摘要
目的明确慢性胃炎恶性转化过程中证候、证素演变规律。方法采用多中心、大样本横断面研究方法,收集慢性胃炎患者四诊信息,联合应用有监督及无监督统计学方法,对恶性转化过程中非萎缩性胃炎(CNAG)、萎缩性胃炎(CAG)见腺体减少、CAG见肠上皮化生、CAG见上皮内瘤变、原发性胃癌5个阶段的证候、证素进行判定及统计分析。结果本研究共收集1 000例慢性胃炎患者;在慢性胃炎恶性转化过程中,整体存在"虚实夹杂、由实至虚"的证候演变规律,而在CAG阶段,呈现从虚实夹杂实证偏多,到虚实夹杂虚证偏多,再到虚实夹杂实证偏多的证候演变趋势;结合证候要素的变化,气滞、热、湿、阴虚、气虚、阳虚、血虚、血瘀、痰均贯穿从CNAG到原发性胃癌发展始终,且随着疾病的进展,呈现气滞、热(实)→气滞、气虚→阳虚、气虚→气滞、热(虚)→血瘀、气虚的变化趋势。结论慢性胃炎恶性转化过程中具有虚实转化的证候、证素演变过程,其关键病理阶段为肠上皮化生,在临床进行有效的干预,实现既病防变,是阻断、逆转慢性胃炎恶性转化过程的可行途径。
Objective To investigate the distribution characteristics of syndrome and syndrome elements in different pathologic stages of chronic gastritis shifting to gastric carcinoma. Methods A multi-center and large-sample cross-sectional survey was applied to collect the four diagnostic information of patients. Factor analysis optimization was combined with the complex system entropy clustering method to analyze the syndrome and syndrome elements of the patients with the different stages, including chronic non-a- trophic gastritis, chronic atrophic gastritis, CAG with intestinal metaplasia, CAG with endothelial neopla- sia and primary gastric cancer. Results A total of 1 000 cases were involved in this study. In the process of the information-carcinoma transformation, the syndrome evolution rule of ＂intermingled defi- ciency and excess, from excess to deficiency＂ was present. And in the stage of CAG, variation tendency from ＂intermingled deficiency and excess with more excess syndrome＂, to＂ intermingled deficiency and excess with more deficiency syndrome＂, to ＂intermingled deficiency and excess with more excess syn- drome＂ in the course of the disease progression were appeared. And qi stagnation, heat, dampness, yin deficiency, qi deficiency, yang deficiency, blood deficiency, blood stasis and phlegm are running through from CNAG to primary gastric cancer. And it presented the trend about ＂qi stagnation → heat （excess）, qi stagnation, qi deficiency → yang deficiency, qi deficiency → qi stagnation, heat （deficiency） → blood stasis, qi deficiency＂. Conclusion In the process of malignant transformation, there is an evolution rule about deficiency and excess inter-transformation of syndrome and syndrome elements. The key pathological stage is the stage of intestinal metaplasia. According to the development trend of syndrome and syndrome elements, effective intervention in clinical practice to prevent the progress of dis- ease is a feasible way to block and reverse the malignant transformation of chronic gastritis.
出处
《现代中医临床》
2017年第6期9-14,共6页
Modern Chinese Clinical Medicine
基金
国家自然科学基金重点项目(No.81630080)
关键词
慢性胃炎
恶性转化
证候
证素
演变规律
chronic gastritis
information-carcinoma transformation
syndrome
syndrome elements
evolution rule
