扶正抗萎方对胃癌前病变ESD术后患者胃肠功能、蛋白组学及Hedgehog信号通路影响

Effect of Fuzheng Kangwei Decoction(扶正抗萎方)on Gastrointestinal Function,Proteomics and Hedgehog Signaling Pathway in Patients with Gastric Precancerous Lesions After ESD

目的探讨扶正抗萎方对胃癌前病变内镜黏膜下剥离术(ESD)术后患者胃肠功能、蛋白组学及Hedgehog信号通路的影响。方法选取2019年3月—2020年6月于徐州市中医院接受治疗的93例胃癌前病变患者进行前瞻性研究,根据随机数字表法将纳入研究的病例分为对照组和中药联合组,患者入院后均行ESD进行治疗,对照组术后采取常规治疗方案并口服叶酸片和替普瑞酮胶囊,中药联合组在常规治疗的基础上加服扶正抗萎方进行治疗。两组患者均连续治疗6个月,疗程结束后统计疗效。对比两组患者治疗前后中医证候积分及血清胃泌素(GAS)、血清胃动素(MOT)含量,通过免疫组织化学染色法对比病理组织中音猬因子(Shh)、平滑因子(Smo)、融合同源物(果蝇)抑制因子(SuFu)蛋白染色结果并评估以上蛋白表达情况。结果治疗后中药联合组疗效分级情况明显优于对照组(P<0.05);治疗后两组患者各项中医证候积分及总分均下降(P<0.05),且中药联合组明显低于对照组(P<0.05);治疗后两组患者血清GAS和MOT含量均升高(P<0.05),且中药联合组明显高于对照组(P<0.05);治疗后两组患者Shh、Smo、SuFu蛋白染色强度均降低(P<0.05),且中药联合组明显低于对照组(P<0.05)。结论扶正抗萎方对胃癌前病变ESD术后患者疗效较好,可有效改善腺体萎缩、肠上皮化生以及上皮内瘤变等病变,促进胃肠功能恢复,其作用机制可能与调节Hedgehog信号通路上Shh、Smo、SuFu等蛋白表达水平有关。

Objective To explore the effects of Fuzheng Kangwei Decoction(扶正抗萎方)on gastrointestinal function,proteomics and Hedgehog signaling pathway in patients with gastric precancerous lesions after endoscopic mucosal dissection(ESD).Methods We selected 93 patients with gastric precancerous lesions treated in Xuzhou hospital of traditional Chinese medicine from June 2019 to June 2020 for a prospective study.According to the random number table method,the included cases were divided into a control group and a traditional Chinese medicine combination group.All patients were admitted to the hospital.ESDwas performed.The control group took the conventional treatment plan after the operation and took folic acid tablets and teprenone capsules orally.The traditional Chinese medicine combination group was treated with Fuzheng Kangwei Fang on the basis of conventional treatment.Patients in both groups were treated for 6 months continuously,and the curative effect was calculated after the course of treatment.Compared the TCM syndrome scores,serum gastrin(GAS),and serum motilin(MOT)levels of the two groups of patients before and after treatment,compared the results of Shh,Smo,and SuFu protein staining in pathological tissues by immunohistochemical staining,and evaluated the above proteins express the situation.Results After treatment,the curative effect classification of the Chinese medicine combination group was significantly better(P<0.05);after treatment,the scores and total scores of the TCM syndromes of the two groups of patients decreased(P<0.05),and the Chinese medicine combination group was significantly lower(P<0.05);After treatment,the serum GAS and MOT levels of the two groups of patients increased(P<0.05),and the Chinese medicine combination group was significantly higher(P<0.05);After treatment,the two groups of patients'Shh,Smo,SuFu intensity of protein staining was reduced(P<0.05),and the Chinese medicine combination group was significantly lower(P<0.05).Conclusion Fuzheng Kangwei Decoction has a good effect on the prevention and treatment of gastric precancerous lesions after ESD.It can effectively improve the symptoms of gland atrophy,intestinal metaplasia and intraepithelial neoplasia,and promote the recovery of gastrointestinal function.Its mechanism may be related to the regulation of Hedgehog signaling.The expression levels of Shh,Smo,SuFu and other proteins in the pathway are related.