Efficacy of Piwei Peiyuan Decoction on patients with chronic atrophic gastritis with intestinal metaplasia of spleen-stomach weakness syndrome
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摘要: 目的 观察脾胃培源方对慢性萎缩性胃炎(CAG)伴肠上皮化生(IM)脾胃虚弱证患者的临床疗效。方法 选取安徽中医药大学第二附属医院2021年5月—2022年9月的56例CAG伴IM脾胃虚弱证的初诊患者作为研究对象。嘱患者口服脾胃培源方治疗24周，记录并比较治疗前后患者的临床证候积分、病理积分的变化；胃炎分期标准OLGA)、IM分期标准(OLGIM)分级分期积分变化；ELISA法检测血清胃蛋白酶原Ⅰ、Ⅱ(PGⅠ、PGⅡ)、PGⅠ/PGⅡ比值(PGR)、胃泌素-17(G-17)水平；RT-PCR技术检测治疗前后胃组织CDX2、MUC2 mRNA的相对表达量。结果 3例未完成胃镜及组织病理学检查，5例中途脱落。治疗后总有效率为93.75%(45/48)，患者的临床症候积分呈持续性下降(除第4周外，P < 0.05)，病理积分较治疗前也明显降低(P < 0.05)，OLGA、OLGIM分级分期积分也明显降低(P < 0.05)，血清PGⅠ、PGⅡ、PGR、G-17较治疗前明显升高(P < 0.05)，胃黏膜CDX2、MUC2 mRNA表达水平较治疗前明显降低(P < 0.05)。结论 脾胃培源方对CAG伴IM脾胃虚弱证患者疗效显著，且能降低此类患者罹患胃癌的风险。Abstract: Objective To observe the clinical efficacy of Piwei Peiyuan Decoction on patients with chronic atrophic gastritis(CAG) with intestinal metaplasia(IM) of spleen-stomach weakness syndrome.Methods Fifty-six patients diagnosed with chronic atrophic gastritic with intestinal metaplasia of spleen-stomach weakness syndrome in the Second Affiliated Hospital of Anhui University of Chinese Medicine were selected from May 2021 to September 2022. All the patients were treated with Piwei Peiyuan Decoction for 24 weeks, and the changes of the patients' clinical syndrome score, pathological score, integral changes of OLGA, OLGIM, the level of the serum pepsinogen Ⅰ, Ⅱ(PGⅠ, PGⅡ), the ratio of PGⅠ/PGⅡ(PGR). gastrin-17(G-17) by ELISA, the relative expression of CDX2 mRNA and MUC2 mRNA in gastric tissues by qRT-PCR were recorded and compared before and after treatment.Results Three cases did not complete gastroscopy and histopathological examination, and Five cases fell off halfway. The total effective rate after treatment was 93.75%(45/48), the clinical symptom score of patients decreased continuously(except for the 4th week, P < 0.05), the pathological score was significantly lower than that before treatment(P < 0.05), and the graded staging score of OLGA and OLGIM was also significantly reduced(P < 0.05). Serum PGⅠ, PGⅡ, PGR, G-17 levels were significantly higher than those before treatment(P < 0.05), The expression levels of CDX2 mRNA and MUC2 mRNA in the gastric mucosa were significantly lower than those before treatment(P < 0.05).Conclusion Piwei Peiyuan Decoction has a significant effect on patients with chronic atrophic gastritis with intestinal metaplasia of spleen-stomach weakness syndrome, and can reduce the risk of gastric cancer in such patients..
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表 1 CAG的OLGA分期系统
胃窦(角) 胃体 无萎缩 轻度萎缩 中度萎缩 重度萎缩 无萎缩 0期 Ⅰ期 Ⅱ期 Ⅱ期 轻度萎缩 Ⅰ期 Ⅰ期 Ⅱ期 Ⅲ期 中度萎缩 Ⅱ期 Ⅱ期 Ⅲ期 Ⅳ期 重度萎缩 Ⅲ期 Ⅲ期 Ⅳ期 Ⅳ期 
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表 2 CAG的OLGIM分期系统
胃窦(角) 胃体 无IM 轻度IM 中度IM 重度IM 无IM 0期 Ⅰ期 Ⅱ期 Ⅱ期 轻度IM Ⅰ期 Ⅰ期 Ⅱ期 Ⅲ期 中度IM Ⅱ期 Ⅱ期 Ⅲ期 Ⅳ期 重度IM Ⅲ期 Ⅲ期 Ⅳ期 Ⅳ期
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表 3 RT-PCR引物序列
名称 引物序列 CDX2 上游：5’-CATGCTAGGGAGAGTCCTG-3’ 下游：5’-TTTCACCGAGGCTGATCTG-3’ MUC2 上游：5’-CTACTGGTGTGAGTCCAAGG-3’ 下游：5’-CACTTGGAGGAATAAACTGGAG-3’ GAPDH 上游：5’-CAGGAGGCATTGCTGATGAT-3’ 下游：5’-GAAGGCTGGGGCTCATTT-3’
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表 4 治疗前后中医证候积分变化
分，X±S 时间 积分 治疗前 15.00±5.27 治疗后4周 12.56±4.61 治疗后8周 10.17±4.041) 治疗后12周 8.35±3.781) 治疗后16周 5.89±3.351) 治疗后20周 4.56±2.971) 治疗后24周 1.63±2.271) 与治疗前比较，1)P < 0.05。
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表 5 治疗前后胃镜病理积分变化
分，X±S 时间 胃体 胃窦 胃角 治疗前 萎缩积分 4.92±1.92 4.73±2.29 6.08±1.83 IM评分 5.79±1.72 5.61±1.51 5.93±1.86 治疗后 萎缩积分 1.88±2.49 3.11±2.99 2.10±2.79 IM评分 3.65±2.33 4.12±2.48 3.12±2.60
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表 6 治疗前后OLGA和OLGIM分级分期变化
例(%) 分期 OLGA OLGIM 治疗前 治疗后 治疗前 治疗后 0期 0 8(16.67) 0 3(6.25) Ⅰ期 0 10(20.83) 0 8(16.67) Ⅱ期 13(27.08) 22(45.83) 12(25.00) 25(52.08) Ⅲ期 24(50.00) 6(12.50) 23(47.92) 9(18.75) Ⅳ期 11(22.92) 2(14.17) 13(27.08) 3(6.25)
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表 8 治疗前后血清PGⅠ、PGⅡ、PGR、G-17水平变化
μg/L，X±S 时间 PGⅠ PGⅡ PGR G-17 治疗前 53.80±7.47 8.24±1.11 6.52±0.85 8.74±1.19 治疗后 101.90±11.54 10.84±1.50 10.32±1.15 11.85±1.51
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