益气活血法对慢性萎缩性胃炎癌前病变Ki-67和肿瘤标记物的影响  

Effect of Therapy of Replenishing Qi and Activating Blood on Ki-67 and Tumor Markers in Precancerous Lesions of Chronic Atrophic Gastritis

作　　者：于勇 黄雅慧 赵唯含 王玥 刘超 张鹏 陈瑶 YU Yong;HUANG Ya-Hui;ZHAO Wei-Han;WANG Yue;LIU Chao;ZHANG Peng;CHEN Yao(Dept.of Spleen and Stomach,Xi'an Hospital of Traditional Chinese Medicine,Xi'an 710021 Shaanxi,China;Dept.of Digestive Medicine,Affiliated Hospital of Shanxi University of Chinese Medicine,Xianyang 712000 Shaanxi,China;Xi'an Chang'an District Hospital,Xi'an 710100 Shaanxi,China)

机构地区：[1]西安市中医医院脾胃病科,陕西西安710021 [2]陕西中医药大学附属医院消化内科,陕西咸阳712000 [3]西安市长安区医院,陕西西安710100

出　　处：《广州中医药大学学报》2023年第2期329-335,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：陕西省自然科学基础研究计划项目(编号:2018JQ8009);第六批全国老中医药专家学术经验继承工作项目(国中医药人教发[2017]29号)。

摘　　要：【目的】观察益气活血法治疗慢性萎缩性胃炎癌前病变患者的临床疗效及其对增殖相关抗原Ki-67蛋白和肿瘤标记物的影响。【方法】将74例慢性萎缩性胃炎癌前病变胃络瘀阻证患者随机分为对照组和观察组,每组各37例。对照组给予常规西药治疗,观察组在对照组基础上给予益气活血方(由党参、丹参、当归、姜半夏、半枝莲、红花等中药组成)治疗,疗程为1个月。观察2组患者的中医证候评分、病理学评分、Ki-67蛋白表达和胃黏膜转化生长因子α(TGF-α)活性、肿瘤标记物水平的变化情况,并评价2组患者的临床疗效及安全性。【结果】(1)治疗1个月后,观察组的总有效率为94.59%(35/37),对照组为83.78%(31/37);组间比较,观察组的疗效优于对照组(P<0.05)。(2)治疗后,2组患者的各项中医证候评分(包括胃痛、纳差、嗳气、乏力、口苦)、各项胃黏膜病理学评分(包括萎缩、肠上皮化生及异型增生)均较治疗前降低(P<0.05),且观察组的降低作用均明显优于对照组(P<0.05)。(3)治疗后,2组患者的增殖相关抗原Ki-67蛋白表达及TGF-α活性均较治疗前明显降低(P<0.05),且观察组的降低作用明显优于对照组(P<0.05)。(4)治疗后,2组患者的癌胚抗原(CEA)、甲胎蛋白(AFP)、肿瘤相关糖链抗原125(CA125)水平均较治疗前降低(P<0.05),且观察组的降低作用均明显优于对照组(P<0.05)。(5)观察组的不良反应为5.41%(2/37),与对照组的8.11%(3/37)比较,差异无统计学意义(P>0.05)。【结论】益气活血法治疗慢性萎缩性胃炎癌前病变疗效确切,可有效减轻患者临床症状和病理学评分,抑制增殖相关抗原Ki-67蛋白表达,降低癌变TGF-α增殖活性,促进胃黏膜修复,降低肿瘤标志物水平,且不良反应少,具有重要的临床应用价值。Objective To investigate the clinical efficacy of therapy of replenishing qi and activating blood(Yiqi Huoxue method)in treating patients with precancerous lesions of chronic atrophic gastritis(CAG),and to observe its effect on proliferation-related antigen Ki-67 protein and tumor markers. Methods Seventy-four patients with precancerous lesions of CAG differentiated as blood stasis blocking stomach collateral syndrome were randomly divided into the control group and the observation group,with 37 patients in each group. The control group was given conventional treatment with western medicine,while the observation group was treated with the Yiqi Huoxue Prescription(composed of Codonopsis Radix,Salviae Miltiorrhizae Radix et Rhizoma,Angelicae Sinensis Radix,Pinelliae Rhizoma Praeparatum Cum Zingibere et Alumine,Scutellariae Barbatae Herba,Carthami Flos,etc.)on the basis of treatment for the control group. The course of treatment covered a period of one month. The changes in the traditional Chinese medicine(TCM)syndrome scores,pathological scores,Ki-67 protein expression level and gastric mucosal transforming growth factor α(TGF-α)activity and tumor marker levels were observed in the two groups. Furthermore,the clinical efficacy and safety in the two groups were evaluated. Results (1)After one month of treatment,the overall effective rate of the observation group was 94.59%(35/37)and that of the control group was 83.78%(31/37). The intergroup comparison showed that the efficacy of the observation group was superior to that of the control group(P<0.05).(2)After treatment,the scores of all of TCM symptoms including stomachache,poor appetite,belching,fatigue and bitter mouth,and the scores of gastric mucosal pathology including atrophy,intestinal epithelial metaplasia and heterogeneous hyperplasia in the two groups were decreased compared with those before treatment(P<0.05),and the effect on decreasing the scores in the observation group was significantly superior to that in the control group(P<0.05).(3)After treatmen

关 键 词：益气活血法 慢性萎缩性胃炎 癌前病变 胃络瘀阻证 增殖相关抗原Ki-67蛋白 转化生长因子α(TGF-α) 肿瘤标记物 

分 类 号：R259.733[医药卫生—中西医结合]