,1997,3(5):52-53.
[9]唐旭东.慢性萎缩性胃炎血淤病机及治疗方法探讨.中医杂志,1998,(11):687.
[2]Brenner H,Rothenbacher D,Weck MN.Epidemiologic findings on serologically defined chronic atrophic gastritis strongly depend on the choice of the cutoff-value.Int J Cancer,2007,121(12):2782-6.
[3]Weck MN,Stegmaier C,Rothenbacher D,Brenner H.Epidemiology of chronic atrophic gastritis:population-based study among 9444 older adults from Germany.Aliment Pharmacol Ther,2007,26(6):879-87.
[4]Ferlay J,Bray F,Pisani P,et al.GLOBOCAN 2002:Cancer Incidence,Mortality and Prevalence Worldwide.IARC CancerBase No 5 version 2.0.Lyon:IARCPress,2004.
[5]Laimas J,Audrius I,Dainius J,Konrads F,Agnese S,IvarsT,et al.Precancerous gastric conditions in high Helicobacter pylori prevalence areas:comparison between Eastern European(Lithuanian,Latvian)and Asian(Taiwanese) patients.Medicina(Kaunas),2007,43(8):623-9.
[6]Melanie NW,Hermann B.Prevalence of Chronic Atrophic Gastritis in Different Parts of the World.Cancer Epidemiol Biomarkers Prev,2006,15(6):1083-94.
[7]De Vries AC,Meijer GA,Looman CW,Casparie MK,Hansen BE,van Grieken NC,et al.Epidemiological trends ofpre-malignant gastric lesions:a long-term nationwide study in the Netherlands.Gut,2007,56(12):1665-70.
[8]Dimitrov G,Gottrand F.Does gastric atrophy exist in children? World J Gastroenterol.2006.12(39):6274-9.
[9]陈灏珠,李宗明主编.内科学.第4版.北京:人民卫生出社,1996:360-366.
[10]J L Whiting,A Sigurdsson,D C Rowlands,M T Hallissey,J W L Fielding.The long term results of endoscopic surveillance of premalignant gastric lesions.Gut,2002,50(3):378-381.
[11]The Eurohepygast Study Group.Risk factors for atrophic chronic gastritis in a European population:results of the Eurohepygast study.Gut,2002,50(6):779-785.
[12]Uemura N,Okamoto S,Yamamoto S,et,al.Helicobacter pylori infection and the development of gastric cancer.N Engl J Med,2001,345:784-789.
[13]Yokata S,Amano K,Fujii N,Comparison of serum antibody to Helicobacter pylori lipopolysaccharides,CagA,VacA and partially purified cellular extracts in a Japenese population.FEMS Microbio Lett,2000,185:193-198.
[14]Sanduleanu S,Hameeteman W,etal.Double infection of the stomach with hlicobacter pylori and non-Helicobacter pylori bacteria a cause for the development of atrophic gastritis during acid-suppressive therapy.European Journal of Gastroenterology and Hepatology,2001,13(12):A1-A2.
[15]Hirano,Atsuyoshi,Yanai,etal.Evaluation of Epstein-Barr Virus DNA load in Gastric Mucosa with Chronic Atrophic Gastritis Usinga Real-Time Quantitative PCRA ssay.International Journal of Gastrointestinal Cancer,2003,34(223):87-94.
[16]郭昱,郭霞.慢性萎缩性胃炎胃泌素,生长抑素、表皮生长因子血管性肠肽的测定及临床意义.中华消化杂志,2003,11:531-534.
[17]Si JM,CA OQ,Gao M,Expression of growth hormone and it receptor in choric atrophic gastritis and its clilnical significance.World J Gastroenterol,2004,10(19):2908-2910.
[18]Green TJ,Venn BJ,Skeaff CM,et al.Serum Vitamine B12 concentrations and atrophic gastritis in older New Zealanders.Eur J Clin Nutr,2004,13:113-115.
[19]Possible means of blocking the formation of carcinogeni N-nitroso compounds. Science.1992,177:65-68.
