慢性萎缩性胃炎到早期胃癌的“炎-癌”中医证候演变特点研究

黄亚芳; 贺舜; 姚玉璞; 刘福生; 陈润花

doi:10.3969/j.issn.1671-038X.2024.11.11

慢性萎缩性胃炎到早期胃癌的“炎-癌”中医证候演变特点研究

- 1.
  北京中医药大学(北京，100029)
- 2.
  北京中医药大学东方医院脾胃肝胆科
- 3.
  中国医学科学院肿瘤医院内镜科
- 4.
  北京中医药大学东方医院急诊科
基金项目:
国家自然科学基金青年基金(No：81903792)；北京中医药大学揭榜挂帅项目基金(No：2023-JYB-JBQN-015)；北京中医药大学校级科研纵向发展基金(No：2021-ZXFZJJ-035)

详细信息

通讯作者: 陈润花，E-mail：excellentcrh@126.com

中图分类号: R256.3

收稿日期: 2024-05-12

刊出日期: 2024-11-15

Study on the evolution of traditional Chinese medicine syndrome of "inflammation-related carcinogenesis": from chronic atrophic gastritis to early gastric cancer

- 1.
  Beijing University of Chinese Medicine, Beijing, 100029, China
- 2.
  Department of Spleen, Stomach and Hepatobiliary, Dongfang Hospital, Beijing University of Chinese Medicine
- 3.
  Department of Endoscopy, Cancer Hospital, Chinese Academy of Medical Sciences
- 4.
  Department of Emergency, Dongfang Hospital, Beijing University of Chinese Medicine

