發(fā)布時(shí)間：2018-01-18 00:19

  本文關(guān)鍵詞：理氣活血解毒法對(duì)慢性萎縮性胃炎伴腸上皮化生的臨床研究及機(jī)制探討　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 慢性萎縮性胃炎 腸上皮化生 理氣活血解毒法 CDX2 MUC2 Bcl-2

【摘要】：目的:慢性萎縮性胃炎伴腸上皮化生是一種胃癌前疾病。腸上皮化生是癌前病變的關(guān)鍵步驟,所以干預(yù)腸上皮化生是減少胃癌發(fā)病率的關(guān)鍵�，F(xiàn)代醫(yī)學(xué)對(duì)于慢性萎縮性胃炎伴腸上皮化生的治療上主要采取目以根除Hp,促進(jìn)胃動(dòng)力,保護(hù)胃黏膜,抗氧化劑、葉酸等治療手段。目前沒有明確有效的手段。中醫(yī)藥在治療、干預(yù)慢性萎縮性胃炎伴腸上皮化生的臨床實(shí)踐中有著突出的優(yōu)勢(shì)。中醫(yī)各家在治療本病時(shí)有著不同的認(rèn)識(shí)及臨證經(jīng)驗(yàn)。我們通過前期對(duì)慢性萎縮性胃炎伴腸上皮化生進(jìn)行的證候?qū)W調(diào)查結(jié)果,我們采用了理氣活血解毒法治療本病,有待于通過進(jìn)一步研究證實(shí)其療效,探索其機(jī)制。本研究觀察分析了理氣活血解毒法治療慢性萎縮性胃炎伴腸上皮化生中肝胃郁熱,氣虛血瘀患者39例。根據(jù)其治療前后的癥狀、病理、CDX2、MUC2、Ki-67、Bcl-2、Bax表達(dá)水平變化,評(píng)價(jià)理氣活血解毒法治療IM的療效,嘗試分析理氣活血解毒法治療慢性萎縮性胃炎伴腸上皮化生可能的作用機(jī)制,同時(shí)豐富本病的理論和臨床診療基礎(chǔ)及依據(jù)。本研究分兩部分:第一部分總結(jié)撰寫中西醫(yī)綜述,總結(jié)CAG伴IM的認(rèn)識(shí)及研究進(jìn)展。第一篇闡述慢性萎縮性胃炎伴腸上皮化生相關(guān)的中醫(yī)學(xué)認(rèn)識(shí)。第二篇總結(jié)現(xiàn)代醫(yī)學(xué)對(duì)慢性萎縮性胃炎伴腸上皮化生的研究進(jìn)展。第二部分臨床研究通過觀察慢性萎縮性胃炎臨床治療前后癥狀、組織病理、免疫組化等相關(guān)指標(biāo)的變化,觀察理氣活血解毒法對(duì)CAG伴IM的療效,探討理氣活血解毒法干預(yù)慢性萎縮性胃炎伴腸上皮化生的作用機(jī)制。方法:本課題觀察來源于2014.09-2016.12就診于北京中醫(yī)藥大學(xué)東直門醫(yī)院的慢性萎縮性胃炎伴腸上皮化生,肝胃郁熱,氣虛血瘀患者39名。對(duì)于符合納入標(biāo)準(zhǔn)的病例,予理氣活血解毒法方藥(醋柴胡10g、紫蘇梗10g、白花蛇舌草10g、生薏苡仁30g、莪術(shù)10g、太子參10g)口服治療,觀察治療前后癥狀、組織病理、CDX2、MUC2、Ki-67、Bcl-2、Bax表達(dá)水平變化,評(píng)價(jià)理氣活血解毒法治療IM的療效,嘗試分析理氣活血解毒法治療慢性萎縮性胃炎伴腸上皮化生可能的作用機(jī)制。結(jié)果:(1)中醫(yī)癥狀積分療效評(píng)價(jià):痊愈7例,占17.95%,顯效5例,占12.82%,有效22例,占56.41%,無效5例,占12.82%,總有效率87.18%。根據(jù)療前療后癥狀積分對(duì)比,發(fā)現(xiàn)胃痛、痞滿、反酸癥狀差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。暖氣、食欲減退、乏力癥狀差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。大便稀溏、口苦咽干、燒心、心煩易怒、呃逆、惡心嘔吐等癥狀差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)病理學(xué)療效評(píng)價(jià):痊愈9例,占23.08%,顯效6例,占15.38%,有效16例,占41.03%,無效8例,占20.51%,總有效率=痊愈率+顯效率+有效率=79.49%。療前療后腸上皮化生、異型增生的差異具有顯著統(tǒng)計(jì)學(xué)意義(P0.01),腺體萎縮、慢性炎癥沒有明顯差異(P0.05)。病理積分療前療后具有顯著差異(P0.01)。(3)治療前后 CDX2、MUC2、Ki67、Bcl-2、Bax表達(dá)差異治療前CDX2中度表達(dá)比例較高(74.36%)。MUC2中輕、中度表達(dá)比例較高(35.90%、46.15%),治療后CDX2輕、中度表達(dá)較高(46.15%、38.46%),MUC2陰性表達(dá)較高(43.59%)。治療前后Ki-67、Bcl-2均為中度表達(dá)比例較高。治療前后Bax均為陰性表達(dá)比例較高。在療前和療后進(jìn)行比較,發(fā)現(xiàn)CDX2差異有統(tǒng)計(jì)學(xué)意義(P0.05);MUC2差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。Ki-67、Bcl-2、Bax差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:(1)慢性萎縮性胃炎伴腸上皮化生收入病人年齡多在40-70歲之間,說明慢性萎縮性胃炎伴腸上皮化生多見于中老年人,符合對(duì)于慢性萎縮性胃炎的流行病學(xué)認(rèn)識(shí)。(2)通過癥狀積分、胃鏡及病理診斷,可證明理氣活血解毒法治療慢性萎縮性胃炎伴腸上皮化生療效可靠。(3)理氣活血解毒法可能是通過影響CDX2的表達(dá),進(jìn)而影響MUC2的表達(dá),從而影響胃粘膜腸上皮化生的進(jìn)程。