[20]张沥,张冷霞,徐俊荣,等.热盐水致胃粘膜细胞凋亡及对热休克蛋白表达影响.世界华人消化杂志,2003,11(12):2038-2041.
[21]Lucy S,ItoSueli M,Obashinjo,Suely K.N,etal.Lifesty factors associated with atrophic gastritis among Helicobacter pylori seropositive Japanese Brazilians in Sao Paulo.Int Clinoncol,2003,8:362-368
[22]中华医学会消化病学分会.中国慢性胃炎共识意见(2006,上海).中华消化杂志,2007,27(1):45-49.
[23]Kim S,Harum K,Ito M,et al.Magnifying gastroendoscopy for diagnosis of histologic gastritis in the gastric antrum.Dig Liver Dis,2004,36:286-291.
[24]Kaminishi M,Yamaguchi H,Nomura S,et al.Endoscoic classification of chronic gastritis based on a pilot study by the research society for gastritis.Dig Endosc,2002,14:138-151.
[25]陈磊,杨建民,李向红,等.放大内镜下胃病患者胃粘膜微细结构改变及其临床病理意义.中华消化内镜杂志,2003,20(2):83-87.
[26]范玉林,杨建民,刘海峰,等.放大内镜对萎缩性胃炎诊断价值的前瞻性研究.中国内镜杂志,2004,10(2):41-44.
[27]Dixon MF,Genta RM,Yardley JH,et al.Classification and grading of gastritis.The updated Sydney system.Am J Surg Pathol,1996,20:1161-81.
[28]李鹏,张澍田.慢性胃炎的内镜诊断标准及评价.临床消化病杂志,200618(3):136-138.
[29]姚永莉,张万岱.慢性萎缩性胃炎的诊断和治疗.新医学,2005,36(12):720-721.
[30]施尧.慢性胃炎的萎缩诊断标准和分期分级.胃肠病学,2006,11(4):195-7.
[31]王国祥,祝旭清,缪扬德,王宏刚.美蓝染色在胃癌前病变和早期胃癌中的应用.胃肠病学和肝病学杂志,2006,15(5)460-462.
[32]周晶,沈志祥,沈磊.慢性萎缩性胃炎内镜与病理结果对照分析.中华消化萨科杂志,2004,21(4):84-88.
[33]李红涛,吴开春,李彩宁.血清胃泌素对老年性萎缩性胃炎的诊断.中华老年医杂志,2004,23(4):238-240.
[34]Ortner MA,Dorta G,Blum AL,Michetti P.Endoscopic interventions for preneoplastic and neoplastic lesions:mucosectomy,argon plasma coagulation,and photodynamic therapy.Digestive Diseases,2002,20(2):167-72.
[35]Rugge M,Leandro G,Farinati F,Di Mario F,Sonego F,Cassaro M.Gastric epithelial dysplasia.How clinicopathologic background relates to management.Cancer,1995,76:376-382.
[36]J L Whiting,A Sigurdsson,D C Rowlands,M T Hallissey,J W L Fielding.The long term results of endoscopic surveillance of premalignant gastric lesions.Gut,2002,50(3):378-381.
[37]Mario DR,Altamiro CP,Carlos L,Luis MD.Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia.Journal of Gastroenterology and Hepatology,2007,22(10):1594-1604.
[38]萧树东.江绍基胃肠病学[M].上海:上海科学技术出版社,2001.364.
[39]Wu KC,Li HT,Qiao TD,et al.Diagnosis of atrophic holygastritis in Chinese patients by measuring serum pepsinogen.Chin J Dig Dis,2004,5:22-27.
[40]中华医学会消化病学分会.幽门螺杆菌共识意见(2003·安徽桐城),中华消化杂志,2004,24:126-127.
[41]Malfertheiner P,Megraud F,O'Morain C,et al.European Helicobacter Pylori Study Group(EHPSG).Current concepts in the management of Helicobacter pylori infection the Maastricht 2-2000 Consensus Report.Aliment Pharmacol Ther,2002,16:167-180.
