摘要
目的观察慢性萎缩性胃炎患者胃黏膜中医微观辨证分型分布规律及癌前病变发生情况。方法170例慢性萎缩性胃炎患者进行无痛胃镜检查及共聚焦激光显微内镜检查,根据内镜下表现中医微观辨证分为胃阴不足型、胃络瘀阻型、脾胃虚寒型、脾胃湿热型、肝郁气滞型和肝胃郁热型。对腺体萎缩部位进行靶向活检判定肠上皮化生或上皮内瘤变,免疫组化法检查胃黏膜组织CD34及Ki67平均光密度,同时判定幽门螺杆菌(Hp)感染情况。结果慢性萎缩性胃炎中医微观辨证胃阴不足型54例、脾胃虚寒型28例、肝郁气滞型26例、胃络瘀阻型24例、肝胃郁热型22例、脾胃湿热型16例。中医微观辨证各证型间Hp感染率差异无统计学意义(P>0.05)。肝郁气滞型和脾胃湿热型的肠上皮化生率及上皮内瘤变率显著高于脾胃虚寒型与胃阴不足型(P<0.05或P<0.01),肝郁气滞型上皮内瘤变率显著高于脾胃虚寒型与胃阴不足型(P<0.01)。肝郁气滞型CD34平均光密度值显著高于肝胃郁热型、胃络瘀阻型、脾胃虚寒型、胃阴不足型(P<0.05或P<0.01);脾胃湿热型与脾胃虚寒型显著高于胃络瘀阻型、胃阴不足型(P<0.05);肝郁气滞型、脾胃湿热型Ki67平均光密度值显著高于脾胃虚寒型、胃阴不足型与胃络瘀阻型(P<0.05或P<0.01),脾胃湿热型显著高于肝胃郁热型(P<0.01)。结论慢性萎缩性胃炎胃黏膜中医微观辨证分型实证较虚证多,各微观证型中肝郁气滞型和脾胃湿热型的癌前病变发生率较高。
Objective To mucosa in patients with chronic observe the distribution laws of TCM microcosmic differentiation syndromes atrophic gastritis and the occurrence of precancerous lesions. Methods of gastric A total of 170 patients with chronic atrophic gastritis were treated with the examination of painless gastroscopy and confocal laser endoscopy. According to the endoscope observation, they were divided into stomach .yin insufficiency type, stasis blocking stomach collaterals type, deficiency cold of spleen and stomach type, spleen-stomach damp-heat type and stagnation of liver-Qi type after microcosmic syndrome differentiation of traditional Chinese medicine. Targeted biopsy was taken on the the glands atrophy to determine the intestinal epithelial metaplasia or intraepithelial neoplasia, the mean optical density of CD34 and Ki67 in gastric mucosa was examined by immunohistochemical method, and at the same time, Helicobacter pylori （Hp） infection would be judged. Results Among all the cases of chronic atrophy gastritis in this study, according to TCM microcosmic syndrome differentiation, there were 54 cases of stomach yin in- sufficiency type, 28 cases of deficiency cold of spleen and stomach type, 22 cases of liver stomach heat type, 16 cases of spleen-stomach damp-heat type. There was no significant difference in the Hp infection rate among different types of TCM microcosmic syndrome differentiation （ P 〉 0.05 ）. Intestinal metaplasia rate and intraepithelial neoplasia rate in stagnation of liver-Qi type and spleen-stomach damp-heat type was significantly higher than that in deficiency cold of spleen and stomach type and stomach yin insufficiency type （P 〈 0. 05 or P 〈 0. 01 ）. The intraepithelial neoplasia rate in stagnation of liver Qi type was significantly higher than that of deficiency cold of spleen and stomach type and stomach yin insufficiency type （ P 〈 0. 01 ）. The CD34 average optical density value of stagnation of liver Qi type val- ue was significantly higher than that of liver stomach heat type, stasis blocking stomach collaterals type, deficiency cold of spleen and stomach type, stomach yin insufficiency type （ P 〈 0. 05 or P 〈 0. 01 ） deficiency cold of spleen and stomach type was significantly Pi-Wei damp-heat type and higher than that in stasis blocking stomach collaterals type and stomach yin insufficiency type （ P 〈 0.05 ） ; Ki67 average optical density value in stagnation of liver-Qi type and spleen-stomach damp-heat type was significantly higher than that in deficiency cold of spleen and stomach type, stomach yin insufficiency type and stasis blocking stomach collaterals type （ P 〈 0. 05 or P 〈 0. 01 ）, Ki67 average optical density value in Pi-Wei damp-heat type was significantly higher than that in liver stomach heat type （P 〈 0. 01 ）. Conclusion Among TCM microcosmic differentiation of gastric mucosa in chronic atrophic gastritis, excess syndrome is more than deficiency syndrome Among all the microscopic syndromes, Stagnation of liver-Qi Type and spleen-stomach damp-heat type have higher incidence rate of precancerous lesions.
出处
《中医杂志》
CSCD
北大核心
2015年第15期1307-1310,共4页
Journal of Traditional Chinese Medicine
基金
山东省自然科学基金(ZR2012HM041)
关键词
慢性萎缩性胃炎
微观辨证
肠上皮化生
上皮内瘤变
癌前病变
chronic atrophic gastritis
microcosmic differentiation
intestinal metaplasia
intraepithelial neoplasia
precancerous lesion
