慢性萎缩性胃炎胃黏膜中医微观辨证与癌前病变的特征分析

Microcosmic Syndrome Differentiation of Chinese Medicine of Gastric Mucosa with Chronic Atrophic Gastritis and Feature Analysis of Precancerous Lesions

目的:探讨慢性萎缩性胃炎(CAG)患者胃黏膜中医微观辨证证型与癌前病变之间的关系。方法:对220例CAG患者胃黏膜进行中医微观辨证分型、病理组织学以及免疫组化检查,比较不同中医微观证型患者癌前病变发生率、免疫组化指标(CD34^+、Ki67)的差异,探讨CAG患者中医微观辨证与癌前病变之间的关系。结果:220例CAG患者的胃黏膜组织中医微观证型中,胃阴不足型72例,脾胃虚寒型36例,肝郁气滞型34例,胃络瘀阻型31例,肝胃郁热型28例,脾胃湿热型19例。不同中医微观证型CAG患者Hp感染阳性率比较,差异无统计学意义(P>0.05)。肝郁气滞型与脾胃湿热型患者肠上皮化生率高于脾胃虚寒型与胃阴不足型,差异均有统计学意义(P<0.05);肝郁气滞型上皮内瘤变率高于脾胃虚寒型与胃阴不足型,差异均有统计学意义(P<0.05)。肝郁气滞型CD34^+平均光密度值高于肝胃郁热型、胃络瘀阻型、脾胃虚寒型、胃阴不足型(P<0.05);脾胃湿热型与脾胃虚寒型高于胃络瘀阻型、胃阴不足型(P<0.05)。肝郁气滞型、脾胃湿热型Ki67平均光密度值高于脾胃虚寒型、胃阴不足型与胃络瘀阻型(P<0.05,P<0.01),且脾胃湿热型高于肝胃郁热型(P<0.01)。结论:CAG患者胃黏膜中医微观辨证与癌前病变有着密切关系,其中肝郁气滞型与脾胃湿热型患者癌前病变发生率更高,应及早予以有效干预,降低胃癌发生率。

Objective：To discuss the relationship between the microcosmic-differentiation syndrome types of gastric mucosa of patients with chronic atrophic gastritis（CAG） and precancerous lesions. Methods：Made microcosmic syndrome differentiation and typing,histopathological and immunohistochemical examination for the gastric mucosa of 220 cases of CAG patients,compared the difference between incidence of precancerous lesions and immunohistochemical indexes（CD34-＋,Ki67） of patients with different microcosmic syndrome types,and discussed the relationship between microcosmic syndrome differentiation of gastric mucosa of CAG patients and precancerous lesions. Results： Among the 220 cases of the microcosmic-differentiation syndrome types of gastric mucosa tissue of CAG patients,there were 72 cases of stomach-yin deficiency type,36 cases of spleen-stomach deficiency cold type,34 cases of liver depression and qi stagnation type,31 cases of blood-stasis in stomach collaterals type, 28 cases of liver-stomach heat stagnation type, 19 cases of spleen-stomach dampness and heat type. Compared the Hp infection positive rate of CAG patients with different microcosmic-differentiation syndrome types,there was no significance being found（P〈0.05）. The rate of intestinal metaplasia of liver depression and qi stagnation type and spleen-stomach dampness and heat type was higher than that of spleen-stomach deficiency cold type and stomach-yin deficiency type,differences being significant（P〈0.05）;the rate of intraepithelial neoplasia of liver depression and qi stagnation type was higher than that of spleen-stomach deficiency cold type and stomach-yin deficiency type,differences being significant（P〈0.05）. The average CD34-＋ optical density of liver depression and qi stagnation type was higher than that of liver-stomach heat stagnation type,blood-stasis in stomach collaterals type,spleen-stomach deficiency cold type and stomach-yin deficiency type（P〈0.05）;the average CD34-＋ optical density of liver-stomach heat stagnation type and spleen-stomach deficiency cold type was higher than that of blood-stasis in stomach collaterals type and stomach-yin deficiency type（P〈0.05）. The average Ki67 optical density of liver depression and qi stagnation type and spleen-stomach dampness and heat type was higher than that of spleen-stomach deficiency cold type,stomach-yin deficiency type and blood-stasis in stomach collaterals type（P〈0.01,P〈0.05）,and the average Ki67 optical density of spleen-stomach dampness and heat type was higher than that of liver-stomach heat stagnation type（P〈0.01,P〈0.05）. Conclusion：Microcosmic syndrome differentiation of gastric mucosa of CAG patients is closely related to precancerous lesions,and incidence of precancerous lesions of patients of type and type is higher,to which effective intervention should be given to decrease incidence of gastric cancer.