[42]Tucci A,Biasco G,Paparo GF,et al.Effect of eradication ofhelicobacter pylori in patients with fundic atrophic gastritis.New Engl J Med,1997,336(3):957-958.
[43]Heu BS,Yang HB,Wang YL,et al.Pretreatment gastric histology is helpful to predict the symptomatic response after H.pylori eradication in patients with non-ulcer dyspepsia.Dig Dis Sci,2001,46:2700-2707.
[44]Zhou L,Sung JJ,Lin S,et al.A five-year follow-up study on the pathological changes of gastric mucosa after H.pylori eradicanon.Chin Med J,2003,116:11-14.
[45]吴本俨,王孟薇.慢性萎缩性胃炎的现代观点.解放军保健医学杂志,2004,6(1):14-16.
[46]许国铭,李兆申,周多武.铝碳酸镁对胆汁反流性胃炎疗效及胃内24小时胆汁的影响.中华内科杂志,1998,37(11):598-599.
[47]朱舜时,胡运彪,施尧,李蓉蓉,房静远,等.维生素逆转胃癌的癌前病变-初期临床干预试验.胃肠病学,1996,1(2):70-74.
[48]宋海连,周宗骏,蒋锡琪,张国瑛.叶酸及维生素B12治疗慢性萎缩性胃炎的临床观察.上海医药,2000,21(9):27-28.
[49]萧树东.消化病学新理论与新技术.上海:上海科技教育出版社,1999.89-95.
[50]陈淑萍.β-胡萝卜素治疗慢性萎缩性胃炎.中国中西医结合消化杂志,2003,11(2):105-106.
[51]刘文忠.重视对胃粘膜萎缩和肠化生的研究.中华消化杂志,2003,23(3):1-2.
[52]赵丽琴.Celecoxib用于治疗息肉在美国批准上市.国外医学药学分册,2000,27(5):319-320.
[53]Sung JJ,Leung W K,Go M Y,et al.Cyclooxygenase-2 expression in Helicobacter pylori-associated premalignant and Malignant gastric lesions.Am J Pathol,2000,157(3):729-735.
[54]Akre K,Ekstrom A M,Signorello LB,et al.Aspirin and risk for gastric cancer a population-based case-control study in Sweden.Br J Cancer,2001,84(7):965-968.
[55]唐保东,曾志荣,胡品津.选择性COX-2抑制剂塞来昔布预防胃癌前病变发生及其机制的研究。 《癌症》Chinese Joumal of Cancer,2006,25(10):1205-1209.
[56]李春启,刘为纹,房殿春.实验动物胃粘膜癌前病变的模型建立、发生机理及其逆转治疗的研究.第三军医大学学报,1994,16(1):5-9,
[57]瞿尔鑫,朱斌.全反式维甲酸对胃粘膜肠上皮化生和异型增生逆转作用的临床观察.安徽医学,1997,18(4):1-2.
[58]石雪迎,赵凤志,戴欣,方杰,杨会敏.三七对大鼠实验性慢性萎缩性胃炎癌前病变作用的形态学观察.北京中医药大学学报.1999,22(6):45-7.
[59]陈建慧.微生态制剂享寿口服液治疗慢性萎缩性胃炎的疗效观察.江苏医药杂志,2002,28(11):864-865.
[60]Di Gregorio C,Morandi P,Fante R,De Gaetani C.Gastric dysplasia.A follow-up study.American Journal of Gastroenterology 1993;88(10):1714-9.
[61]Zhou L,Lin S,Ye S.Endoscopic mucosectomy for resection of early gastric cancer and precancerous lesions.Zhonghua Nei Ke Za Zhi,1995,34(7):443-5.
[62]Hamada T,Kondo K,Itagaki Y,Nishida J.Endoscopic mucosal resection for early gastric cancer.Nippon Rinsho,1996,54(5):1292-7.
[63]Ortner MA,Dorta G,Blum AL,Michetti P.Endoscopic interventions for preneoplastic and neoplastic lesions:mucosectomy,argon plasma coagulation,and photodynamic therapy.Digestive Diseases,2002,20(2):167-72.
