结直肠腺瘤性息肉中医证型与病理类型和粪便多配体聚糖2基因甲基化的相关性  

Correlation between TCM syndrome types,pathological types and fecal SDC2 gene methylation in colorectal adenomatous polyps

作　　者：张强[1] 王再见 李会霞 李彤 雷雪 曲冬梅[3] ZHANG Qiang;WANG Zaijian;LI Huixia;LI Tong;LEI Xue;QU Dongmei(Beijing University of Chinese Medicine,Beijing 100020,China)

机构地区：[1]北京中医药大学,100020 [2]北京中医药大学第三附属医院脾胃病科 [3]山东省荣成市人民医院多功能室

出　　处：《环球中医药》2022年第4期583-590,共8页Global Traditional Chinese Medicine

基　　金：北京中医药大学基本科研业务费青年教师项目(2018-JYBZZ-JS163);国家重点研发计划(2019YFC1710405)。

摘　　要：目的探讨结直肠腺瘤性息肉(adenomatous polyps,APs)中医临床各证型与病理类型及多配体聚糖2(syndecan-2,SDC2)基因甲基化的相关性。方法选取符合纳入标准的310例APs患者为研究对象,按中医证型分为大肠湿热、湿瘀阻滞、脾虚湿蕴和气滞血瘀4组,并以75名健康体检者为正常对照组,记录每个中医证型患者的年龄、性别、中医四诊信息及腺瘤的数量、大小、组织学类型和上皮内瘤变等信息,采用磁珠捕获、亚硫酸盐处理和荧光定量聚合酶链式反应(polymerase chain reaction,PCR)等方法检测各组粪便SDC2基因甲基化情况,并分析APs中医证型与组织学类型、上皮内瘤变和粪便SDC2基因甲基化的相关性。结果(1)APs各证型在组织学类型和上皮内瘤变程度方面均有统计学差异(P<0.05),其中大肠湿热组管状腺瘤占比高于气滞血瘀组(P<0.05),湿瘀阻滞组绒毛状腺瘤和高级别上皮内瘤变占比高于大肠湿热组和脾虚湿蕴组(P<0.01,P<0.05),气滞血瘀组管状绒毛状腺瘤和绒毛状腺瘤合计占比高于大肠湿热组和脾虚湿蕴组(P<0.05)。(2)310例APs患者粪便SDC2基因甲基化阳性率为56.77%,管状腺瘤、管状绒毛状腺瘤和绒毛状腺瘤的粪便SDC2基因甲基化阳性率无显著差异(P>0.05),高级别上皮内瘤变粪便SDC2基因甲基化阳性率高于低级别上皮内瘤变(P<0.01)。(3)APs各证型SDC2甲基化阳性率大小依次为湿瘀阻滞组(65.79%)>气滞血瘀组(64.00%)>大肠湿热组(51.28%)>脾虚湿蕴组(46.91%),湿瘀阻滞组和气滞血瘀组粪便SDC2基因甲基化阳性率均明显高于脾虚湿蕴组(P<0.05)。(4)Spearman相关性分析表明,湿瘀阻滞证与绒毛状腺瘤、高级别上皮内瘤变呈正相关(P<0.05,P<0.01),与低级别上皮内瘤变呈负相关(P<0.01)。脾虚湿蕴证与粪便SDC2基因甲基化阳性呈负相关(P<0.05)。气滞血瘀证与管状腺瘤呈负相关(P<0.05)。结论临床病理类型和粪便SDC2基因甲基化与中�Objective To explore the correlation between TCM clinical syndrome types,pathological types and Syndecan-2(SDC2)gene methylation of colorectal adenomatous polyps(APs).Methods 310 APs patients who met the inclusion criteria were selected as the research objects,and divided into four groups according to TCM syndrome types:large intestine damp heat,dampness and blood stasis block,spleen deficiency and dampness accumulation and Qi stagnation and blood stasis.75 healthy subjects were taken as the normal control group.The information of age,sex,four diagnostics about TCM,the number,size,histological type and intraepithelial neoplasia of adenomas were recorded.The methylation of SDC2 gene in feces of each group was detected by magnetic-bead method,sulfite treatment and fluorescent quantitative polymerase chain reaction(PCR).The statistical data was collected,and the correlation between TCM syndrome types of APs and histological types,intraepithelial neoplasia and fecal SDC2 gene methylation was analyzed.Results(1)There were significant differences in histological types and degree of intraepithelial neoplasia among APs syndrome types(P<0.05).The proportion of tubular adenoma in large intestine damp heat group was higher than that in the Qi stagnation and blood stasis group(P<0.05),and the proportion of villous adenoma and high-grade intraepithelial neoplasia in the damp blood stasis block group was higher than that in the large intestine damp heat group and spleen deficiency and the dampness accumulation group(P<0.01,P<0.05).The total proportion of tubular villous adenoma and villous adenoma in Qi stagnation and blood stasis group was higher than that in the large intestine damp heat group and spleen deficiency damp accumulation group(P<0.05).(2)The positive rate of fecal SDC2 methylation in 310 patients with APs was 56.77%.There was no significant difference among tubular adenoma,tubular villous adenoma and villous adenoma(P>0.05).The positive rate of fecal SDC2 methylation in high-grade intraepithelial neoplasia was hi

关 键 词：结直肠腺瘤性息肉 中医证型 SDC2基因甲基化 绒毛状腺瘤 上皮内瘤变 

分 类 号：R259[医药卫生—中西医结合]