More Information

Corresponding author: CHEN Runhua, E-mail: excellentcrh@126.com

Received Date: 12 May 2024

Publish Date: 15 November 2024

摘要

摘要: 目的研究慢性萎缩性胃炎(chronic atrophic gastritis，CAG)到萎缩背景下的早期胃癌(early gastric cancer，EGC)的中医证候演变规律。方法前瞻性横断面分析300例CAG和100例萎缩背景下的EGC患者的资料，根据幽门螺杆菌(Helicobacter pylori，HP)感染情况分为HP(+)CAG组、HP(-)CAG组、HP(+)EGC组、HP(-)EGC组，采用χ²检验得出CAG到EGC的中医证候演变规律。结果涉及CAG和EGC有3个病位要素：肝、脾、胃；7个病性要素：气虚、气滞、痰湿、热、阴虚、阳虚、瘀血；5个基本证型：脾胃虚弱证、脾胃湿热证、胃阴不足证、胃络瘀阻证、肝胃不和证。经χ²检验，气虚、阴虚、瘀血与EGC的相关性较高，气滞、痰湿、热、阳虚与CAG的相关性较高，对CAG而言，其病性要素相关性大小为：痰湿>热>气滞>气虚，阴虚>阳虚，气滞>瘀血>阳虚；EGC则刚好相反。在HP(+)条件下，CAG的病性要素相关性则为痰湿>热>气虚，气滞>阴虚>阳虚，痰湿>热>瘀血>阳虚；EGC则刚好相反。经χ²检验，脾胃虚弱证、胃阴不足证、胃络瘀阻证与EGC的相关性较高，肝胃不和证、脾胃湿热证与CAG的相关性较高；对于CAG而言，其证型相关性大小为：肝胃不和证>脾胃湿热证>脾胃虚弱证，脾胃湿热证>胃络瘀阻证>胃阴不足证；EGC则刚好相反。在HP(+)条件下则为脾胃湿热证>脾胃虚弱证，肝胃不和证>胃阴不足证，脾胃湿热证>胃络瘀阻证>胃阴不足证；EGC则正好相反；HP(-)条件下为肝胃不和证>脾胃虚弱证，肝胃不和证>胃络瘀阻证>胃阴不足证；EGC则刚好相反。结论 CAG阶段偏向于邪实，EGC阶段偏向于正虚；CAG阶段的邪实主要是痰湿、热、气滞，而EGC阶段的邪实主要是瘀血；CAG阶段的正虚是以阴虚为主，而EGC阶段的正虚以阳虚为主。随着疾病进展，EGC的瘀血程度比CAG更高，热毒不断侵扰，阴虚程度逐渐加重；在两个不同阶段，HP感染对证素、证型的影响有所差别。
- 慢性萎缩性胃炎 /
- 早期胃癌 /
- 幽门螺杆菌 /
- 证候演变
Abstract: Objective To study the evolution of traditional Chinese medicine(TCM) syndromes from chronic atrophic gastritis(CAG) to early gastric cancer(EGC) in atrophic background.Methods The clinical data of 300 patients with chronic atrophic gastritis and 100 patients with early gastric cancer under the background of atrophy were prospectively analyzed. According to Helicobacter pylori(HP), the patients were divided into HP(+) CAG group, HP(-) CAG group, HP(+) EGC group and HP(-) EGC group. The evolution of TCM syndrome from CAG to EGC was compared by χ² test.Results There were three sites involved in CAG and EGC: liver, spleen and stomach. Seven pathogenic factors: Qi deficiency, Qi stagnation, phlegm dampness, heat, Yin deficiency, Yang deficiency, and blood stasis.There are five basic syndromes: spleen and stomach weakness spleen and stomach dampness-heat, deficiency of stomach and Yin, stomach and collateral stasis of blood, and disconcerting of liver and stomach. By χ² test, "Qi deficiency", "Yang deficiency" and "blood stasis" are highly correlated with EGC, while "Qi stagnation", "phlegm-dampness", "heat" and "Yin deficiency" are highly correlated with CAG. For CAG, the correlation of syndrome elements is as follows: phlegm-dampness>heat>Qi stagnation>Qi deficiency. Yin deficiency>Yang deficiency, Qi stagnation>blood stasis>Yang deficiency; EGC is the opposite. Under HP(+) condition, phlegm-dampness>heat>Qi deficiency; Qi stagnation>Yin deficiency>Yang deficiency, phlegm-dampness>heat>blood stasis>Yang deficiency, EGC is the opposite. By χ² test, the syndrome of spleen and stomach weakness, deficiency of stomach Yin, stomach collateral stasis and EGC were highly correlated, while the syndrome of disharmony between liver and stomach, spleen and stomach dampness-heat and CAG were highly correlated. For CAG, the correlation of syndrome types was as follows: disharmony between liver and stomach>spleen and stomach dampness-heat>spleen and stomach weakness. Spleen and stomach dampness-heat syndrome>stomach collateral stasis syndrome>stomach Yin deficiency syndrome, EGC is the opposite. Under HP(+) condition, spleen and stomach damp-heat syndrome>spleen and stomach weakness syndrome; syndrome of disharmony between liver and stomach>syndrome of deficiency of stomach Yin; spleen and stomach dampness-heat syndrome>stomach collateral stasis syndrome>stomach Yin deficiency syndrome; for EGC, the opposite is true. Under HP(-) condition, syndrome of disharmony between liver and stomach>syndrome of weakness of spleen and stomach; syndrome of disharmony between liver and stomach>syndrome of blockage of stomach collagals>syndrome of deficiency of stomach Yin; EGC is the opposite.Conclusion CAG stage is biased towards bad accumulation, EGC stage is biased towards positive deficiency. The pathogenic flora in CAG stage is mainly phlegm dampness, heat and Qi stagnation, while the pathogenic flora in EGC stage is mainly blood stasis. Positive deficiency in CAG stage is mainly Yang deficiency, while positive deficiency in EGC stage is Yin deficiency. With the progression of the disease, EGC has a higher degree of blood stasis than CAG, heat toxicity constantly increases, and the degree of Yin deficiency is gradually aggravated. The influence of HP infection on syndrome elements and types differed between the two stages.
- chronic atrophic gastritis /
- early gastric cancer /
- Helicobacter pylori /
- syndrome evolution

HTML全文

表 1 CAG与EGC的病位要素分布例(%)

病位要素	CAG		EGC
病位要素	HP(+)	HP(-)	HP(+)	HP(-)
肝	59(19.7)	46(15.3)	29(29.0)	23(23.0)
脾	132(44.0)	86(28.7)	46(46.0)	28(28.0)
胃	87(29.0)	59(19.7)	30(30.0)	27(27.0)

下载: 导出CSV

表 2 CAG与EGC的病性要素分布例(%)

病性要素	CAG		EGC
病性要素	HP(+)	HP(-)	HP(+)	HP(-)
热	81(27.0)	68(22.7)	19(19.0)	17(17.0)
气滞	21(7.0)	20(6.7)	5(5.0)	2(2.0)
痰湿	79(26.3)	69(23.0)	11(11.0)	14(14.0)
阴虚	13(4.3)	10(3.3)	3(3.0)	2(2.0)
阳虚	16(5.3)	15(5.0)	16(16.0)	10(10.0)
气虚	75(25.0)	71(23.7)	42(42.0)	30(30.0)
瘀血	58(19.3)	52(17.3)	27(27.0)	21(21.0)

下载: 导出CSV

表 3 CAG和EGC的基本证型分布例(%)