[64]Hojo M,Miwa H,et al.Alteration of histological gastritis after cure of Helicobacter pylori infection.Aliment Pharmacother,2002,16:1923-1932.
[65]Sung JY,Lin SR,Leung WK,et al.Does eradication of H.pylori prevent deterioration of gastric atrophy and intestinal metaplasia? A 52 year follow-up.Gastroenterology,2002,122:Abstract.
[66]李春启,刘为纹.胃癌前病变研究的进展及展望.胃肠病学和肝病学杂志,1996,5(1):1-3.
[67]劳绍贤.胃癌癌前病变的现代医学与中医学研究近况.广州中医学院学报,1995,55-59.
[1]李益民,李纪云.“脏腑一体”气血并调谈慢性萎缩性胃炎的中医整体治疗.河北中医药学报,1998,13(2):20-22.
[2]李汉文,周继友.陈伯咸教授从肝论治萎缩性胃炎.山东中医杂志,1995,14(11):512-513.
[3]张效科,王国栋.慢性胃痛从肝论治的立论依据及意义.四川中医,2006,24(9):30-31.
[4]余恒先.试论调肝法治疗慢性萎缩性胃炎.新疆中医药,2005,23(2):4-6.
[5]于世良,韩继春。慢性萎缩性胃炎从肝论治.辽宁中医学院学报,2005,7(4):328.
[6]张德贵,贺建丽.肝脾同调法治疗慢性萎缩性胃炎68例.山西中医,2000,16(6):11.
[7]高捷.萎缩性胃炎从肝论治举隅.甘肃中医,2000,(5):23-25.
[8]冯心爱,阎双印,赵伟丽.柔肝滋胃汤.治疗慢性萎缩性胃炎56例.中日友好医院学报,2001,15(3):185.
[9]温佰胜.慢性胃炎从“脏腑”论治.中华中医药杂志,2005,20(2):107-108.
[10]唐旭东.董建华“通降论”学术思想整理.北京中医药大学学报,1995,18(2):45-48.
[11]傅志泉,金亚城,黄谦.萎缩性胃炎肝胃不和症辨识.实用中医内科杂志,2004,18(5):400-401.
[12]李文艳.慢性萎缩性胃炎中医治疗七法.甘肃科技,20,03,19(5):83-84.
[13]刘冬梅.治痿独取阳明。与慢性萎缩性胃炎的健脾治疗.山东中医药大学学报,2002,26(1):7-9.
[14]刘元周,姚央,辛勇,李国民.消导健脾法治疗慢性萎缩性胃炎疗效观察.北京军区医药,1994,6(1):25-26.
[15]董可宝,项华美,王丽云,等.论理肺以治胃肠病.安徽中医临床杂志,2002,6(14):208.
[16]邹立华,廖志锋.慢性胃炎从肺论治探析.湖北中医杂志,2002,24(10):22.
[17]张培彤.论慢性萎缩性胃炎从肾论治.山东中医药杂志,1996,15(6):245-246
[18]刘浙伟.从命门学说论治慢性萎缩性胃炎探析.浙江中医杂志,1998,152.
[19]刘庆华.温胃运脾益肾法治疗慢性萎缩性胃炎61例.天津中医,1995,12(5):15
[20]李胜.从脾肾论治慢性萎缩性胃炎虚寒证38例.中国中西医结合脾胃杂志,2000,8(2):117.
[21]陈小忆,邱志楠.“补肾调胃”法治慢性萎缩性胃炎46例的体会.广州医学院学报,1999,27(1):76-7.
[22]张玉波.浅谈对萎缩性胃炎的认识与治疗.中医函投通讯,1996,(5):28-9.
[23]李培英,孙寒光,王桂英.调节心肾法治疗萎缩性胃炎64例.河南中医,1997,17(3):169,146.
[24]杨容青.调和气血法治疗慢性萎缩性胃炎思考.辽宁中医杂志,2005,32(6):551-552.
