胃肠道肿瘤患者的中医体质辨识及MLH1基因多态性研究

Study on Constitution Identification of Traditional Chinese Medicineand MLH1 Gene Polymorphism in Patients with Gastrointestinal Cancer

目的探索胃肠道肿瘤高危人群的分子靶标及辨识胃肠道肿瘤患者的中医体质类型,为胃肠道肿瘤的中医防控提供理论依据。方法选取2018年1月—2019年12月期间北京大学第三医院海淀分院和北京市第一中西医结合医院收治的胃肠道肿瘤患者100例作为研究对象,同时选取同一时期体检的80名健康人群。分别对100例胃肠道肿瘤患者(胃肠道肿瘤组)和80名健康人群(健康人群组)发放标准化中医体质量表问卷,采用被调查者自填问卷方式,对两组患者进行中医体质辨识,用Sanger测序进行错配修复基因MLH1 SNP检测。结果胃肠道肿瘤的发病率与性别无关,60岁以上人群罹患胃肠道肿瘤的概率高于60岁以下人群。胃肠道肿瘤患者的体质类型与健康人群有明显区别,所有胃肠道肿瘤患者均表现为气虚质(P<0.0001),其他主要的体质类型分别为阳虚质(P<0.0001)、痰湿质(P<0.0001)和湿热质(P<0.0001)。MLH1基因检测胃肿瘤患者和肠肿瘤患者等位基因A的携带率明显高于健康人群(P<0.01),MLH1-1151T>A(rs63750447)突变与胃肠道肿瘤的发生具有相关性。结论胃肠道肿瘤患者主要表现为气虚为主的混合偏颇体质,大多数患者具有阳虚质、痰湿质和湿热质。MLH1基因检测胃肠道肿瘤人群中等位基因A的携带率显著高于健康人群,MLH1-1151T>A突变者为胃肠道肿瘤高危人群。以气虚为主线索,通过中医药调整胃肠道肿瘤高危人群的气、血、痰平衡,是中医防控胃肠道肿瘤发生、发展的一条途径。

Objective To explore the molecular targets of high-risk groups of gastrointestinal cancer and to identify the constitutional types of patients with gastrointestinal cancer,so as to provide a theoretical basis for the prevention and control of gastrointestinal cancer in traditional Chinese medicine.Methods From January 2018 to December 2019,100 patients with gastrointestinal cancer admitted to the Haidian Branch of Peking University Third Hospital and Beijing First Hospital of Integrated Traditional Chinese and Western Medicine were selected as the research objects,and 80 patients who received physical examination during the same period were selected as health people.100 cases of gastrointestinal cancer patients(gastrointestinal cancer group)and 80 healthy people(healthy person group)were distributed through standardized TCM body mass scale questionnaires,and the surveyed subjects were used to fill in the questionnaires to conduct the survey on the two groups of patients for TCM physical identification.Sanger sequencing was used to detect the SNP of the mismatch repair gene MLH1.Results The incidence of gastrointestinal cancer has nothing to do with gender.People over 60 years of age are more likely to suffer from gastrointestinal cancerthan those under 60 years old.The physique type of patients with gastrointestinal tumors is obviously different from that of healthy people.All patients with gastrointestinal tumors have Qi deficiency(P<0.0001).And the other main physique types are Yang deficiency(P<0.0001)and phlegm dampness(P<0.0001)and damp heat quality(P<0.0001),respectively.The MLH1 gene detection of gastric cancer patients and colorectal cancer patients has a significantly higher allele A carrier rate than healthy people(P<0.01).The MLH1-1151 T>A(rs63750447)mutation is related to the occurrence of gastrointestinal cancer.Conclusion The patients with gastrointestinal cancer mainly show mixed biased constitution of Qi deficiency.Most patients have Yang deficiency constitution,phlegm dampness constitution and damp heat constitution.The carrier rate of allele A in patients with gastrointestinal cancer detected by MLH1 gene was significantly higher than that in healthy people.The patients with MLH11151 T>A mutation were at high risk of gastrointestinal cancer.Based on the clue of Qi deficiency,the balance of Qi,blood and phlegm in high-risk population of gastrointestinal cancer should be adjusted by TCM,which is a way to prevent and control the occurrence and development of gastrointestinal cancer.