证型	CAG		EGC
证型	HP(+)	HP(-)	HP(+)	HP(-)
脾胃虚弱证	88(29.3)	81(27.0)	45(45.0)	32(32.0)
胃阴不足证	16(5.3)	15(5.0)	16(16.0)	10(10.0)
肝胃不和证	51(17.0)	52(17.3)	13(13.0)	6(6.0)
胃络瘀阻证	58(19.3)	52(17.3)	27(27.0)	21(21.0)
脾胃湿热证	60(20.0)	44(14.7)	11(11.0)	13(13.0)

下载: 导出CSV

参考文献(22)

[1]	Fox JG, Wang TC. Inflammation, atrophy, and gastric cancer[J]. J Clin Invest, 2007, 117(1): 60-69. doi: 10.1172/JCI30111
[2]	中华医学会消化病学分会. 中国慢性胃炎共识意见(2017年, 上海)[J]. 中华消化杂志, 2017, 37(11): 721-738.
[3]	蒙仕祥, 陈卜伟, 冯永锋. 香茶花芽汤对脾胃虚弱型慢性萎缩性胃炎疗效及异型增生、腺体萎缩的改善研究[J]. 中华中医药学刊, 2023, 42(3): 96-99.
[4]	古文姝, 杨文臣, 王婷, 等. 中医药治疗慢性萎缩性胃炎的研究进展[J]. 中国医药导报, 2022, 19(31): 53-56.
[5]	段馨. 半夏泻心汤为主方加减治疗慢性萎缩性胃炎的临床疗效[J]. 中医临床研究, 2022, 14(14): 52-54.
[6]	吴灿, 邓行行, 罗燕文. 针灸联合加味香砂六君子汤对脾胃虚弱型慢性萎缩性胃炎中医证候、组织学及疗效的影响[J]. 中华中医药学刊, 2022, 40(7): 185-188.
[7]	胡宗轩, 常调芳, 李美娜, 等. 中医药治疗逆转慢性萎缩性胃炎癌前病变的研究进展[J]. 中医临床研究, 2022, 14(18): 117-119.
[8]	吕瑞民, 李吉, 乔美君. 回顾法研究962例慢性萎缩性与非萎缩性胃炎的中医证治规律[J]. 中国中医药现代远程教育, 2022, 20(4): 67-69, 89.
[9]	陈润花, 张厂, 苏泽琦, 等. 非萎缩性胃炎到萎缩性胃炎的中医证候演变研究[J]. 北京中医药大学学报, 2015, 38(5): 310-314.
[10]	张泰, 张北华, 马祥雪, 等. 慢性萎缩性胃炎炎-癌转化中医病机探析[J]. 中华中医药杂志, 2022, 37(11): 6414-6417.
[11]	游绍伟, 詹亚梅, 王文素, 等. 基于"脾虚宛滞"探讨慢性萎缩性胃炎"炎癌转化"与防治思路[J]. 中国实验方剂学杂志, 2023, 29(21): 188-195.
[12]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 幽门螺杆菌感染基层诊疗指南(实践版·2019)[J]. 中华全科医师杂志, 2020, 19(5): 403-407.
[13]	中华中医药学会脾胃病分会. 慢性胃炎中医诊疗专家共识意见(2017)[J]. 中华中医现代中医肿瘤学药杂志, 2017, 32(7): 3060-3064.
[14]	杨金坤. 现代中医肿瘤学[M]. 上海: 上海中医药大学出版社, 2004: 48-53.
[15]	林洪生. 恶性肿瘤中医诊疗指南[M]. 北京: 人民卫生出版社, 2014: 246-249.
[16]	朱文锋. 要素辨证学[M]. 北京: 人民卫生出版社, 2008: 167-169.
[17]	国家技术监督局. 中医临床诊疗术语证候部分: GB/T 16751.2-1997[S]. 北京: 中国标准出版社, 1997: 23-29.
[18]	徐迪华, 徐剑秋. 中医量化诊断[M]. 南京: 江苏科学技术出版社, 1997: 35-84.
[19]	赵静怡, 赵鲁卿, 张声生. 张声生以微观癥积论治慢性萎缩性胃炎伴低级别上皮内瘤变经验[J]. 北京中医药, 2020, 39(1): 31-35.
[20]	张传龙, 姜晓晨, 庞博, 等. 基于"热极成毒"理论探讨肺"炎-癌转化"与防治思路[J]. 北京中医药大学学报, 2022, 45(3): 291-295.
[21]	陈明歌, 刘松江. 从"初病在经, 久病入络"论治胃癌[J]. 西部中医药, 2022, 35(11): 108-111.
[22]	许戈林. 慢性萎缩性胃炎中医证型分布与病理特点分析[J]. 河南中医, 2022, 42(8): 1226-1230.