[25]赵卫红,裴正义.行气化湿治疗慢性萎缩性胃炎.武汉市职工医学院学报第,2000,28(1):35-36.
[26]郝俊良.从湿论治慢性萎缩性胃炎.河北中医,2003,25(2):115-116.
[27]张宏,马华.散寒除湿法治疗慢性萎缩性胃炎的体会.山西医科大学学报,2006,37(8):883-884.
[28]李淑英,吴彩娥.清热燥湿法治疗萎缩性胃炎188例.山西中医,2001,17(1):15-16.
[29]顾庆华.清热化湿法治疗慢性萎缩性胃炎60例浅议.实用中医药杂志,2003,19(4):175-176.
[30]罗珠林.胃脘痛与瘀血的临床研究.实用中西医结合杂志,1991,4(5):302.
[31]潘秀珍,等.慢性胃病的血液流变学研究.中华消化杂志,1984,4(4):260.
[32]危北海.慢性胃炎诊治.中西医结合杂志,1990,10(5):265.
[33]马静.活血化瘀法治疗萎缩性胃炎探析。中医药管理杂志,2006,14(8):60-1.
[34]吴伯聪.活血化瘀法治疗萎缩性胃炎当议.山西中医,1995,11(3):27,40.
[35]吴红梅,崔濡涛.活血化瘀是治疗慢性萎缩性胃炎的重要法则.国医论坛,1997,12(2):20-21.
[36]刘迎.慢性萎缩性胃炎从瘀论治80例疗效观察.北京中医,2001,(4):17-18.
[37]赵进明.从血瘀论治慢性萎缩性胃炎.山东中医杂志,1999,18(3):107-108.
[38]喜新,单兆伟.益气活血方治疗慢性萎缩性胃炎气虚血瘀证36例.南京中医 药大学学报,1998,14(3):177-178.
[39]瞿绪军.健脾生津法治疗慢性萎缩性胃炎62例.华夏医学,2005,18(4):608-609.
[40]马贵同,张万贷,陈泽民,等.中医药治疗慢性萎缩性胃炎专家经验谈.中医杂志,1992,33(3):49-52.
[41]鲁香凤,赵凤志,戴欣,等.中药治疗实验性慢性萎缩性胃炎的酶组化及电镜观察.中国中西医结合脾胃杂志,2000,8(5):257.
[42]任宏义,牛灵地,郝万青,等.慢性萎缩性胃炎脾虚证的病理组织学与超微结构观察.中国中西医结合杂志,1992,12(10):593.
[43]孙梅,詹小萍,金晨宇,杜勤.重用补托方治疗慢性萎缩性胃炎80例临床观察.中国中药杂志,2005,30(12):952-953.
[44]阚士宇,田德茂,陈如芳,林美娟,孙秀峰,马岚.养阴荣胃丸治疗萎缩性胃炎癌前病变临床研究.山东中医杂志,2006,25(2):94-95
[45]刘晴生,阮新华.养胃阴法治疗萎缩性胃炎.湖北中医杂志,2000,22(8):36.
[46]唐志英,曹光誉.养阴法为主治疗慢性萎缩性胃炎86例.实用中医内科杂志,2001,15(1):26.
[47]宫宪文.养阴法治疗萎缩性胃炎30例疗效观察.中医药信息,2002,19(3):57.
[48]杨锦侠,张升良,杨小丽.滋阴益气法治疗慢性萎缩性胃炎103例.现代中医药,2006,26(3):11-12.
[1]瞿绪军.健脾生津法治疗慢性萎缩性胃炎62例.华夏医学,2005,18(4):608-609.
[2]马贵同,张万贷,陈泽民,等.中医药治疗慢性萎缩性胃炎专家经验谈.中医杂志,1992,33(3):49-52.
[3]刘冬梅.“治痿独取阳明”与慢性萎缩性胃炎的健脾治疗.山东中医药大学学报,2002,26(1):7-9.
[4]李连英.浅述脾胃病用药规律.黑龙江中医药,2005,5:58-59.