[Abstract]:Objective: Chronic Atrophic Gastritis with intestinal metaplasia is a precancerous disease. Intestinal metaplasia is a key step in precancerous lesions, so the intervention of intestinal metaplasia is the key to reduce the incidence of gastric cancer. The treatment of modern medicine for chronic atrophic gastritis with intestinal metaplasia and should be taken in order to the eradication of Hp, promote gastric motility, protect gastric mucosa, antioxidant and folic acid treatment. At present there is no clear and effective means. In the treatment of Chinese medicine, has a prominent advantage in clinical practice intervention of chronic atrophic gastritis with intestinal metaplasia. Various Chinese medicine have different understanding and clinical experience in the treatment of this when the disease investigation results. We through the early syndrome of chronic atrophic gastritis with intestinal metaplasia were, we adopt the method of regulating qi and activating blood in treating this disease detoxification, need to be further research confirmed its efficacy, to explore its mechanism. Study the Qi blood detoxification method with intestinal metaplasia in the liver and stomach syndrome in treatment of chronic atrophic gastritis, 39 cases of qi deficiency and blood stasis patients. According to their clinical symptoms, pathology, CDX2, MUC2, Ki-67, Bcl-2, the expression of Bax, evaluation of curative effect of Qi Huoxue Jiedu Decoction Treat IM, try to analyze the treatment of chronic atrophic gastritis with intestinal metaplasia of the possible mechanism of regulating qi and activating blood detoxification, and enrich the theory of disease and clinical basis. This research is divided into two parts: the first part summarizes the writing of Chinese and Western medicine review, summarize the progress of knowledge and research of CAG with IM. The first part of chronic atrophic gastritis intestinal metaplasia associated with TCM. The second article summarizes the research progress of modern medicine for chronic atrophic gastritis with intestinal metaplasia. The second part is clinical research through observation of clinical treatment of chronic atrophic gastritis Before and after the symptoms, pathological changes, immunohistochemistry and other related indicators, to observe the curative effect of Qi blood detoxification method on CAG with IM, and explore mechanisms of Liqi Huoxue Jiedu therapy in the treatment of chronic atrophic gastritis with intestinal metaplasia. Methods: This study observed the chronic atrophic gastritis from 2014.09-2016.12 treated at the Beijing University of Chinese Medicine hospital in Dongzhimen with intestinal metaplasia, liver stomach heat, Qi deficiency and blood stasis patients 39. For the cases that meet the inclusion criteria, to Qi Huoxue Jiedu prescription (vinegar Bupleurum 10g, perilla 10g, Oldenlandia 10g, raw coix seed 30g, Rhizoma Curcumae 10g, Radix Pseudostellariae 10g) oral treatment, observation of symptoms before and after treatment, the organization CDX2, MUC2, pathology, Ki-67, Bcl-2, the expression of Bax, evaluation of curative effect of Qi Huoxue Jiedu Decoction Treat IM, try to analyze with intestinal metaplasia may be the treatment of chronic atrophic