中医药治疗胃癌前病变研究进展

Research Progress of Traditional Chinese Medicine in the Treatment of Precancerous Lesions of Gastric Cancer

胃癌前病变(precancerous lesions of gastric cancer,PLGC)是正常胃黏膜向胃癌转化过程中的一个重要阶段,中医临床工作者可运用辨证论治的理论,采用经验方、中医外治法、中成药等治疗措施有效阻断或逆转PLGC,但由于PLGC病因繁多,发病机制十分复杂,故也存在一定的问题,主要体现在以下几个方面:(1)临床研究没有统一的诊断标准和详细的疗效判定标准,不同的研究者参考的胃镜和病理活检标准也不统一;(2)目前还没有制定统一的中医辨证标准,临床工作者对PLGC治疗疗程的长短也没有形成统一的认识;(3)目前中医药治疗PLGC的方法很多,如健脾和胃、调和肝脾、解毒化瘀、化湿泄浊、益气养阴,但没有一个主导原则;(4)大多数临床观察只重视近期疗效,对疾病动态变化及远期疗效的观察相对不足;(5)由于各医家对本病病因病机的认识尚不统一,在临床上进行多中心、大样本的随机对照研究十分困难;(6)中药在治疗本病的同时是否具有不良反应,中药在有效抑制胃癌组织基因表达的同时,对其他正常组织是否也有影响,鲜有报道。

Precancerous lesions of gastric cancer（ PLGC） is an important stage in the progress of normal gastric mucosa to gastric carcinoma,and clinical practitioners of TCM can use the theory of syndrome differentiation and treatment,using experience,external treatment of Chinese medicine,Chinese patent medicine and other treatment measures to effectively block or reverse PLGC,however,because of the various etiology and complex pathogenesis of PLGC,there are some problems,which are mainly reflected in the following aspects：（1） there was no uniform diagnostic criteria and detailed evaluation criteria in clinical studies,and neither were the gastroscopy and pathological biopsy criteria referred to by different researchers;（2）because of the variety of etiology and complicated pathogenesis of PLGC,there is no unified standard of TCM syndrome differentiation at present,and the clinical workers have not formed a unified understanding of the duration of treatment for PLGC;（3）there are many methods of traditional Chinese medicine to treat PLGC,such as invigorating spleen and stomach,harmonizing liver and spleen,detoxifying and removing blood stasis,removing dampness and releasing turbidity,nourishing Qi and nourishing Yin,but there is not a leading principle;（4）most clinical observation only pay attention to the short-term curative effect,but the observation of the disease dynamic change and the longterm curative effect is relatively insufficient;（5）because the understanding of the etiology and pathogenesis of the disease is not uniform,it is very difficult to carry out a multicenter,large sample randomized controlled study in clinic;（6）it is seldom reported that whether traditional Chinese medicine has adverse reactions at the same time as treating this disease,and while effectively inhibiting gene expression in gastric cancer tissues,whether Chinese medicine also has an effect on other normal tissues.