芪竹健胃方治疗慢性萎缩性胃炎及癌前病变临床研究  

Clinical Study on the Treatment of Chronic Atrophic Gastritis and Precancerous Lesions with Qizhu Jianwei Formula

作　　者：左巧云 傅雨娴 王倩倩 叶涛 郭涵卿 查天悦 徐陆周[3] ZUO Qiaoyun;FU Yuxian;WANG Qianqian;YE Tao;GUO Hanqing;ZHA Tianyue;XU Luzhou(Bengbu Traditional Chinese Medicine Hospital,Anhui Bengbu 233020,China;Nanjing University of Chinese Medicine,Nanjing 210029,China;Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)

机构地区：[1]蚌埠市中医医院,安徽蚌埠233020 [2]南京中医药大学,江苏南京210029 [3]南京中医药大学附属医院,江苏南京210029

出　　处：《现代中医药》2024年第6期69-75,共7页Modern Chinese Medicine

基　　金：第五批全国中医临床优秀人才研修项目(国中医药人教函〔2022〕1号)(2022FTJ12-6);江苏省中医消化病医学创新中心项目(CXZX202208)。

摘　　要：目的研究芪竹健胃方治疗脾虚湿热血瘀型慢性萎缩性胃炎及癌前病变的临床疗效,并探讨该方药的作用机制。方法采用自身前后对照研究方法,纳入符合中西医诊断标准的患者31例作为治疗组,予芪竹健胃方中药汤剂进行治疗,疗程12 w,对比治疗前后中医症状疗效、胃镜征象、粘膜病理、癌变风险,血清胃功能三项的变化。另外,用蛋白免疫印迹法检测20例治疗组患者治疗前、治疗后胃粘膜Lgr5、Wnt1、C-myc蛋白表达情况,进行对比分析,对该方的作用机制开展探索性研究。结果治疗12 w后,治疗组患者的中医证候评分、胃镜病理改善情况具有统计学意义(P<0.01),降低癌变风险,血清G17、PGⅠ值升高,有统计学差异(P<0.01),PGR有升高趋势,且具有统计学差异(P<0.05);PGⅡ方面,结果不具统计学差异(P>0.05)。20例治疗组患者治疗前后胃粘膜Lgr5、Wnt1、C-myc蛋白表达情况皆呈逐渐下降的趋势。结论芪竹健胃方能明显改善慢性萎缩性胃炎及胃癌前病变患者的中医证候,促进胃黏膜的修复,降低癌变风险的机制可能与调控Wnt/Lgr5信号通路,抑制Lgr5标记的胃干细胞异常增殖分化有关。Objective To study the clinical efficacy of Qizhu Jianwei formula in treating chronic atrophic gastritis and precancerous lesions of spleen deficiency,dampness,blood stasis type,and explore the mechanism of action of this formula.Methods A self controlled study was conducted,including 31 patients who met the diagnostic criteria of traditional Chinese and Western medicine as the treatment group.They were treated with Qizhu Jianwei formula Chinese herbal decoction for 12 weeks.The changes in traditional Chinese medicine symptoms,gastroscopy signs,mucosal pathology,cancer risk,and serum gastric function were compared before and after treatment.In addition,protein immunoblotting was used to detect the expression of Lgr5,Wnt1,C-myc proteins in the gastric mucosa of 20 patients in the treatment group before and after treatment.Comparative analysis was conducted to explore the mechanism of action of this formula.Results After 12 weeks of treatment,the TCM syndrome score and improvement in gastroscopy pathology of the treatment group patients showed statistical significance(P<0.01),reducing the risk of cancer.The serum G17 and PGⅠvalues increased with statistical differences(P<0.01),and PGR showed an increasing trend with statistical differences(P<0.05);In terms of PGⅡ,there was no statistically significant difference in the results(P>0.05).The expression of Lgr5,Wnt1,and C-myc proteins in the gastric mucosa of 20 patients in the treatment group before and after treatment,showed a gradually decreasing trend in all three groups.Conclusion Qizhu Jianwei formula can significantly improve the traditional Chinese medicine syndrome of patients with CAG and precancerous lesions of gastric cancer,promote the repair of gastric mucosa,and reduce the risk of cancer.The mechanism may be related to regulating the Wnt/Lgr5 signaling pathway and inhibiting the abnormal proliferation and differentiation of Lgr5 labeled gastric stem cells.

关 键 词：慢性萎缩性胃炎 胃癌前病变 脾虚湿热血瘀证 芪竹健胃方 临床研究 LGR5 WNT/Β-CATENIN C-MYC 

分 类 号：R573.32[医药卫生—消化系统]