[5]徐江雁,李郑生,刘文礼.李振华教授调理脾胃用药规律探讨.河南中医,2006, 26(1):27-29.
[6]傅志泉,金亚城,黄谦.萎缩性胃炎肝胃不和症辨识.实用中医内科杂志,2004,18(5):400-401.
[7]储浩然,张闻东.马骏治疗慢性萎缩性胃炎的用药经验.安徽中医临床杂志,2000,12(3):215-216.
[8]吴红梅,崔濡涛.活血化瘀是治疗慢性萎缩性胃炎的重要法则.国医论坛,1997,12(2):20-21.
[9]赵清.单兆伟治疗慢性萎缩性胃炎的处方用药特点.辽宁中医杂志,2002,29(9):524.
[10]杨晋翔.老年萎缩性胃炎的治疗特点.中医函授通讯,1996,(3):26-27.
[1]董建华(唐旭东整理).对治疗慢性萎缩性胃炎的看法.中国医药学报,1993,8(2):57-60.
[2]苏新宁,杨新林,邓三鸿,等.数据挖掘理论与技术.北京:北京科学技术文献出版社,2003.P6.
[1]Deeks JJ,Dinnes J,D'Amico R,et al.Evaluating non-randomized intervention studies.Health Technol assess,2003,7(27):iii-x,1-173.
[2]倪克中,秦岚.益气化淤法治疗萎缩性胃炎伴不典型增生肠上皮化生72例.中国中西医结合脾胃杂志,1996,4(4):236.
[3]邱志楠,潘俊辉,梁淑仪.健胃汤治疗慢性萎缩性胃炎96例疗效观察.新中医,1998,30(2):25-26.
[4]黄晋红,张仲海,罗红,于海英.消萎灵Ⅰ号胶囊治疗慢性萎缩性胃炎及胃癌前病变52例临床研究.武警医学,2004,15(11):815-817.
[5]刘远林.活血化瘀法治疗慢性萎缩性胃炎的疗效及对血液流变学的影响.中国中西医结合消化杂志,2005,13(2):127-128.
[6]阚士宇,田德茂,陈如芳,林美娟,孙秀峰,马岚.养阴荣胃丸治疗萎缩性胃炎癌前病变临床研究.山东中医杂志,2006,25(2):94-95.
[7]彭国英.自拟益胃消萎汤治疗慢性萎缩性胃炎58例.陕西中医,2007,28(1):40-42.
[8]袁红霞,黄文政,陈通,方桢,代二庆,于强,等.善胃号方对血瘀热毒型胃粘膜异型增生P21蛋白的影响.天津中医药,2003,20(1):16-18.
[9]杨莉莉,杨薇薇,姚强.胃复春对萎缩性胃炎胃粘膜病理组织学变化的影响.新疆中医药,2006,24(1)13-15.
[10]李恺.健脾泻胃汤治疗慢性萎缩性胃炎60例.陕西中医学院学报,2007,30(4):21-22.
[11]路文军,孙成栋,于大猛.夏连杞贞胶囊治疗胃阴亏损型慢性萎缩性胃炎癌前病变临床研究.中国中西医结合消化杂志,2007,15(4):224-226.
[12]田晶晶,陈桂芳,袁红霞.善胃Ⅲ号方治疗气阴两虚型慢性萎缩性胃炎的疗效观察.辽宁中医杂志,2006,33(11):1437-1438.
[13]陈欣童,蒋红玉,陈李华,李小球,匡忠生,谢宇辉,方永奇.胃炎康加维酶素对胃癌前病变的作用及其机理研究.中医药学刊,2004,22(9):1703-1704.
[14]刘重阳,陈东风,王军,彭安国.猴头菌提取物颗粒治疗慢性萎缩性胃炎30例.中国临床保健杂志,2007,10(3):290-291.
[15]曹志群.芪莲舒痞颗粒治疗慢性萎缩性胃炎癌前病变61例.山东中医药大学学报,2003,27(5):346-347.
[16]杨幼新,袁红霞,杨曼,代二庆,赵强.善胃方对气阴两虚型萎缩性胃炎癌前病变患者p16的影响.天津中医学院学报,2006,25(1):15-17.