gastritis Qi and activating blood detoxification Mechanism. Results: (1) the curative effect evaluation of TCM symptom score: 7 cases were cured, accounting for 17.95%, effective in 5 cases, accounting for 12.82%, effective 22 cases, invalid 5 cases, accounting for 56.41%, accounting for 12.82%, the total efficiency of 87.18%. according to the symptoms before and after treatment the integral comparison, found a stomachache, fullness, was statistically significant the significance of differences in symptoms of acid reflux (P0.01). The heating, loss of appetite, fatigue symptoms were statistically significant difference (P0.05). Loose stool, throat pain, heartburn, irritability, hiccups, nausea and vomiting and other symptoms had no significant difference (P0.05). (2) the pathological evaluation of curative effect: 9 cases were cured, accounted for 23.08%. Effective in 6 cases, accounting for 15.38%, effective 16 cases, invalid 8 cases, accounting for 41.03%, accounting for 20.51%, the total effective rate = ofabove remarkable rate + efficiency of =79.49%. before therapy of intestinal metaplasia, there was a statistically significant difference (P0.01), dysplasia of glandular atrophy, there was no significant difference between chronic inflammation (P0.05) the pathological scores of treatment. Before and after treatment with significant difference (P0.01). (3) before and after treatment, CDX2, MUC2, Ki67, Bcl-2, Bax expression of CDX2 before the treatment of moderate expression of a higher proportion (74.36%) in.MUC2 light, a higher proportion of moderate expression (35.90%, 46.15%), after treatment of CDX2 light, moderate high expression (46.15%, 38.46%). The negative expression of MUC2 was higher (43.59%). Before and after treatment Ki-67, Bcl-2 were moderate expression. A higher proportion of Bax before and after treatment were negative expression. A higher proportion in comparison before treatment and after treatment, found that there were significant differences in CDX2 (P0.05 MUC2); statistically significant (P0.01).Ki-67, Bcl-2, no significant differences in Bax (P0.05). Conclusion: (1) chronic atrophic gastritis with intestinal metaplasia patient income over the age between 40-70 years old, chronic atrophic gastritis with intestinal metaplasia is more common in the elderly, in conformity with the epidemiology of chronic atrophic gastritis (2) through the understanding. Symptoms, gastroscopy and pathological diagnosis, that Qi and activating blood detoxification in treatment of chronic atrophic gastritis with intestinal metaplasia (3). The curative effect is reliable Qi blood detoxification method may be affected by the expression of CDX2, thereby affecting the expression of MUC2, thus affecting the intestinal metaplasia of gastric mucosa in the process.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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