| BackgroundPrecancerous lesions of gastric cancer refer to the histopathological changes with cancer risk,including metaplasia and dysplasia of intestinal epithelium of gastric mucosa,the latter is more recognized.It is usually accompanied by chronic atrophic gastritis.Scientific screening and effective treatment of precancerous lesions of gastric cancer are important two steps to reduce the incidence rate and mortality of gastric cancer.In modern medicine,there is still a lack of recognized and effective treatment,of which the eradication of Helicobacter pylori is the most concerned,but its effect on precancerous lesions of gastric cancer is still controversial.Traditional Chinese medicine plays an active role in promoting the histological reversion of pathological changes.The accuracy and standardization of syndrome identification is an important aspect to ensure the curative effect of traditional Chinese medicine.However,in clinical practice,the syndrome of traditional Chinese medicine often exists in combination.If we can find objective reference for the complex syndrome in terms of histopathology and molecular biology,it has important reference value for clinical syndrome differentiation and treatmentObjective1.Through the collection and analysis of PLGC patients' clinical information,we can synthesize the distribution law of TCM syndrome,so as to prove the pathogenesis characteristics.2.By observing the relationship between complex TCM syndromes and serological indexes(PGI,PG ?,PGR,G-17,CEA,CA724),pathological changes(atrophy degree and scope,intestinal degree and scope,intraepithelial neoplasia degree and scope),intestinal classification,mucin phenotype and immunophenotypic markers(MUC2,MUC5AC,MUC6,CD 10),the tissue of PLGC complex TCM syndromes was summarized Molecular biological characteristics,for clinical accurate syndrome differentiation to find possible objective reference indicators.3.By analyzing the correlation between PLGC pathological changes and clinical parameters,such as serological indicators,intestinal classification,mucin phenotype and immunophenotypic markers,the clinical characteristics of PLGC were summarized.Methods1.Research object:patients who were hospitalized in the outpatient,inpatient and Endoscopic Center of Xiyuan Hospital,Chinese Academy of traditional Chinese medicine from January 2018 to December 2019 were diagnosed as chronic atrophic gastritis with intestinal metaplasia and intraepithelial neoplasia by electronic gastroscopy and histopathology.2.Adopt cross-sectional survey design.Through face-to-face questionnaire survey,general data(gender,age,BMI,etc.),family tumor history,clinical symptoms,tongue vein,gastroscopy,pathological changes and other information were collected,and venous blood was collected for serological indicators(PG ?,PG ?,PGR,G-17,CEA,CA724)detection;histological paraffin sections were used for HE staining,ab-pas staining,immunohistochemistry staining The expression of MUC2,MUC5AC,MUC6 and CD 10 were analyzed.TCM syndrome type is determined by senior chief physician of spleen and stomach department according to diagnosis and treatment consensus and diagnosis standard,and extract TCM syndrome elements.3.Build the database,input the collected information and test index data,and analyze the TCM syndromes,pathological changes,serological indexes and immunohistochemical indexes by professional statisticians.Results1.128 patients were included in this study.(1)The ratio of male to female was 1:1.17,59 males(46.1%)and 69 females(53.9%).(2)Age:the average age of the patients was 57.41 1± 9.604 years.The average age of female was higher than that of male(P = 0.286>0.05).(30 BMI:23.56 ± 2.674.The BMI of male(24.41 ± 2.70)was higher than that of female(22.84 ± 2.45)(P=0.001<0.05)(4)History:HP infection in 14 cases(10.9%),family history of gastric cancer in 19 cases(14.8%),family history of other tumors in digestive tract in 15 cases(11.7%),family history of other tumors in 19 cases(14.8%).