胃癌前病变中医证候分型与胃蛋白酶原的相关性研究

The correlation study of TCM syndrome type of PLGC with pepsinogen

[目的]研究胃癌前病变（PLGC）中医证型与血清胃蛋白酶原（PG）检测结果的相关性,为临床辨证论治提供依据。[方法]对经胃镜和病理确诊为PLGC的65例患者进行病史采集工作,包括流行病学资料（性别、年龄、病程、疾病危险因素、既往史和家族史）,胃镜表现,病理分级,中医四诊资料,以及血清PG检测结果。运用描述性统计方法找出PLGC的发病因素,分析PLGC中医证型与胃镜、病理关系;运用统计学方法分析PLGC患者不同证候血清PG的分布规律,分析两者与病理的相关性,从而探索与中医证型的关系。[结果]61-70岁患者所占比例最大,病程多在6-10年,危险因素主要以饮食无规律,三餐不定时及紧张、焦虑、急躁易怒情绪为主;胃镜表现以黏膜红白相间、黏膜粗糙为主;病理以中度萎缩、轻度肠化、轻度不典型增生为主;症状表现以痞闷不舒、胃脘疼痛、纳呆少食为前3位。中医辨证分为6个证型：肝胃不和证15例,肝胃郁热证8例,脾胃湿热证10例,脾胃虚寒证8例,胃阴不足证9例,胃络瘀阻证14例。PGI含量：肝胃不和证〉脾胃湿热证〉肝胃郁热证〉胃阴不足证〉脾胃虚寒证〉胃络瘀阻证。PGII含量：肝胃不和证〉脾胃湿热证〉胃络瘀阻证〉肝胃郁热证〉胃阴不足证〉脾胃虚寒证。[结论]PLGC中医证型主要包括肝胃不和证、肝胃郁热证、脾胃湿热证、脾胃虚寒证、胃阴不足证和胃络瘀阻证。胃络瘀阻证、胃阴不足证、脾胃虚寒证患者PGⅠ降低,脾胃虚寒证患者PGⅡ相对降低;PGⅠ降低与胃黏膜萎缩程度有关,PGⅡ含量相对降低可能与胃黏膜严重萎缩形成多灶性萎缩性胃炎（MAG）或伴肠腺化生、不典型增生有关。

[Objective]The correlation study of TCM syndrome type of PLGC with serum Pepsinogen（PG）,provide the basis for clinical treatment based on syndrome differentiation.[Methods]Collect 65 cases were diagnosed with PLGC,including the data of epidemiology（sex,age,course,risk factors,medical history and family history）,endoscopy,pathological results,diagnostic information of TCM,and the results of serum PG.Using statistical method to find out the risk factors of PLGC,analysis of relationship between TCM syndrome type and endoscopy and pathology.And analyze the distribution of serum PG in PLGC patients with different syndrome,so as to explore the relationship between PG with TCM syndrome type.[Results]The largest proportion of patients is 61-70 years old,course of disease most in 6-10 years.Risk factors is mainly by eating disorders,meals or timing tension,and anxiety,irritability.Gastroscope manifestation is given priority to with mucosal red and white,mucosal rough.Pathology manifestation is moderate atrophic gastritis,mild intestinal metaplasia,mild dysplasia.The top three symptoms is uneasiness with full and stuffy sensation,stomach pain,eat less.TCM syndrome has 6types：the patients with liver-stomach disharmony are 15 cases,heat stagnation of liver and stomach are 8cases,dampness-heat of spleen and stomach are 10 cases,deficient cold of spleen and stomach are 8cases,stomach yin deficiency are 9cases,gastric stasis winding resistance are 14 cases.PG I expression：liver-stomach disharmony〉dampness-heat of spleen and stomach〉heat stagnation of liver and stomach〉stomach yin deficiency〉deficient cold of spleen and stomach〉gastric stasis winding resistance.PGII expression：liver-stomach disharmony〉dampness-heat of spleen and stomach〉gastric stasis winding resistance〉heat stagnation of liver and stomach〉stomach yin deficiency〉deficient cold of spleen and stomach.[Conclusion]The PGⅠ reduce of gastric stasis winding resistance,heat stagnation of liver and stomach and deficient cold of spleen and stomach decreased.The PGⅡ reduce of deficient cold of spleen and stomach relatively decreased.PGⅠis related to the gastric mucosa atrophy.PGⅡ relatively decreased may be concerned with multifocal atrophic gastritis（MAG）or with intestinal metaplasia,and atypical hyperplasia.