健脾祛瘀解毒方治疗慢性胃炎伴胃黏膜低级别上皮内瘤变的临床研究  

Clinical Study on the Treatment of Chronic Gastritis with Low-grade Intraepithelial Neoplasia of Gastric Mucosa by Jianpi Quyu Jiedu Capsules

作　　者：康宜兵[1,2] 吕永慧 吴宇金 丛龙玲 廖媛 杨洁 陈文剑 王学川 曾会萍 谢少玲 KANG Yibing;LYU Yonghui;WU Yujin;CONG Longling;LIAO Yuan;YANG Jie;CHEN Wenjian;WANG Xuechuan;ZENG Huiping;XIE Shaoling(Applicants Pursuing Doctoral Degree with Equivalent Qualifications in Guangzhou University of Chinese Medicine,Guangzhou 510006 Guangdong,China;Department of Spleen and Stomach,Affiliated Hospital of Traditional Chinese Medicine,Guangzhou Medical University,Guangzhou 510130 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510006 [2]广州医科大学附属中医医院脾胃科,广东广州510130

出　　处：《中药新药与临床药理》2022年第10期1428-1434,共7页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：广东省中医药局课题(20192069);广州市卫健委课题(20192A011006)。

摘　　要：目的 观察健脾祛瘀解毒方治疗慢性胃炎伴胃黏膜低级别上皮内瘤变(LGIN)的临床疗效及对胃黏膜肿瘤高危标志物的影响。方法 将116例患者随机分为对照组(58例)和观察组(58例)。对照组口服健脾祛瘀解毒胶囊模拟剂+叶酸片;观察组口服健脾祛瘀解毒胶囊+叶酸片模拟剂,疗程12周。进行治疗前后电子胃镜检查,对胃镜下黏膜征象进行评分,并进行胃黏膜病理组织学检查,对萎缩、肠化生、炎症和异型增生情况评分;进行治疗前后中医症状评分;检测治疗前后胃组织人表皮生长因子受体2(HER2)、增殖相关的核抗体(Ki67)、肿瘤蛋白53(P53)和α-甲酰基辅酶A消旋酶(P504s)蛋白;并进行疗效及安全性评价。结果 (1)治疗后,两组患者胃镜下黏膜征象(黏膜充血、水肿、糜烂、黏膜白相、颗粒增生、血管透见、胆汁反流)评分均降低(P<0.01),且观察组低于对照组(P<0.01)。(2)治疗后,两组患者萎缩、肠化生、炎症和异型增生评分均降低(P<0.05,P<0.01),且观察组低于对照组(P<0.01)。(3)治疗后,两组患者主要症状(胃脘胀满、胃痛、食少纳呆、早饱)评分和中医症状总分均降低(P<0.01),且观察组低于对照组(P<0.01)。(4)治疗后,观察组HER2表达减轻(P<0.05),且观察组轻于对照组(P<0.05);治疗后,两组Ki67表达均减少(P<0.05),且观察组少于对照组(P<0.05),治疗后,两组Ki67阳性率均降低(P<0.01),且观察组低于对照组(P<0.05);治疗后,观察组P53和P504s表达减少(P<0.05),且观察组少于对照组(P<0.05),观察组P53和P504s蛋白阳性率均降低(P<0.05),且观察组低于对照组(P<0.05)。(5)观察组临床疗效总有效率为94.23%(49/52),高于对照组的79.25%(42/53)(χ^(2)=5.101,P<0.05)。(6)治疗期间没有发现服用健脾祛瘀解毒胶囊相关的不良反应。结论 健脾祛瘀解毒方治疗慢性胃炎伴LGIN可抑制胃黏膜癌前病变进展,减轻临床症状和胃镜下黏膜征象,可逆转萎缩、肠化�Objective To observe the clinical efficacy of Jianpi Quyu Jiedu Capsules in the treatment of chronic gastritis with low-grade intraepithelial neoplasia(LGIN)of gastric mucosa and its influence on high-risk markers of gastric mucosal tumors. Methods The 116 patients were randomly divided into a control group(58 cases)and an observation group(58 cases). Patients in the control group received administration of Jianpi Quyu Jiedu Capsules simulation medicine and folic acid tablets. Patients in the observation group received administration of Jianpi Quyu Jiedu Capsules and folic acid tablets simulation drug. Courses of treatment continued 12 weeks. Electronic gastroscopy was performed before and after treatment and the mucosal signs were scored under the gastroscope.Besides, the gastric mucosal histopathological examination was carried out to score the atrophy, intestinal metaplasia,inflammation and dysplasia. The TCM symptom was also scored before and after treatment. Protein level detection of human epidermal growth factor receptor 2(HER2), proliferation-related nuclear antibodies(Ki67),tumor protein 53(P53) and α-formyl-CoA racemase(P504s) in gastric tissue was performed before and after treatment. A safety evaluation was conducted. Results(1)After treatment,the scores of mucosal signs(mucosal hyperemia,edema,erosion,mucosal white phase,granular hyperplasia,vascular permeability,bile reflux)under gastroscopy of the two groups of patients were reduced(P<0.01),of which the observation group were lower than those in the control group(P<0.01).(2)After treatment,the scores of atrophy,intestinal metaplasia,inflammation and dysplasia of the two groups of patients were reduced(P<0.05,P<0.01),and those of the observation group were lower than the control group(P<0.01).(3)After treatment,the scores of the main symptoms(gastric fullness,stomachache,poor appetite and early satiety)and the total scores of TCM symptoms in the two groups were reduced(P<0.01), while the data in observation group were lower than those in control gr

关 键 词：慢性胃炎 低级别胃黏膜上皮内瘤变 健脾祛瘀解毒方 人表皮生长因子受体2 增殖相关的核抗体 肿瘤蛋白53 Α-甲酰基辅酶A消旋酶 

分 类 号：R285.6[医药卫生—中药学]