Study On The Distribution Of TCM Syndrome Types Of Chronic Atrophic Gastritis With Intestinal Metaplasia Based On Histopathology

Objective:1.Through collecting and analyzing the clinical information of CAG patients with IM at different time points,combined with TCM syndrome,to summarize the distribution of TCM syndrome types in CAG patients with IM.2.Based on the observation of the expression of CDX2,p53 and Ki67,the TCM syndromes and molecular biological distribution of CAG with IM in gastric cancer were summarized,in order to realize the clinical accurate early diagnosis and treatment,strengthens to the CAG companion IM patient prognosis appraisal.Methods:This study included patients who had undergone more than two gastroscopy and tissue biopsies in the endoscope room and ward of WangJing Hospital of China Academy of Chinese Medical Sciences from November 2010 to November 2021.They met the diagnostic criteria of CAG with IM.The general data and information of the four diagnoses of traditional Chinese medicine were collected.Under the guidance of more than two deputy chief physicians,syndrome differentiation was re-performed by two chief pathologists to observe the expression of p53,CDX2 and Ki67.After the data were sorted into the database for statistical analysis,the expression of molecular markers in a TCM syndrome type was summarized.Results:A total of 172 histological samples from 76 patients were included in this study.76 patients were divided into progressive group and non-progressive group according to the presence or absence of Dys or Gin or GC at the endpoint.1.General population informationThere was no significant difference in sex and age groups(P>0.05).The average duration of disease was 59.47±24.07 months in the non-progressive group and 38.39± 26.15 months in the progressive group,the difference was statistically significant(P<0.001).2.TCM syndrome type informationThere was a significant difference between the liver-stomach qi stagnation syndrome and the spleen-stomach deficiency syndrome in the non-progressive group(P<0.05)There were significant differences in liver-stomach qi stagnation syndrome and stomach-yin deficiency syndrome between the two groups(P<0.05).3.Histopathologic informationThere were 4 pathological sites in 172 cases,and the gastric antrum was the most common site in the progressive group(P<0.001).There were 4 pathological types.Mild and moderate IM were the main types in the non-progressive group,and moderate IM was the main type in the progressive group.There was no significant difference between the two groups(P>0.05)There was significant difference between the two groups(P<0.001).4.Molecular marker expression information:Low proliferative activity(61.5%vs.46.8%)was found in Ki67,p53 positive expression(25.6%vs.53.2%)and CDX2 positive expression(74.4%vs.87.2%)in both groups at the start of the study.The positive expression of p53 was significantly different between the two groups(P<0.05),but the positive expression of Ki67 and CDX2 had no significant difference(P>0.05).At the end of the study,the expression of Ki67 was significantly lower in the non-progressive group than in the progressive group(P<0.001),and the positive expression of p53 was 10.3%vs.70.2%,respectively,the difference was statistically significant(P<0.001);the positive expression of CDX2 was 79.5%vs.83.0%(P>0.05).5.The relationship between TCM syndrome type and IM in CAG patientsThe TCM syndrome of the progressive group was mainly spleen-stomach deficiency syndrome at the beginning and deficiency of stomach-yin syndrome at the end(P<0.05).In the non-progressive group,the liver-stomach Qi stagnation syndrome was the main type of TCM syndrome,and the end point was liver-stomach Qi stagnation syndrome,the difference was not statistically significant(P>0.05).6.Progress in molecular markers and CAG with IMThe low proliferative activity was the main starting point and the low proliferative activity was the main end point in the Ki67 progression group(P>0.05),and the low proliferative activity was the main end point in the non-progression group,there was no significant difference(P>0.05).The positive expression rate of CDX2 was 87.2%at the beginning and 83.0%at the end,and there was no significant difference(P>0.05).The positive expression rate of CDX2 was 74.4%at the beginning and 79.5%at the end,there was no significant difference(P>0.05).The positive rate of p53 was 53.2%at the beginning and 70.2%at the end of p53 progression group,the positive rate of p53 progression group was 25.6%and the positive rate of p53 progression group was 10.3%,there was no significant difference(P>0.05).ConclusionFor patients with IM and CAG,middle-aged men are at higher risk of malignancy than women,and the TCM syndrome types of patients with or without CAG in this study were mainly different from those of patients with deficiency of stomach-yin,the expression of molecular markers in the progression group was different from that of Ki67 and p53 in the non-progression group,therefore,the combination of patients with histopathology and TCM syndrome type changes,the progress of the disease can play a role in the prognosis.