(5)Serological indexes:the mean level of PG I was(55.42 ± 45.59),PG ? was(5.36 ± 5.79),PGR was(12.95 ± 6.21),G-17 was(2.72 ±4.16),CEA was(3.87 ± 16.08),CA724 was(5.613 ± 14.01).(6)Histopathology:CAG with im 118 cases(92.2%),in10 cases(7.8%).The distribution of atrophy degree:66 cases(51.6%)>56 cases(43.8%)>6 cases(4.7%);70 cases(54.7%)>52 cases(40.6%)>6 cases(4.7%);10 cases of lgin,0 cases of HgIn.The lesion site:83 cases(64.8%)were atrophic and intestinal in antrum,45 cases(35.2%)were atrophic and intestinal in antrum.(7)Classification of intestinal metaplasia:67 cases(52.3%)were complete type of intestinal metaplasia,61 cases(47.7%)were incomplete type of intestinal metaplasia.(8)Mucin phenotype:83 cases of small intestine type(64.8%)were more than 45 cases of gastrointestinal mixed type(35.2%).(9)Immunophenotypic markers of mucin:CD 10 was positive in 83 cases,with a positive rate of 64.8%;MUC2 was all positive(100%),the positive rates of MUC5AC and MUC6 were 98.4%and 90.6%,respectively.2.PLGC complex TCM Syndrome Distribution:(1)Syndrome elements:The frequency from high to low was 84 times(65.6%)of qi stagnation,65 times(50.8%)of qi deficiency,57 times(44.5%)of blood stasis,54 times(42.2%)of damp heat,33 times(25.8%)of phlegm dampness,13 times(10.2%)of yin deficiency.(2)Complex TCM syndrome:The frequency is 44 times(34.4%)of spleen deficiency and qi stagnation,40 times(31.2%)of qi stagnation and blood stasis,30 times(23.4%)of spleen deficiency and blood stasis,20 times(15.6%)of spleen deficiency and damp heat,18 times(14.1%)of spleen deficiency and phlegm dampness,and 5 times(3.9%)of Qi and yin deficiency.(3)General information of complex syndrome:Gender:in spleen deficiency and qi stagnation syndrome and Qi Yin deficiency syndrome,female is higher than male(P=0.042,0.015<0.05);Age:the average age of qi stagnation and blood stasis group was higher than that of non qi stagnation and blood stasis group(P>0.05);BMI index:Qi Yin deficiency group(20.94 ± 2.72)was lower than non Qi Yin deficiency group(23.67±2.63)(P=0.024<0.05).(4)Serum indexes and TCM syndromes:the level of PG ? in the group of spleen deficiency and qi stagnation was lower than that in the group of non spleen deficiency and Qi Stagnation(P?0.024<0.05);PG ? and PG ? in the group of qi stagnation and blood stasis were lower than that in the group of non qi stagnation and blood stasis(P?0.001,0.003<0.05);The level of G-17 in spleen deficiency phlegm dampness group was higher than that in non spleen deficiency phlegm dampness group(P=0.021<0.05).(5)The degree of pathological changes of histopathology and syndrome elements of traditional Chinese medicine:Degree of lesion:In all patients,qi stagnation and spleen deficiency were the main symptoms,followed by damp heat,blood stasis and phlegm dampness,and yin deficiency was the least(P>0.05).The scope of pathological changes:atrophy and intestinal transformation of antrum:Qi stagnation>spleen deficiency>damp heat>blood stasis>phlegm dampness>Yin deficiency;atrophy and intestinal transformation of antrum:Qi stagnation>spleen deficiency>blood stasis>damp heat>phlegm dampness>Yin deficiency;intraepithelial neoplasia of antrum:spleen deficiency>Qi stagnation>damp heat>phlegm dampness>blood stasis>Yin deficiency.There was no significant difference in the scope of disease between syndrome elements(P>0.05).(6)Degree of pathological changes and complex syndromes of histopathology:Spleen deficiency and qi stagnation were the most common causes of mild atrophy,intestinal transformation and intraepithelial neoplasia,and qi stagnation and blood stasis were the most common causes of moderate and severe atrophy and intestinal transformation.There was no significant difference in the distribution of complex syndrome in the degree of pathological changes(P>0.05).There was no significant difference in the distribution of each complex syndrome in the lesion range(P>0.05).(7)Intestinal metatype:According to Chi square test,there was no statistical difference in the distribution of complex syndromes among the types of intestinal metaplasia.