慢性萎缩性胃炎到早期胃癌的“炎-癌”中医证候演变特点研究  

Study on the evolution of traditional Chinese medicine syndrome of"inflammation-related carcinogenesis":from chronic atrophic gastritis to early gastric cancer

作　　者：黄亚芳 贺舜[3] 姚玉璞[2] 刘福生[4] 陈润花[2] HUANG Yafang;HE Shun;YAO Yupu;LIU Fusheng;CHEN Runhua(Beijing University of Chinese Medicine,Beijing,100029,China;Department of Spleen,Stomach and Hepatobiliary,Dongfang Hospital,Beijing University of Chinese Medicine;Department of Endoscopy,Cancer Hospital,Chinese Academy of Medical Sciences;Department of Emergency,Dongfang Hospital,Beijing University of Chinese Medicine)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学东方医院脾胃肝胆科 [3]中国医学科学院肿瘤医院内镜科 [4]北京中医药大学东方医院急诊科

出　　处：《中国中西医结合消化杂志》2024年第11期1001-1005,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：国家自然科学基金青年基金(No:81903792);北京中医药大学揭榜挂帅项目基金(No:2023-JYB-JBQN-015);北京中医药大学校级科研纵向发展基金(No:2021-ZXFZJJ-035)。

摘　　要：目的研究慢性萎缩性胃炎(chronic atrophic gastritis,CAG)到萎缩背景下的早期胃癌(early gastric cancer,EGC)的中医证候演变规律。方法前瞻性横断面分析300例CAG和100例萎缩背景下的EGC患者的资料,根据幽门螺杆菌(Helicobacter pylori,HP)感染情况分为HP(+)CAG组、HP(-)CAG组、HP(+)EGC组、HP(-)EGC组,采用χ^(2)检验得出CAG到EGC的中医证候演变规律。结果涉及CAG和EGC有3个病位要素:肝、脾、胃;7个病性要素:气虚、气滞、痰湿、热、阴虚、阳虚、瘀血;5个基本证型:脾胃虚弱证、脾胃湿热证、胃阴不足证、胃络瘀阻证、肝胃不和证。经χ^(2)检验,气虚、阴虚、瘀血与EGC的相关性较高,气滞、痰湿、热、阳虚与CAG的相关性较高,对CAG而言,其病性要素相关性大小为:痰湿>热>气滞>气虚,阴虚>阳虚,气滞>瘀血>阳虚;EGC则刚好相反。在HP(+)条件下,CAG的病性要素相关性则为痰湿>热>气虚,气滞>阴虚>阳虚,痰湿>热>瘀血>阳虚;EGC则刚好相反。经χ^(2)检验,脾胃虚弱证、胃阴不足证、胃络瘀阻证与EGC的相关性较高,肝胃不和证、脾胃湿热证与CAG的相关性较高;对于CAG而言,其证型相关性大小为:肝胃不和证>脾胃湿热证>脾胃虚弱证,脾胃湿热证>胃络瘀阻证>胃阴不足证;EGC则刚好相反。在HP(+)条件下则为脾胃湿热证>脾胃虚弱证,肝胃不和证>胃阴不足证,脾胃湿热证>胃络瘀阻证>胃阴不足证;EGC则正好相反;HP(-)条件下为肝胃不和证>脾胃虚弱证,肝胃不和证>胃络瘀阻证>胃阴不足证;EGC则刚好相反。结论CAG阶段偏向于邪实,EGC阶段偏向于正虚;CAG阶段的邪实主要是痰湿、热、气滞,而EGC阶段的邪实主要是瘀血;CAG阶段的正虚是以阴虚为主,而EGC阶段的正虚以阳虚为主。随着疾病进展,EGC的瘀血程度比CAG更高,热毒不断侵扰,阴虚程度逐渐加重;在两个不同阶段,HP感染对证素、证型的影响有所差别。Objective To study the evolution of traditional Chinese medicine(TCM)syndromes from chronic atrophic gastritis(CAG)to early gastric cancer(EGC)in atrophic background.Methods The clinical data of 300 patients with chronic atrophic gastritis and 100 patients with early gastric cancer under the background of atrophy were prospectively analyzed.According to Helicobacter pylori(HP),the patients were divided into HP(+)CAG group,HP(-)CAG group,HP(+)EGC group and HP(-)EGC group.The evolution of TCM syndrome from CAG to EGC was compared by χ^(2) test.Results There were three sites involved in CAG and EGC:liver,spleen and stomach.Seven pathogenic factors:Qi deficiency,Qi stagnation,phlegm dampness,heat,Yin deficiency,Yang deficiency,and blood stasis.There are five basic syndromes:spleen and stomach weakness spleen and stomach dampness-heat,deficiency of stomach and Yin,stomach and collateral stasis of blood,and disconcerting of liver and stomach.By χ^(2) test,"Qi deficiency","Yang deficiency"and"blood stasis"are highly correlated with EGC,while"Qi stagnation","phlegm-dampness","heat"and"Yin deficiency"are highly correlated with CAG.For CAG,the correlation of syndrome elements is as follows:phlegm-dampness>heat>Qi stagnation>Qi deficiency.Yin deficiency>Yang deficiency,Qi stagnation>blood stasis>Yang deficiency;EGC is the opposite.Under HP(+)condition,phlegm-dampness>heat>Qi deficiency;Qi stagnation>Yin deficiency>Yang deficiency,phlegm-dampness>heat>blood stasis>Yang deficiency,EGC is the opposite.By χ^(2) test,the syndrome of spleen and stomach weakness,deficiency of stomach Yin,stomach collateral stasis and EGC were highly correlated,while the syndrome of disharmony between liver and stomach,spleen and stomach dampness-heat and CAG were highly correlated.For CAG,the correlation of syndrome types was as follows:disharmony between liver and stomach>spleen and stomach dampness-heat>spleen and stomach weakness.Spleen and stomach dampness-heat syndrome>stomach collateral stasis syndrome>stomach Yin deficiency syndrome,EGC

关 键 词：慢性萎缩性胃炎 早期胃癌 幽门螺杆菌 证候演变 

分 类 号：R256.3[医药卫生—中医内科学]