隆起糜烂性胃炎的中西医研究概况

Overview of Chinese and Western Medical Research on Raised Erosive Gastritis

隆起糜烂性胃炎是一种特殊类型的胃炎,具有高度癌变倾向,临床上主要依靠其独特的内镜下表现进行诊断。现代医学认为隆起糜烂性胃炎的发生原因与幽门螺旋杆菌(Hp)感染、胃黏膜损伤、自身免疫以及焦虑抑郁等因素相关;中医学则考虑外邪、饮食、情志、体虚等原因导致脾胃虚弱,通降失常,而发为隆起糜烂性胃炎。其发病机制复杂,现代医学主要围绕三个方面展开:原癌与抑癌基因表达异常、抗炎与致炎因子高表达、增殖与凋亡失衡;中医学认为其基本病机多为本虚标实,本虚为脾胃虚弱,标实为热郁、湿困、血瘀、气滞、痰结等各种病理产物相互交错。西医治疗隆起糜烂性胃炎分为围绕抑酸、保护胃黏膜及抗Hp感染展开的西药保守治疗与内镜下介入治疗为主,目前临床上最常见为二者联合疗法;中医学根据中医观念指导,结合临床辨证思维以及通过多成分、多靶点的中药组方,在治疗隆起糜烂性胃炎上有着独特的优势。因其病因、发病机制尚不明确,故治疗上主要以对症支持、缓解症状为主,尚无有效的治疗方法。因此,临床中需要拓展西医诊疗思路,发挥中医药特色,逐步提高中西医结合诊疗隆起糜烂性胃炎的水平。

Raised erosive gastritis is a special type of gastritis with a high propensity for carcinogenesis and is diagnosed clinically mainly on the basis of its unique endoscopic manifestations. Most studies in modern medicine suggest that the cause of augmented erosive gastritis is related to Hp infection, gastric mucosal injury, autoimmunity, and anxiety and depression, while traditional Chinese medicine considers external evil, diet, emotion, and physical deficiency as causes of weakness of the spleen and stomach and derangement of the flux and descent, resulting in augmented erosive gastritis. The pathogenesis is complex, and modern medical research mainly focuses on the following three aspects: abnormal expression of proto-oncogenes and oncogenes, high expression of anti-inflammatory and inflammatory factors, and imbalance of proliferation and apoptosis. Western medicine treatment for augmented erosive gastritis is divided into conservative western medicine treatment and endoscopic intervention based on acid suppression, gastric mucosa protection and anti-Hp infection, and currently the most common combination of the two in clinical practice;traditional Chinese medicine has unique advantages in the treatment of augmented erosive gastritis based on the guidance of Chinese medicine concepts, combined with clinical evidence-based thinking and through multi-component, multi-targeted Chinese medicine formulations. Since its etiology and pathogenesis are still unclear, the treatment is mainly based on symptomatic support and symptom relief, and there is no effective treatment method yet. Therefore, it is necessary to expand the western medical treatment ideas and give full play to the characteristics of Chinese medicine in clinical practice, so as to gradually improve the level of combined Chinese and western medicine in the treatment of augmented erosive gastritis.