附子理中汤加味治疗慢性萎缩性胃炎肠上皮化生的临床疗效及机制

Clinical Curative Effects on Modified Fuzi Lizhong Decotion on Chronic Atrophic Gastritis with Intestinal Metaplasia and Its Mechanism

目的研究附子理中汤加味治疗脾胃虚寒型慢性萎缩性胃炎肠上皮化生(intestinal metaplasia,IM)的临床疗效及机制。方法 116例IM患者被随机分为2组,对照组与研究组各58例,对照组口服叶酸片(每天5mg,1日3次)和胃复春片(每天1.436g,1日3次);研究组口服附子理中汤加味,1日2次,连续治疗6个月。定标活检治疗后病变胃黏膜,直观模拟评分法对病理标本IM进行评分;免疫组化法检测病理标本中音猬因子sonic hedgehog(Shh)表达,比较两组治疗前后IM的不同,Shh表达的差异。结果对照组治疗后胃黏膜IM显著低于治疗前(P<0.05),而Shh表达显著高于治疗前(P<0.05)。研究组治疗后胃黏膜IM显著低于治疗前(P<0.005),而Shh表达显著高于治疗前(P<0.005)。2组治疗后胃黏膜IM,Shh表达,组间比较差异无显著性(P>0.05)。结论附子理中汤加味可一定程度上逆转IM,其机制可能与调节病变胃粘膜中Shh表达有关。

Objective To study the clinical cruative effects of modified Fuzi Lizhong decotion in treating of chronic atrophic gastritis with IM with Spleen-Stomach Deficiency-cold type and its mechanism. Methods 116cases of patients with IM were randomly divided into two groups, control group and study group with 58 cases in each group. The control group used folic acid tablets（5mg/ time, 3times/day）, Weifuchun （1.436g/time, 3times/day）. The study group orally modified Fuzi Lizhong decotion, 2times/day, continuous treatment for 6 months. After treatment, the lesions of gastric mucosa underwent the pieketage biopsy, using a visual analogue score on the gastric mucosal pathological specimens with IM, the expression of Shh in the specimens was detected by immunohistochemical method, compared with the differences of IM and Shh in the specimens. Results In the control group after treatment, the gastric mucosal IM was significantly lower than that before treatment （P〈0.05）, while the expression of Shh was significantly higher than that before treatment （P〈0.05）. In the study group after treatment, the gastric mucosal IM was significantly lower than that before treatment（P〈0.005）, while the expression of Shh was significantly higher than that before treatment（ P〈0.005 ）. There weren＇t significantly differeces of the gastric mucosal 1M and the expression of Shh between the two groups after treatment （P〉 0.05 ）. Conclusion Modified Fuzi Lizhong decotion can reverse intestinal metaplasia in certain degree, the mechanism may be related to the regulation of Shh expression in gastric mucosal lesions.