Preliminary study on the effect and molecular action mechanisms of Jianpi Huayu Recipe in the treatment of patients with precancerous lesions of gastric cancer
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摘要: 目的 观察中药健脾化瘀方治疗胃癌前病变(PLGC)的疗效，并初步探讨其治疗机制。方法 选择2020年7月—2022年7月期间收治的118例PLGC患者，均予以中药健脾化瘀方口服，Hp阳性患者予以四联疗法根除Hp，疗程12周。比较118例PLGC患者治疗前后中医证候评分、胃黏膜组织病理评分，并比较治疗前后胃黏膜组织端粒重复序列结合因子1(TRF1) mRNA、p53 mRNA的表达情况，统计治疗总有效率。结果 治疗后118例PLGC患者主证胃脘痛、胃脘胀满及次证纳差、大便稀溏、倦怠乏力、面色晦暗评分均低于治疗前(P < 0.05)；黏膜萎缩、肠上皮化生、异型增生、黏膜炎症和炎症活动度低于治疗前(P < 0.05)；胃黏膜组织TRF1 mRNA、p53 mRNA相对表达量低于治疗前(P < 0.05)；治疗总有效率高达91.53%。结论 健脾化瘀方可改善PLGC患者中医证候和胃黏膜病理状态，治疗PLGC效果显著，其机制可能与下调胃黏膜组织中TRF1 mRNA、p53 mRNA的表达有关。
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关键词:
- 胃癌前病变 /
- 中药 /
- 健脾化瘀方 /
- 端粒重复序列结合因子1 /
- p53
Abstract: Objective To observe the effect of Jianpi Huayu Recipe on precancerous lesion of gastric cancer(PLGC) and explore its action mechanism.Methods One hundred and eighteen patients with PLGC admitted to the Department of Gastroenterology of our hospital from July, 2020 to July, 2022 were given Traditional Chinese Medicine(TCM) Jianpi Huayu Recipe for 12 weeks orally, and the patients with positive Helicobacter pylori were given 2-week quadruple therapy for Helicobacter pylori; the score of syndrome and gastric mucosa histopathology of 118 patients using TCM treatment was compared before and after treatment, the expression of telomere repeat binding factor 1(TRF1) mRNA and p53 mRNA in gastric mucosa was compared before and after treatment, and we counted the effective rate of TCM treatment.Results After treatment, the main syndromic epigastric pain, full epigastric distension, poor appetite, loose stools, the score of lethargy and dull complexion in 118 PLGC patients were all lower than that of patients before treatment(P < 0.05). The scores of mucosal atrophy, intestinal metaplasia, dysplasia, mucosal inflammation and inflammatory activity were lower than that of patients before treatment(P < 0.05), and the expression level of TRF1 mRNA and p53 mRNA in gastric mucosa was lower than that of patients before treatment(P < 0.05). The effective rate of Jianpi Huayu Recipe in the treatment of patients with PLGC was 91.53%.Conclusion Jianpi Huayu Recipe can improve the TCM syndrome and pathological state of gastric mucosa in PLGC patients, and it has significant therapeutic effect on PLGC. Its mechanism may be related to the down-regulation of TRF1 mRNA and p53 mRNA expression in gastric mucosa. -
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表 1 118例PLGC患者治疗前后中医证候评分比较
分，X±S 时间 例数 胃脘痛 胃脘胀满 纳差 大便稀溏 倦怠乏力 面色晦暗 治疗前 118 5.09±0.86 4.95±0.93 2.19±0.48 1.95±0.47 2.11±0.49 2.24±0.73 治疗后 118 1.29±0.41 1.11±0.34 0.76±0.25 0.64±0.19 0.77±0.28 0.81±0.29 t 43.327 42.126 28.702 28.070 25.792 19.776 P < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 < 0.05 
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表 2 118例PLGC患者治疗前后胃黏膜病理评分比较
分，X±S 时间 例数 黏膜萎缩 肠上皮化生 异型增生 黏膜炎症 炎症活动度 治疗前 118 4.85±1.78 5.60±1.89 4.75±1.80 2.28±0.69 1.76±0.47 治疗后 118 1.91±0.67 2.16±0.81 1.91±0.73 1.04±0.35 0.79±0.27 t 16.792 18.173 15.883 17.410 19.440 P < 0.05 < 0.05 < 0.05 < 0.05 < 0.05
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表 3 118例PLGC患者治疗前后胃黏膜组织TRF1 mRNA、p53 mRNA相对表达量比较
X±S 时间 例数 TRF1 mRNA p53 mRNA 治疗前 118 5.63±1.41 2.11±0.68 治疗后 118 3.83±1.01 0.98±0.33 t 11.274 16.240 P < 0.05 < 0.05
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