胃癌前病变中医证型分类探讨

Classification of Precancerous Lesions of Gastric Cancerin TCM Syndrome Types

目的:探讨胃癌前病变(precancerous lesions of gastric cancer,PLGC)的中医证型分类现状和结构,为PLGC的临床辨证和确定治法主次提供参考依据。方法:采用回顾性队列研究方法调查分析被南京中医药大学附属中西医结合医院确诊为PLGC的110例患者的临床资料,通过胃镜、病理诊断和中医证型分析,归纳PLGC的证型分类结构,并分析证型构成与胃黏膜萎缩、肠上皮化生、低级别上皮内瘤变相关性。结果:嗳气、腹胀、胃脘胀痛或灼痛或刺痛、口苦、口干为PLGC大多患者最常见的共性症状。PLGC常见证型按构成比从高到低依次是脾胃虚弱证(24.55%)、脾胃湿热证(22.73%)、肝胃气滞证(20.00%)、胃络瘀血证(12.73%)、胃阴不足证(8.18%)。其中,胃黏膜萎缩以脾胃虚弱证多见(32.14%),肠上皮化生以肝胃气滞证多见(28.95%),低级别上皮内瘤变以胃络瘀血证多见(50.00%)。结论:脾胃虚弱证、脾胃湿热证、肝胃气滞证、胃络瘀血证和胃阴不足证5种证型为PLGC的临床主要证型;不同证型与萎缩、肠化及低级别上皮内瘤变等不同的病理阶段具有一定相关性,随着萎缩-肠化-低级别上皮内瘤变的病理变化,呈由脾胃虚弱-肝胃气滞-胃络瘀血发展的病机变化趋势。

Objective:To study the current situation and structure of precancerous lesions of gastric cancer(PLGC),and to provide references for PLGC′s clinical syndrome differentiation and establishment of the primary treatment.Methods:The retrospective cohort research was used to investigate and analyze the clinical data of 110 cases diagnosed with PLGC in our hospital.Through gastroscopy,pathological diagnosis,and TCM syndrome analysis,the classification structure of PLGC syndrome is summarized,and the relationship between the syndrome composition and gastric mucosal atrophy,intestinal metaplasia,and low-grade intraepithelial neoplasia is analyzed.Results:Belching,abdominal distension,gastric pain or burning or tingling,bitter mouth,dry mouth are the most common symptoms of most patients with PLGC.In descending order of composition ratio,the common syndrome types of PLGC are Spleen-Stomach Deficiency syndrome(24.55%),Spleen-Stomach Dampness-Heat syndrome(22.73%),Liver and Stomach Qi stagnation syndrome(20.00%),Stomach collateral Blood stasis syndrome(12.73%)and Stomach Yin Deficiency syndrome(8.18%).Among them,gastric mucosal atrophy is more common in Spleen-Stomach Deficiency syndrome(32.14%),intestinal metaplasia is more common in Liver and Stomach Qi stagnation syndrome(28.95%),and low-grade intraepithelial neoplasia is more common in Stomach collateral Blood stasis syndrome(50.00%).Conclusion:The five syndromes of Spleen-Stomach Deficiency syndrome,Spleen-Stomach Dampness-Heat syndrome,Liver and Stomach Qi stagnation syndrome,Stomach collateral Blood stasis syndrome and Stomach Yin Deficiency syndrome are the main clinical syndromes of PLGC.Different syndromes are associated with different pathological stages such as atrophy,intestinal metaplasia,and low-grade intraepithelial neoplasia.With the pathological progression of atrophy-intestinal metaplasia-low-grade intraepithelial neoplasia,the pathogenesis changes in trend of Spleen-Stomach Deficiency-Liver and Stomach Qi stagnation-Stomach collateral Blood stasis.