健胃消痞汤对胃癌前病变患者转归的影响与机制作用  

Effect and Mechanism of Jianwei Xiaopi Decoction on Disease Prognosis and Development of Patients with Precancerous Lesion of Gastric Cancer

作　　者：周亮[1] 邓丽娅[2] 郭凌飞[3] 李金存 ZHOU Liang;DENG Li-ya;GUO Ling-fei;LI Jin-cun(Provincial Hospital Affiliated to Shandong University, Ji＇nan 250021, China;The Second Hospital People＇s Hospital, Ji＇nan 250022, China;Shandong Medical Imaging Research Institute, Ji＇nan 250021, China;West Hospital of Shangdong Province-owned Hospital, Ji＇nan 250022, China)

机构地区：[1]山东大学附属省立医院,济南250021 [2]济南市第二人民医院,济南250022 [3]山东省医学影像研究所,济南250021 [4]山东省立医院西院,济南250022

出　　处：《中国实验方剂学杂志》2018年第10期206-211,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：山东省科学技术研究计划项目(2015JQ4014G)

摘　　要：目的：观察健胃消痞汤治疗胃癌前病变（PLGC）的临床疗效及对胃泌素17,血清胃蛋白酶原、炎症因子水平和胃黏膜组织环氧合酶-2（COX-2）蛋白表达的影响。方法：将140例符合患者,以SAS软件生成的,随机按数字表法分为对照组和观察组各70例。两组患者均给予导入期治疗,包括给予抑酸、黏膜保护剂、促动力剂、助消化药等对症处理;导入期结束后给予叶酸片,10 mg/次,3次/d,饭前15 min服用。对照组服用温胃舒胶囊,3粒/次,3次/d。观察组采用健胃消痞汤,每天1剂,两组疗程均为连续治疗4个月。两组患者临床进行治疗前后主要症状评分,检查两组患者治疗前后胃镜和胃黏膜组织病理变化,检测治疗前后胃泌素17（G17）,血清胃蛋白酶原（PGⅠ和PGⅡ）,白细胞介素-1β（IL-1β）,肿瘤坏死因子-α（TNF-α）,干扰素-γ（IFN-γ）水平和COX-2蛋白表达。结果：两组患者治疗后各项指标均有降低;观察组临床疗效总有效率为91.04%,高于对照组的76.92%（χ^2=4.919,P〈0.05）;治疗后观察组胃镜下黏膜病变积分低于对照组（P〈0.01）;观察组治疗后上腹疼痛、饱胀、痞闷、嗳气、纳差评分均低于对照组（P〈0.01）;治疗后观察组黏膜炎症、腺体减少/萎缩和肠上皮化生评分均低于对照组（P〈0.01）,COX-2蛋白阳性表达低于对照组（P〈0.01）;治疗后观察组患者清G17,PGⅠ水平均高于对照组（P〈0.01）,PGⅠ/PGⅡ也高于对照组（P〈0.01）;治疗后观察组患者IL-1β和TNF-α水平均低于对照组,IFN-γ水平高于对照组（P〈0.01）。结论：健胃消痞汤能减轻PLGC临床症状和萎缩程度,对肠上皮化生（IM）,异型增生（Dys）有一定的阻断或逆转作用;并能提高G17,PGⅠ水平和PGⅠ/PGⅡ比值,抑制COX-2蛋白表达,调节IL-1β,TNF-α,IFN-γ炎症因子水平。Objective：To observe the clinical efficacy of Jianwei Xiaopi decoction on precancerous lesion of gastric cancer（PLGC） and its effect on levels of gastrin 17,serum pepsinogen,inflammatory factors,and expression of cyclooxygenase in gastric mucosa-2（COX-2）.Method：One hundred and forty patients were randomly divided into control group and observation group by random number table.Both groups＇ patients got the introduction-stage treatment,including acid suppression,mucosal protective agent,accelerator and digestant.After the introduction stage,folic acid tablets were given 15 min before dinner,10 mg/time,3 times/days.Patients in control group got Wenweishu capsule,3 capsules/time,3 times/day.And Jianwei Xiaopi decoction was given to patients in observation,2 times/dose,1 dose/day.A course of treatment was 4 months.Before and after treatment,main symptoms were scored,gastroscopic and pathological changes of gastric mucosa were detected,and levels of gastrin 17（G17）,serum pepsinogen（PGⅠand PGⅡ）,interleukin-1β（IL-1β）,tumor necrosis factor-α（TNF-α）,interferon-γ（IFN-γ） and expression of COX-2 were measured.Result：The total effect rate in observation group was 91.04%,which was higher than 76.92% in control group（χ~2= 4.919,P〈0.05）.After treatment,score of mucosal lesions detected by gastroscope in observation group was lower than that in control group（P〈0.01）.Scores of upper abdominal pain,fullness,blocks and chest pressure,belching and poor appetite in observation group were all lower than those in control group（P〈0.01）.Scores of mucosal inflammation,glandular reduction or atrophy and intestinal metaplasia in observation group were all lower than those in control group（P〈0.01）.And positive expression of COX-2 in observation group was weaker than that in control group（P〈0.01）.And G17,PGⅠ and PGⅠ/PGⅡ and IFN-γ in observation group were higher than those in control group（P〈0.01）.After treatment,IL-1β and TNF-α in observation group were

关 键 词：胃癌前病变 健胃消痞汤 胃泌素17 胃蛋白酶原 环氧合酶-2 炎症因子 

分 类 号：R24[医药卫生—中医临床基础] R289[医药卫生—中医学]