胃黏膜异型增生证候演变及肿瘤标志物水平两年跟踪研究  

A two-year follow-up study on gastric mucosal dysplasia syndrome evolution and the relationship between it and the level of tumor markers

作　　者：沈舒文[1] 宇文亚[2] 赵运[1] 惠建萍[1] 陈丽英[3] 王捷虹[4] 牛阳[5] 彭宁[6] 刘梅君[7] 

机构地区：[1]陕西中医学院中医临床学院,咸阳712046 [2]中国中医科学院,北京100700 [3]商洛市中心医院,商洛726000 [4]陕西中医学院附属医院,咸阳712000 [5]宁夏医学院中医学院,银川750000 [6]陕西省人民医院,西安710000 [7]延安市人民医院,延安716000

出　　处：《中华中医药杂志》2010年第1期38-42,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目资助(No.30572383)~~

摘　　要：目的:从中医证候层面探讨胃黏膜异型增生的演变规律及不同证型的癌变趋向。方法:多中心临床协作,采集324例胃黏膜异型增生(Dys)虚实关联证患者,设5个时位观察窗进行为期2年的临床跟踪研究,并同步检测肿瘤标志物肿瘤相关物质(TSGF)、癌胚抗原(CEA)。结果:0.5-2年,Dys消失率为28%;跟踪6个典型证候2年演变平均转为虚实关联证为56%;5个时位观察窗上的证候结构类型演化走势与首诊证型结构类型分布无显著差异(P>0.05),其演化规律与病性寒热及体质阴阳盛衰有关。肿瘤标志物检测水平值最高的证型是:湿热蕴胃并/兼脾胃虚寒证TSGF值为(59.5±2.0)U/L,CEA值为(12.8±4.5)μg/L;胃络瘀血并/兼气阴两虚TSGF值为(59.2±5.4)U/L,CEA值为(14.4±2.4)μg/L。结论:Dys证候以本虚标实、虚实关联证居多,证候结构类型动态演化与首诊类型分布基本相似。证候层面显示:湿热蕴胃并/兼脾胃虚寒证、胃络瘀血并/兼气阴两虚证可能最具癌变趋向。Objective ：To explore the evolution law of Gastric mucosal dysplasia syndrome and to judge the degree of cancerous trends of its different types of syndrome. Methods： With multi-center clinical collaboration, 324 cases with deficiencyexcess correlation syndrome of Dys were selected to receive follow-up study with five-bit observation windows for two years, and the values of TSGF and CEA were tested simultaneously. Results： The disappearance rate of Dys was 28% from six months to two years, The average rate of the syndrome change to deficiency-excess correlation syndrome accounted for 56% according to six typical syndromes＇ tracking for two years. There were no significant differences among the first syndrome-types of Dys and other syndrome-types （P〉0.05）, the evolution law was related to cold or heat of disease nature, and exuberance and decline of yin and yang of constitution. The highest values of TSGF and CEA of syndrome of accumulation of damp-heat in stomach and deficiency cold of spleen were （59.5±2.0） U/L, （12.8±4.5） pg/L respectively, and of stagnation of blood in stomach collaterals combine/concurrence with deficiency of both qi and yin syndrome were （59.2±5.4） U/L, （14.4±2.4） μg/L. Conclusion： A majority of Dys syndrome were asthenia in origin and asthenia in superficiality and deficiency-excess correlation syndrome, the distribution of dynamic evolution of syndrome-types was similar to the first diagnosis. The study showed that the syndrome of damp-heat in stomach and deficiency cold of spleen and the syndrome of stagnation of blood in stomach collaterals combine/concurrence with deficiency of both qi and yin had the highest rate of canceration than other syndromes.

关 键 词：胃黏膜异型增生 虚实关联证 证候演变 TSGF CEA 临床研究 

分 类 号：R259[医药卫生—中西医结合]