中医微观辨证法分析慢性萎缩性胃炎胃黏膜组织发生癌变的风险  

Analysis of the risk of canceration of gastric mucosa in patients with chronic atrophic gastritis by microscopic dialectics of TCM

作　　者：赵长普 尹金磊[2] 党中勤 李波 王红霞 席玉红 许戈林[3] ZHAO Changpu1, YIN Jinlei2, DANG Zhongqin1, LI Bo1, WANG Hongxia1, XI Yuhong1, XU Gelin3 [1. Henan Traditional Chinese Medicine Hospital(the Second Affiliated Hospital of Henan University of traditional Chinese Medicine） liver and stomach, 450002 ; 2. Department of pharmacy, Nanyang Central Hospital, Henan, Nanyang 473000, Henan, China; 3. Department of Gastroenterology, the Third Affiliated Hospital of Henan University of traditional Chinese medicine, 450008)

机构地区：[1]河南省中医院河南中医药大学第二附属医院肝胆脾胃科,450002 [2]南阳市中心医院药剂科,河南南阳473000 [3]河南中医药大学第三附属医院消化内科,450008

出　　处：《中华中医药学刊》2018年第5期1181-1183,共3页Chinese Archives of Traditional Chinese Medicine

基　　金：河南省科技攻关计划项目(152102310036)

摘　　要：目的：采用中医微观辨证法分析慢性萎缩性胃炎患者的胃黏膜组织发生癌变的风险。方法：回顾性分析2015年2月—2017年2月在医院接受治疗的慢性萎缩性胃炎患者的临床资料,观察不同中医微观辨证证型分布规律,比较不同证型萎缩性胃炎患者肠上皮化生率、上皮瘤变率和Ki67阳性表达率的差异。结果：100例慢性萎缩性胃炎中,肝郁气滞型占14.0%、肝胃郁热型占13.0%、脾胃湿热型占9.0%、胃络瘀阻型占15.0%、脾胃虚寒型占17.0%、胃阴不足型占32.0%;不同证型萎缩性胃炎患者肠上皮化生率最高者为脾胃湿热型（88.9%）、其次为肝郁气滞型（85.7%）,最低为胃阴不足型（40.6%）,脾胃湿热型、肝郁气滞型与胃阴不足型间比较差异有统计学意义;不同证型萎缩性胃炎患者上皮瘤变率最高为肝郁气滞型（71.4%）、其次为脾胃湿热型（66.7%）,最低为胃阴不足型（25.0%）,肝郁气滞型、脾胃湿热型与胃阴不足型间比较差异有统计学意义;不同证型萎缩性胃炎患者Ki67阳性表达率最高者为肝郁气滞型（78.6%）、其次为脾胃湿热型（77.8%）,最低者为胃阴不足型,肝郁气滞型、脾胃湿热型与胃阴不足型间比较差异有统计学意义。结论：脾胃湿热型、肝郁气滞型慢性萎缩性胃炎患者的肠上皮化生率和上皮瘤变率均高于其他证型,可作为临床指导的重要指标。Objective： To analyze the risk of canceration of gastric mucosa tissue in patients with chronic atrophic gastritis by the microscopic dialectics of tcm. Methods： Retrospective analysis of clinical data of patients with chronic atrophic gastritis in February 2015 to February 2017 in our hospital,to observe the different TCM microcosmic syndrome type distribution,comparison of different syndromes of atrophic gastritis patients were intestinal metaplasia rate,epithelial neoplasia rate and Ki67 positive expression rate. Results： 100 cases of chronic atrophic gastritis,liver qi stagnation type accounted for 14%,liver stomach heat type accounted for 13%,accounting for 9%,the stomach spleen type and blood stasis type accounted for 15%,accounting for 17% of spleen and stomach and stomach yin deficiency type accounted for32%; Different syndromes in patients with atrophic gastritis intestinal metaplasia rate was the highest in spleen type（88. 9%）,followed by stagnation of liver qi stagnation（85. 7%）,the lowest for stomach yin deficiency type（40. 6%）,there was statistical significance of spleen stomach damp heat type,qi stagnation and stomach yin deficiency type differences; Different syndromes in patients with atrophic gastritis intraepithelial neoplasia is the highest rate of liver qi stagnation（71. 4%）,followed by spleen type（66. 7%）,the lowest for stomach yin deficiency type（25%）,there was statistical significance of liver qi stagnation,spleen and stomach yin deficiency type differences; Different types of atrophic gastritis patients Ki67 positive expression rate was the highest in liver qi stagnation（78. 6%）,followed by spleen type（77. 8%）,the lowest was stomach yin deficiency,significant liver qi stagnation,spleen type and stomach yin deficiency type differences. Conclusion： The spleen type,liver qi stagnation type chronic atrophic gastritis with intestinal metaplasia and epithelial neoplasia were higher than the other syndromes,as an important index for clinical guidance.

关 键 词：辨证 萎缩性胃炎 黏膜 癌变 

分 类 号：R573.32[医药卫生—消化系统]