培土化浊法序贯治疗慢性萎缩性胃炎

Sequential Treatment of Chronic Atrophic Gastritis by Invigorating Spleen,Stomach and Resolving Turbidity

目的:观察培土化浊法序贯治疗脾胃虚弱型慢性萎缩性胃炎的临床疗效及可能的作用机制。方法:112例脾胃虚弱型慢性萎缩性胃炎患者随机分为治疗组(培土化浊法)和对照组(胃复春),各56例。比较治疗前后的中医证候疗效、中医证候积分、胃黏膜内镜检查及胃镜黏膜病理,检测Hedgehog(Hh)通路的音猬因子(Shh)及Wnt通路的Wnt3A表达。结果:治疗组中医证候疗效(89.30%)优于对照组(73.21%),差异有统计学意义(P<0.05)。两组治疗后中医证候总积分、胃脘胀满或隐痛、胃部喜按或喜暖等中医证候积分均低于治疗前,治疗组治疗后以上积分均低于对照组治疗后,差异均有统计学意义(P<0.05)。与治疗前比较,治疗后两组患者黏膜颗粒/节结增生、血管显露、黏膜皱襞及黏膜红白相间等情况均显著改善(P<0.05);且治疗组治疗后改善优于对照组治疗后,差异具有统计学意思(P<0.05)。治疗后,两组患者胃镜黏膜病理积分均低于较治疗前(P<0.05),且治疗组治疗后低于对照组治疗后(P<0.05)。治疗后,治疗组Shh表达明显高于对照组(P<0.05),Wnt3A表达明显低于对照组(P<0.05)。结论:培土化浊法序贯治疗脾胃虚弱型慢性萎缩性胃炎疗效显著,可显著降低患者中医证候总积分、胃脘胀满或隐痛、胃部喜按或喜暖等中医证候积分,降低胃镜黏膜病理积分,改善胃黏膜病理情况,升高Shh表达,降低Wnt3A表达,其可能的机制是通过调控Hh-Wnt基因信号通路环等起到对胃黏膜病变的治疗作用。

Objective:To observe the clinical efficacy and possible mechanism of the sequential treatment of chronic atrophic gastritis(CAG)with spleen and stomach deficiency syndrome by invigorating spleen,stomach and resolving turbidity method.Methods:112 cases of CAG with spleen and stomach deficiency syndrome were randomly divided into treatment group(invigorating spleen,stomach and resolving turbidity method)and control group(Weifuchun),56 cases in each group.Before and after treatment,TCM syndrome efficacy,TCM syndrome score,gastric mucosal endoscopy and endoscopic mucosal pathology were compared.The expression of Shh in Hedgehog(Hh)pathway and Wnt3 a in Wnt pathway were detected.Results:The TCM syndrome efficacy in the treatment group(89.30%)was better than that in the control group(73.21%),and the difference was statistically significant(P<0.05).After treatment,the total scores of TCM syndromes,gastric fullness or dull pain,stomach pressing or warming and other TCM syndromes scores were lower than before treatment,and the scores of the treatment group were lower than those of the control group after treatment.All were statistically significant(P<0.05).Compared with before treatment,after treatment,mucosal granule/nodular hyperplasia,vascular exposure,mucosal folds,and red and white interstices in the two groups were significantly improved(P<0.05);and the improvement in the treatment group was better than that in the control group after treatment,The difference is statistically significant(P<0.05).After treatment,the gastroscopic mucosal pathology scores of the two groups were lower than those before treatment(P<0.05),and the treatment group was lower than the control group after treatment(P<0.05).After treatment,the expression of Shh in the treatment group was significantly higher than that in the control group(P<0.05),and the expression of Wnt3 A was significantly lower than that in the control group(P<0.05).Conclusion:Sequential treatment of CAG by invigorating spleen,stomach and resolving turbidity method can significantly reduce the total score of TCM syndrome,the epigastric fullness or dull pain,the stomach likes pressing or warming,reduce the pathological score of gastroscope mucosa,improve the pathological condition of gastric mucosa,increase the expression of Shh and decrease the expression of Wnt3 A.The possible mechanism is to regulate the signal pathway of Hh-Wnt gene to treat gastric mucosal lesions.