健脾化浊通络法治疗慢性萎缩性胃炎胃癌前病变

Treatment of Precancerous Lesions of Gastric Cancer in Chronic Atrophic Gastritis with Jianpi Huazhuo Tongluo Therapy

目的:观察健脾化浊通络法治疗慢性萎缩性胃炎(chronic atrophic gastritis,CAG)胃癌前病变患者的临床疗效,并观察其对Hedgehog信号通路相关因子的影响。方法:120例CAG伴异型增生(dysplasia,Dys)或者CAG伴肠上皮化生(intestinal metaplasia,IM)患者随机分为对照组和观察组,每组各60例。对照组给予胃复春片;观察组给予健脾化浊通络法。比较两组患者治疗前后的临床疗效、病理评分、中医证候以及Hedgehog信号通路相关因子的水平。结果:与治疗前比较,两组患者治疗后胃脘痛、饱胀、嗳气、反酸、便溏、消瘦、厌食等证候评分均显著降低(P<0.05);观察组治疗后以上证候评分低于对照组治疗后(P<0.05)。治疗后,两组患者胃黏膜萎缩评分、IM评分、Dys评分均显著低于治疗前(P<0.05),观察组以上评分均低于同期对照组(P<0.05)。治疗后,观察组Hedgehog信号通路相关因子sonic hedgehog、ptched、smoothened和胶质瘤相关癌基因同源物-1(glioma-associated oncogene homolog-1,Gli-1)水平显著升高(P<0.05),且高于对照组治疗后(P<0.05)。结论:健脾化浊通络法治疗CAG癌前病变疗效显著,可显著降低中医证候评分、胃黏膜萎缩评分、IM评分、Dys评分,其机理可能与上调Hedgehog信号通路中多个靶分子的蛋白表达水平、激活Hedgehog通路,从而进一步促进胃黏膜的腺体分泌有关。

Objective:To observe the clinical efficacy of Jianpi Huazhuo Tongluo therapy in the treatment of precancerous lesions of gastric cancer in patients with chronic atrophic gastritis(CAG),and to observe the influence on Hedgehog signaling pathway related factors.Methods:120 cases of CAG with dysplasia(Dys)or CAG with intestinal metaplasia(IM)were randomly divided into control group and observation group,60 cases in each group.The control group was given Weifuchun tablets;the observation group was given Jianpi Huazhuo Tongluo therapy.The clinical efficacy,pathological score,TCM syndrome and Hedgehog signaling pathway related factors were compared between the two groups before and after treatment.Results:Compared with before treatment,the scores of epigastralgia,fullness,belching,acid regurgitation,loose stool,emaciation,anorexia and other syndromes in the two groups were significantly lower after treatment(P<0.05);the scores of the above syndromes in the observation group were lower than those in the control group after treatment(P<0.05).After treatment,the gastric mucosal atrophy score,IM score and Dys score of the two groups were significantly lower than those before treatment(P<0.05),and the above scores of the observation group were lower than those of the control group(P<0.05).After treatment,the levels of sonic Hedgehog,ptched,smoothened and glioma-associated oncogene homolog-1(Gli-1)in the observation group were significantly higher than those in the control group(P<0.05).Conclusion:Jianpi Huazhuo Tongluo group has a significant effect in treating CAG precancerous lesions,which can significantly reduce the TCM syndrome score,gastric mucosal atrophy score,IM score and DysDys score.Its mechanism may be related to up regulating the protein expression level of multiple target molecules in Hedgehog signaling pathway,activating Hedgehog pathway,and further promoting the gland secretion of gastric mucosa.