中医药治疗慢性萎缩性胃炎癌前病变的研究进展

Research Progress in the Treatment of Precancerous Lesions of Chronic Atrophic Gastritis with TCM

慢性萎缩性胃炎(chronic atrophic gastritis,CAG)的病因主要为外邪犯胃、饮食不节、情志失调、素体脾虚;病机属本虚标实,本乃脾胃虚弱,标乃寒、热、湿、瘀、毒等。中医治疗慢性萎缩性胃炎癌前病变的主要方法有:辨证论治、古方化裁、自拟方治疗、其他疗法(如:针灸、穴位敷贴、耳穴压丸、穴位埋线等)、中成药治疗、中西医结合治疗等。中医药治疗CAG癌前病变,目前仍存在许多不足:①历代医家对CAG癌前病变的认识不一,如何制定一套合理、统一的辨证分型及疗效评判标准值得进一步研究。②中医药对本病治疗的临床研究,能够满足随机、对照、双盲、多中心原则的研究少之又少,使临床研究的科学性产生一定的偏倚和误差。③中医药治疗取得效果后很少对患者进行随访,对该病是否复发,临床研究很难作出评估,故中医治疗该疾病的远期疗效缺乏有效的验证。④临床实验表明,CAG癌前病变的发生、发展与多种酶、蛋白质及分子基因密切相关,临床中应当加强动物实验方面的研究,从分子生物学角度对中药的作用机理加以阐释,从而使其临床推广价值得以提升。⑤注意早期发现和早期预防,中医辨证应当与现代技术相结合,如胃镜下黏膜的形态变化,定期复查,早期干预,根据不同病期、不同阶段进行辨证施治,做到方随证变。

Chronic atrophic gastritis(CAG)is mainly caused by external pathogenic factors,eating disorders,emotional disorders and constant constitution deficiency.The pathogenesis of CAG is root deficiency and branch excess.Root deficiency means spleen-stomach deficiency,while branch excess refers to cold,heat,dampness,blood stasis and toxin.The main methods to treat precancerous lesions of CAG with TCM include syndrome differentiation and treatment,treatment with modified ancient prescriptions,treatment with self-made prescriptions,other therapies(such as acupuncture,acupoint application,ear acupoint pressing pill,acupoint embedding thread,etc.),treatment with Chinese patent medicine,treatment with integrated traditional Chinese and Western medicine.At present,there are still many shortcomings in the treatment of precancerous lesions of CAG with TCM:①There are different understandings of CAG precancerous lesions among doctors of all ages.How to formulate a set of reasonable and unified syndrome differentiation classification and evaluation criteria of curative effect is worth further study.②There is fewer clinical research of TCM on the treatment of this disease which can satisfy the principle of randomization,control,double-blind and multicenter,which makes the scientific research of clinical research produce certain bias and error.③After certain effect of TCM treatment,patients are rarely followed up,that is why it is difficult to evaluate the recurrence of the disease in clinical research.Therefore,the long-term effect of TCM in the treatment of the disease is lack of effective verification.④Clinical experiments have shown that the occurrence and development of CAG precancerous lesions are closely related to a variety of enzymes,proteins and molecular genes.In clinical practice,we should strengthen the research of animal experiments,and explain the mechanism of TCM from the perspective of molecular biology,so as to enhance its clinical promotion value.⑤We should pay attention to early detection and early prevention.TCM syndrome differentiation should be combined with modern technology,such as the morphological changes of mucosa under gastroscope,regular reexamination,early intervention,according to different disease stages,different stages of syndrome differentiation and treatment,so that the formulas can change with the syndrome.