Study on the pathophysiologic basis of classification of‘spleen’ deficiency in chronic gastritis

Background Most of the studies on traditional Chinese medicine (TCM) ‘spleen’ deficiency syndrome in the recent 30 years were conducted only on the basis of single functional index, neglecting the study on the pathophysiologic internal relationship between spleen deficiency syndrome and gastric diseases in modern medicine. But it was at the subcellular molecular biological level that we explored the pathophysiologic basis of classification of spleen deficiency in chronic gastritis by detecting the bioactive substances in gastric mucosa nuclei and mitochondria. Methods By means of optical microscope, scanning electron microscope (SEM), transmission electron microscopy (TEM) and histochemical staining, we conducted histopathological, subcellular ultrastructural analysis and nuclei and mitochondrial ultrastructural analysis of gastric mucosa of 188 spleen deficiency patients and of 42 voluntary blood donors. At the same time, bioactive substances were measured by means of X-ray energy dispersive analysis system (EDAX) image analysis system, radioimmunoassay method and chemiluminescence method. Results The content of cAMP, superoxide dismutase (SOD), Zn and Cu in gastric mucosa, and the content of Zn and Cu in mitochondria decreased progressively in order of groups: healthy control (HC), spleen Qi deficiency without organic lesion (F-SQD), spleen Yang deficiency without organic lesion (F-SyangD), disease without symptoms group, spleen Qi deficiency with organic lesion (G-SQD), spleen Yang deficiency with organic lesion (G-SyangD), spleen Yin deficiency (SyinD) and spleen deficiency with Qi stagnation (SDQS), chronic spleen deficiency gastritis (CSG) and chronic atrophic gastritis (CAG); decreased in order of HC, intestinal metaplasia (IM)Ⅰ_a, IMⅠ_b, IMⅡ_a and IMⅡ_b, P<0.05. The content of DNA, Zn and Cu in nuclei progressively increased in order mentioned above, P<0.05.Conclusions The quantitative changes of gastric mucosal cAMP, SOD, Zn, Cu, of mitochondrial Zn, Cu and of nuclear DNA, Zn and Cu are not only the substance base on which the lesion of gastric mucosa tissue structure occurs, but also the substance base on which spleen deficiency is classified. G-SQD and G-SyangD were more likely to be found in low-grade or middle-grade CSG and CAG, while SyinD and SDQS in middle-grade or high-grade CSG, CAG and IMⅡ_b.

黄芪建中汤联合常规西药治疗慢性非萎缩性胃炎脾胃虚寒证患者的效果

目的:观察黄芪建中汤联合常规西药治疗慢性非萎缩性胃炎(CNG)脾胃虚寒证患者的效果。方法:选取2018年1月至2021年12月德化县中医院收治的140例CNG脾胃虚寒证患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各70例。对照组予以常规西药治疗,观察组在对照组基础上联合黄芪建中汤治疗,两组均连续治疗2个月。比较两组临床疗效、治疗前后中医证候积分、胃黏膜内镜分型分级、血清炎性因子[前列腺素E_(2)(PGE_(2))、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平和不良反应发生率。结果:观察组治疗总有效率为98.57%(69/70),高于对照组的88.57%(62/70),差异有统计学意义(P<0.05);治疗后,观察组胃部隐痛、泛吐清水、神倦纳差、大便溏薄等中医证候积分均低于对照组,胃黏膜内镜分型分级优于对照组,差异有统计学意义(P<0.05);观察组PGE_(2)水平高于对照组,TNF-α、IL-6水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:黄芪建中汤联合常规西药治疗CNG脾胃虚寒证患者可提高治疗总有效率,改善胃黏膜内镜分型分级和血清炎性因子水平,降低中医证候积分,效果优于单纯常规西药治疗。

舌苔脱落细胞理化指标与慢性胃炎患者中医证型相关性分析

目的探讨舌苔脱落细胞理化指标与慢性胃炎患者中医辨证分型的相关性。方法选择2017年3月-2018年5月本院慢性胃炎患者148例,经辨证分为脾胃虚弱证36例、肝胃不和证39例、胃阴不足证32例、脾胃湿热证41例,分别入组相应的中医证型组;再选择无寒热虚实证候的50位健康志愿者作为健康对照组。于高倍镜下观察各组受试者舌苔脱落细胞,分别行表、中、底层细胞计数,并计算成熟指数(maturity index,MI)及成熟价值(mature value,MV),检测舌苔脱落细胞中酸性磷酸酶(acid phosphatases,ACP)、LDH、琥珀酸脱氢酶(succinate dehydrogenase,SDH)及巯基含量,采用流式细胞术检测舌苔脱落细胞的细胞周期;采用Spearman等级相关法分析舌苔脱落细胞理化指标与中医证型分布的相关性。结果与健康对照组比较,脾胃虚弱证组、肝胃不和证组、胃阴不足证组、脾胃湿热证组受试者中层细胞百分比[(26.47±3.94)%、(22.32±5.41)%、(31.47±3.28)%、(35.62±3.96)%比(14.85±4.03)%]升高(P<0.05),表层细胞百分比[(73.53±6.47)%、(77.68±5.38)%、(68.53±4.20)%、(64.38±4.39)%比(85.15±5.33)%]降低(P<0.05),MV值[(83.52±3.10)%、(87.64±2.95)%、(79.38±3.21)%、(75.63±2.83)%比(92.61±3.74)%]降低(P<0.05)。与健康对照组比较,脾胃虚弱证组、肝胃不和证组、胃阴不足证组受试者舌苔脱落细胞中ACP、LDH、SDH、巯基均降低(P<0.05),脾胃湿热证组受试者ACP、LDH、SDH、巯基均升高(P<0.05);胃阴不足证组、脾胃湿热证组受试者G1期细胞百分降低(P<0.05),S期细胞百分升高(P<0.05)。Spearman等级相关法分析,脾胃虚弱证组、肝胃不和证组、胃阴不足证组、脾胃湿热证组与ACP、LDH、SDH、巯基均有相关性(r值分别为0.608、0.712、0.704、0.631,P值均<0.05)。结论慢性胃炎不同中医证型患者可出现不同的舌苔脱落细胞形态学变化、细胞周期差异较大且细胞生化指标水平不同。