(8)mucin phenotype and complex syndrome:Spleen deficiency and qi stagnation are the most common in small intestine type,and spleen deficiency and blood stasis are the most common in gastrointestinal mixed type.According to Chi square test,there was no significant difference in the distribution of complex syndrome among mucin phenotypes(P>0.05).(9)Immunophenotypic markers:according to Chi square test,there was no significant correlation between complex syndrome and CD 10,MUC5AC,MUC6 expression(P>0.05).MUC2 was not analyzed for all positive.3.Clinical characteristics of PLGC lesions:(1)The mean age of patients with antral atrophy and intestinal metaplasia was higher than that of patients with antral atrophy or intestinal metaplasia(P=0.08,0.013<0.05).(2)Family history:family history of other tumors of digestive tract:the number of cases with mild intestinal metaplasia was more severe(P=0.007<0.05).Family history of extragastrointestinal tumors:atrophic and intestinal antrum>antrum body(P=0.044,0.027<0.05).(3)Serological indexes:Serological indexes:PG I and PGR decreased in moderate and severe atrophy(P=0.037,0.008<0.05);PGR of moderate and severe intestinal metaplasia was lower than that of mild intestinal metaplasia(P=0.003<0.05);PGR of moderate and severe intestinal metaplasia was lower than that of mild intestinal metaplasia(P=0.003<0.05).Pathological range:the levels of PG ? and PG ? in antrum were lower than that in antrum(P=0.002,0.026<0.05).(4)There was no significant difference in the distribution of intestinal metatype and mucin phenotype in the degree and scope of lesions(P>0.05).(5)Immunophenotypic markers:MUC6 did not express in 9 patients with antral intestinal metaplasia and 3 patients with antral intestinal metaplasia(P=0.007<0.05).There was no significant difference in the degree and range of pathological changes among CD10,MUC2 and MUC5AC(P>0.05).ConclusionsPLGC is characterized by qi stagnation and Qi deficiency,followed by blood stasis and damp heat,and phlegm dampness and yin deficiency are the least.PLGC complex syndrome mainly consists of spleen deficiency,qi stagnation and blood stasis,followed by spleen deficiency,blood stasis,spleen deficiency,damp heat,spleen deficiency and phlegm dampness,with the least deficiency of both qi and Yin.Spleen deficiency,combined with qi stagnation,blood stasis,damp heat,phlegm heat and yin deficiency,constitute the five main syndromes of PLGC.Qi stagnation and blood stasis are the important factors of PLGC.Mild atrophy and intestinal transformation are mainly due to spleen deficiency and qi stagnation,while moderate to severe atrophy and intestinal transformation are mainly due to qi stagnation and blood stasis.In mucin phenotype,spleen deficiency and qi stagnation are the main types of small intestine,and spleen deficiency and blood stasis are the main types of gastrointestinal mixed type.MUC6 is related to the scope of intestinal metaplasia,and no expression of MUC6 may be related to the intestinal metaplasia of the sinus body.The histopathological changes of PLGC were not related to intestinal metatype and mucin phenotype.PLGC complex syndrome was not related to intestinal classification,mucin phenotype and immunophenotypic markers.The complex syndrome is related to PG and G-17.Spleen deficiency and qi stagnation are related to the decrease of PG ?,qi stagnation and blood stasis are related to the decrease of PG ? and PG ?,and spleen deficiency and phlegm dampness are related to the increase of G-17.The extent and extent of PLGC are related to PG.With the increase of atrophic degree,PGI and PGR decreased;with the increase of intestinal metaplasia degree,PGR decreased;with the increase of atrophic range,PG ? and PG ? decreased.In clinical diagnosis and treatment,TCM complex syndrome should be combined with PLGC patients' pathological degree and scope,serological indexes PG and G-17 levels,so as to improve the diagnosis and treatment program. |
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