[1]左巧云 傅雨娴 王倩倩 叶涛 郭涵卿 查天悦 徐陆周**.芪竹健胃方治疗慢性萎缩性胃炎及癌前病变临床研究*[J].现代中医药,2024,(06):069-75.[doi:10.13424/j.cnki.mtcm.2024.06.013]
　ZUO Qiaoyun FU Yuxian WANG Qianqian YE TaoGUO Hanqing ZHA Tianyue XU Luzhou.Clinical Study on the Treatment of Chronic Atrophic Gastritisand Precancerous Lesions with Qizhu Jianwei Formula[J].Modern Traditional Chinese Medicine,2024,(06):069-75.[doi:10.13424/j.cnki.mtcm.2024.06.013]
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芪竹健胃方治疗慢性萎缩性胃炎及癌前病变临床研究*()
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《现代中医药》[ISSN:1006-6977/CN:61-1281/TN]

卷:
期数:
2024年06期
页码:
069-75
栏目:
出版日期:
2024-11-20

文章信息/Info

Title:
Clinical Study on the Treatment of Chronic Atrophic Gastritisand Precancerous Lesions with Qizhu Jianwei Formula
文章编号:
1672-0571(2024)04-0064-06
作者:
左巧云1 傅雨娴2 王倩倩2 叶涛2 郭涵卿2 查天悦2 徐陆周3**
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
Author(s):
ZUO Qiaoyun1 FU Yuxian2 WANG Qianqian2 YE Tao2GUO Hanqing2 ZHA Tianyue2 XU Luzhou3
1.Bengbu Traditional Chinese Medicine Hospital, Anhui Bengbu 233020,China;2.Nanjing University of Chinese Medicine, Nanjing 210029,China;3.Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029,China
关键词:
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
Keywords:
Key words:Chronic atrophic gastritis; Precancerous lesions of gastric cancer;  Spleen deficiency;  dampness;  blood stasis syndrome; Qizhu Jianwei formula;  Clinical research; Lgr5; Wnt/β-catenin; C-myc
分类号:
R573.3+2
DOI:
10.13424/j.cnki.mtcm.2024.06.013
文献标志码:
A
摘要:
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。
Abstract:
Abstract：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 PG Ⅰ values increased with statistical differences (P<0.01), and PGR showed an increasing trend with statistical differences (P<0.05); In terms of PG Ⅱ, 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.

参考文献/References:

［1］葛均波，徐永健．内科学［M］.8版．北京：人民卫生出版社，2013．
［2］DUC TRONG，QUACH，TORU，HIYAMA，et al.Identifying high-risk individuals for gastric cancer surveillance from western and eastern perspectives：Lessons to learn and possibility to develop an integrated approach for daily practice［J］.World J Gastroenterol，2019，25(27):3546-3562.
［3］HONGMEI ZENG，WANQING CHEN，RONGSHOU ZHENG，et al.Changing cancer survival in China during 2003-15：a pooled analysis of 17 population-based cancer registries［J］.Lancet Glob Health，2018，6(5):e555-e567.
［4］王雄文，林龙，李佩华，等.周岱翰诊治肿瘤的中医学术思想探讨［J］.广州中医药大学学报，2015，32(4):762-764.
［5］赵雷.徐景藩教授三型论治慢性萎缩性胃炎癌前病变的疗效观察及其对生活质量的影响［D］.南京：南京中医药大学，2011.
［6］史锁芳，陆为民.单兆伟治疗慢性萎缩性胃炎癌前病变的经验［J］.中医杂志，1998(8):461-463.
［7］GUN JB，BYUNGLAN L，WOO HO K.Distribution of LGR5+ cells and associated implications during the early stage of gastric tumorigenesis［J］.Plos One，2013，8(12):e82390
［8］YANG KE，WANG XIN，ZHANG HONGMEI，et al.The evolving roles of canonical WNT signaling in stem cells and tumorigenesis：implications in targeted cancer therapies［J］.Lab Invest，2016，96(2)：116-136.
［9］童凤翔，徐艺.浅谈单兆伟教授治疗慢性萎缩性胃炎经验［J］.天津中医药，2021，38(4):438-441.
［10］黄婷婷，周晓虹.二参三草汤治疗慢性萎缩性胃炎癌前病变的临床观察及其对PTEN、ERK、AKT表达影响的研究［J］.中医药信息，2016，33(1):49-52.
［11］张婷，单兆伟.单兆伟教授自拟芪竹方加减治疗胃癌术后气阴两虚［J］.长春中医药大学学报，2013，29(6):991-992.
［12］程宁昌，周晓虹.二参三草汤对胃低级别上皮内瘤变PTEN、PCNA表达影响研究［J］.辽宁中医药大学学报，2013，15(12):68-70.
［13］王卯.芪竹方中单体薯蓣皂苷及莪术醇对人胃癌细胞MGC-803抑制作的研究［D］.南京：南京中医药大学，2012.
［14］SHIRAKI M，YAMAZAKI Y，KURODA T，et al.Serum level of pepsinogen significantly associated with gastric distress induced by amino-bisphosphonates［J］.Osteoporos Int，2011，22(6)：1717-1723.
［15］KIYOHIRA KUNINUSHI，YOSHIHARA MASAHARU，ITO MASANORI，et al.Serum pepsinogen concentration as a marker of Helicobacter pyloriinfection and the histologic grade of gastritis；evaluation of gastric mucosa by serum pepsinogen levels［J］.J Gastroenterol，2003，38(4)：332-338.
［16］陈春春，罗和生，张维兰，等.血清胃蛋白酶在慢性胃部病变中的相关研究［J］.临床消化病杂志，2018，30(6):400-403.
［17］李松财.血清G17、PG联合Hp抗体检测在萎缩性胃炎患者中的表达及其意义［J］.现代实用医学，2021，33(5):641-642.
［18］刘明峰，陈妍.柴芍六君子汤联合西药对慢性萎缩性胃炎患者胃泌素-17、胃蛋白酶原及糖类抗原724的影响［J］.现代中西医结合杂志，2020，29(9):987-991.
［19］叶海潇.二陈平胃散治疗慢性萎缩性胃炎的疗效观察及其对血清胃泌素17、胃蛋白酶原的影响［J］.中国中医药科技，2020，27(1):60-62.
［20］刘伟，倪家慧，张丹，等.中医药调控胃“炎癌转化”癌前微环境的思考与策略［J］.中华中医药杂志，2023，38(4):1431-1435.
［21］BARKER NICK，HUCH MERITXELL，KUJALA PEKKA，et al.Lgr5(+ve) stem cells drive self-renewal in the stomach and build long-lived gastric units in vitro［J］.Cell Stem Cell，2010，6(1)：25-36.
［22］ARNOLD KATRIN，SARKAR ABBY，YRAM MARY ANNA，et al.Sox2(+) adult stem and progenitor cells are important for tissue regeneration and survival of mice［J］.Cell Stem Cell，2011，9(4)：317-329.
［23］OSHIMA HIROKO，MATSUNAGA AKIHIRO，FUJIMURA TAKASHI，et al.Carcinogenesis in mouse stomach by simultaneous activation of the Wnt signaling and prostaglandin E2 pathway［J］.Gastroenterology，2006，131(4)：1086-1095.
［24］HILKENS J，TIMMER NC，BOER M，et al.RSPO3 expands intestinal stem cell and niche compartments and drives tumorigenesis［J］.Gut，2017，66(6)：1095-1105.
［25］SIGAL MICHAEL，ROTHENBERG MICHAEL E，LOGAN CATRIONA Y，et al.Helicobacter pylori Activates and Expands Lgr5(+) Stem Cells Through Direct Colonization of the Gastric Glands［J］.Gastroenterology，2015，148(7):1392-404.e21.
［26］SIGAL MICHAEL，REINS MARIA DEL MAR，MLLERKE STEFANIE，et al.R-spondin-3 induces secretory，antimicrobial Lgr5 cells in the stomach［J］.Nat Cell Biol，2019，21(7):812-823.
［27］JANG BO GUN，LEE BYUNG LAN，KIM WOO HO.Intestinal Stem Cell Markers in the Intestinal Metaplasia of Stomach and Barrett’s Esophagus［J］.PLoS One，2015，10(5):e0127300.
［28］ZHANG HONGFENG，XUE YINGWEI.Wnt pathway is involved in advanced gastric carcinoma［J］.Hepatogastroenterology，2008，55(84):1126-1130.
［29］ARAKAWA N，SUGAI T，HABANO W，et al.Genome-wide analysis of DNA copy number alterations in early and advanced gastric cancers［J］.Molecular Carcinogenesis，2017，56(2):527-537.
［30］ZUQIN，NIE，GANGQING，et al.c-Myc Is a Universal Amplifier of Expressed Genes in Lymphocytes and Embryonic Stem Cells-ScienceDirect［J］.Cell，2012，151(1):68-79.
［31］LIN CHARLES Y，LOVN JAKOB，RAHL PETER B，et al.Transcriptional amplification in tumor cells with elevated c-Myc［J］.Cell，2012，151(1):56-67.

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备注/Memo

备注/Memo:
基金项目：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）
更新日期/Last Update: 2024-11-21