[17]李宪禄,苗华军.胃得安与猴菇片治疗慢性萎缩性胃炎的比较.泰山医学院学报,2001,22(3):242-243.
[18]覃业姣.健胃汤治疗慢性萎缩性胃炎53例临床观察.广西医学,1997,19(2):300-301.
[19]罗宪津.养胃汤治疗慢性萎缩性胃炎.天津中医,2000,17(5):15-16.
[20]高望望,朱振华.萎胃消合剂治疗萎缩性胃炎癌前病变.现代实用医学,2003,15(8):503.
[21]赵红,周学锋.胃复春治疗慢性萎缩性胃炎癌前病变144例.临床药学,2004,13(8):70-71.
[22]莫天栩.益气养阴化瘀汤治疗慢性萎缩性胃炎癌前病变临床观察.中国中医急症,2005,14(6):523-524.
[23]李景巍.参苓蚤休汤为主治疗慢性萎缩性胃炎68例.中医杂志,2007,48(10):909-910.
[24]余道兵.当归补血口服液对慢性萎缩性胃炎伴型增生的逆转治疗(附50例临床分析).咸宁学院学报(医学版),2005,19(2):113-114.
[25]李恺.健脾泻胃汤治疗慢性萎缩性胃炎60例.陕西中医学院学报,2007,30(4):21-22.
[26]李兴锋.建中调胃汤治疗慢性萎缩性胃炎60例.中医研究,2003,16(6):30-31.
[27]胡蔚.健脾和胃法治疗脾胃虚弱型慢性萎缩性胃炎疗效观察.河北中医,2007,29(11):983-984.
[28]陈之光,张梅芬.中西医结合治疗慢性萎缩性胃炎68例疗效观察.浙江中医学院学报,2000,24(4):28.
[29]杨大昭.中西医结合治疗慢性萎缩性胃炎胃癌前期病变48例.中国中西医结合消化杂志,2003,11(4):236-237.
[30]郑镇雄.加味一贯煎治疗慢性萎缩性胃炎35例.湖北中医杂志,2000, 22(2):36.
[31]韩守信.消萎散治疗慢性萎缩性胃炎126例临床观察.河北中医,2006,28(9):667.
[32]卓玉珍,袁红霞,袁红梅,王学.善胃系列方治疗胃癌前病变的相关基因蛋白表达试验研究.天津中医学院学报,2006,25(1)18-21.
[33]中华医学会消化病学分会.中国慢性胃炎共识意见(2006,上海).中华消化杂志,2007,27(1):45-49.
[34]米庆海.影响萎缩性胃炎中医疗效的因素探讨.中国民间疗法,2008,(1):6
[1]董建华(唐旭东整理).对治疗慢性萎缩性胃炎的看法.中国医药学报,1993,8(2):57-60.
[2]罗珠林.胃脘痛与瘀血的临床研究.实用中西医结合杂志,1991,4(5):302.
[3]潘秀珍,林才经,等.慢性胃病的血液流变学研究.中华消化杂志.1984:4(4):260.
[4]戴晓玲,张庚良,海滨,滕玲,程丽娜.从血液流变学探讨萎缩性胃炎的血瘀改变.辽宁中医杂志,1994,21(1):10-11.
[5]张玉,林庚金,金惠铭,钱睿哲,张国平.慢性萎缩性胃炎胃粘膜血流量的研究.中华消化内镜杂志,1997,14(2):101-102.
[6]葛文松,刘杰民,安祯祥,王 敏.中医药对逆转慢性萎缩性胃炎病理变化的探讨.四川中医,2004,22(1):19-20.
[7]危北海.慢性胃炎诊治.中西医结合杂志,1990,10(5):265.
[8]樊群.活血化瘀是治疗胃癌前病变的关键环节.中国中医基础医学杂志,1997,3(5):52-53.
[9]唐旭东.慢性萎缩性胃炎血淤病机及治疗方法探讨.中医杂志,1998,(11):687.