| ObjectiveOn the basis of chronic atrophic gastritis is associated with intestinal metaplasia and/or dysplasia known as precancerous lesions of gastric cancer(PLGC).Experts and scholars have proposed that "advancement of gastric cancer research into PLGC and timely intervention in the early or even early stage of the tumor may be the best way to reduce the incidence and mortality of gastric cancer." Therefore,how to effectively interfere with PLGC and cut off the progression of gastric cancer is the key to the prevention and treatment of gastric cancer.However,Western medicine has no definite conclusions about the etiology and mechanism of PLGC,and there is no specific treatment for the treatment.General symptomatic treatments,Such as eradication of H.pylori,protection of gastric mucosal barrier,application of antioxidants,etc,have no significant effect on reversing the development trend of PLGC.Traditional Chinese medicine has unique advantages in intervening PLGC in the clinical practice,not only can effectively control the development of the disease,but also can revers atrophy,IM,and even Dys.The research on the prevention and treatment of gastric cancer,it is obvious that TCM treatment research has become the focus of research at home and abroad.The application of Qi and activating blood detoxification method on the intervention of this study has shown that this method has a definite effect on atrophy,IM,and Dys in clinical treatment in recent years,but.its mechanism is not yet clear.Therefore,this study combines clinical symptoms,gastroscopy,pathological tissue and biological indicators PTEN,NF-?B,CDX2,Bcl-2,Ki-67 expression to study the precancerous lesions of CAG.It is no longer only stagnating in clinical efficacy studies,further from the molecular level to its mechanism of action.The research of this study consists of two parts:The first part is to explain the knowledge of precancerous lesions of chronic atrophic gastritis from the ancient times to the present,which is the relevant knowledge and research progress of Chinese medicine and modern medicine.The second part is clinical and experimental research to explore the efficacy and intervention mechanism of Qi and activating blood detoxification method on this disease.MethodThis research project uses self-contrast research methods.All the cases were treated at Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine from 2015.09 to 2017.12.There were 51 patients with gastroscope and pathological diagnosis of chronic atrophic gastritis precancerous lesions,TCM syndromes of liver and stomach stagnation fever,and Qi deficiency and blood stasis type.We treated them with Qi and activating blood detoxification treatment.Observe the improvement of clinical symptoms,gastric mirror image and histopathology before and after treatment,Observe the effect of this method on the expression levels of PTEN,NF-KB,CDX2,Bcl-2,Ki-67 by immunohistochemistry,and try to explore the possible mechanism of intervention of Qi and activating blood detoxification method on PLGC.result(1)Comparison of general conditionsThere is no difference in age distribution between different sexes;most patients are between 40-70 years old,and the more concentrated age group is between 50-60 years old;in terms of the degree of pathology,there is no difference in gender distribution between patients with atrophy,IM,and Dys.(2)TCM symptom score evaluation:3 cases were cured,accounting for 5.88%,markedly effective in 10 cases,accounting for 19.61%,effective in 32 cases,accounting for 62.75%,invalid in 6 cases,accounting for 11.76%,and the total effective rate was 88.24%.From the comparison of symptom scores after treatment,it can be seen that there are significant differences in the symptoms of stomach pain,fullness,fatigue,mouth pain,dry mouth and abnormal stool(P<0.01);the symptoms of acid reflux and heartburn were statistically significant(P<0.05);There was no significant difference in symptoms such as loss of appetite,belching,nausea,vomiting,and irritability(P>0.05).(3)Histopathological evaluation:9 cases were cured,accounting for 17.65%,markedly effective in 8 cases,accounting for 15.69%,effective in 22 cases,accounting for 43.14%,invalid in 12 cases,accounting for 23.53%,and the total effective rate was 76.47%.The difference in pathological improvement about atrophy,intestinal metaplasia,and dysplasia was statistically significant(P<0.01);there was no significant difference in chronic inflammation(P>0.05).The total score of pathology after treatment was statistically significant(P<0.01).There were significant differences in the degree of pathological grade changes before and after treatment of atrophy,intestinal metaplasia,and dysplasia(P<0.01);there was no significant difference in improvement of chronic inflammation(P>0.05).(4)PTEN,NF-KB,CDX2,Bcl-2,and Ki-67 expression and the positive rate distribution before and after treatment.The PTEN moderate expression ratio was higher(72.55%)before treatment,and the PTEN moderate and severe expression were higher(47.06%,41.18%)after treatment.The proportion of moderate expression of NF-KB was higher(50.98%)before treatment,and the light and moderate expression of NF-KB were higher(37.25%,45.10%)after treatment.The proportion of moderate expression of CDX2 was higher(56.86%)before treatment,and the light and moderate expression of CDX2 were higher(35.29%,39.22%)after treatment.The proportion of moderate and severe expression of Bcl-2 was higher(49.02%,41.18%)before treatment,and the moderate expression of Bcl-2 was higher(66.67%)after treatment.The Ki-67 moderate expression ratio was high before and after treatment.Before and after treatment,it can be seen that the expression of PTEN,NF-KB,and CDX2 had significant differences(P<0.05),and there was no significant difference in the expression of Bcl-2 and Ki-67(P>0.05).In conclusion(1)Most of the patients with precancerous lesions of chronic atrophic gastritis are between the ages of 40 and 70,and the more concentrated age group is 50-60 years old.This shows that the disease is more common in middle-aged and elderly patients,in line with the epidemiology of chronic atrophic gastritis understanding.(2)Before and after treatment,through clinical symptom scores,gastroscopy,pathological tissue diagnosis and scores can be concluded:Qi and activating blood detoxification treatment of precancerous lesions of CAG can effectively improve clinical symptoms,improve the gastroscopy and histopathology,and have certain effect on clinical treatment.(3)By immunohistochemical method,the expression of PTEN increased after treatment compared with before treatment.After treatment,the expression of NF-KB and CDX2 decreased compared with before treatment.After treatment,the expression of Bcl-2 and Ki-67 did not change significantly before treatment.(4)The Qi and activating blood detoxification method has a certain influence on the expression of PTEN,NF-KB,and CDX2,and may interfere with the regulation of related genes and the process of cell proliferation,differentiation,and apoptosis,thereby affecting the progression of gastric precancerous lesions. |
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