Study On The Syndrome Elements In Precancerous State And Lesions Of Gastric Cancer

BackgroundGastric cancer is the third leading cause of cancer-related deaths,which seriously affecting the physical health of the Chinese people.Prevention is a crucial link among the countermeasures for gastric cancer while appropriate diagnosis and management of precancerous lesions can reduce the mortality rate to gastric cancer.And this is in line with the idea of treating diseases before they occur in traditional Chinese medicine.ObjectiveTo investigate the distribution of syndrome elements in the precancerous state and lesion of gastric cancer.MethodThe study is divided into three parts:literature study,expert questionnaire survey,and clinical case review.1.Literature researchA systematic and comprehensive collection of domestic literature on the distribution of syndrome elements in the precancerous state and lesion of gastric cancer was conducted to summarize the distribution of syndrome elements in the precancerous state and lesion of gastric cancer.OQAQ scale was used to evaluate literature review studies,and Joanna Briggs Institute’s(JBI)critical appraisal checklist for studies reporting prevalence data was used to evaluate clinical case studies.2.Questionnaire survey of expertsExperts in the fields of digestion and tumor of traditional Chinese and Western medicine were selected for the questionnaire survey.According to the summary of the literature research on the distribution of syndrome elements in precancerous state and lesion of gastric cancer,an expert questionnaire was prepared and distributed.The experts’ opinions were analyzed statistically after recovery.A second round of expert questionnaire was conducted for the disagreement items.3.Clinical case review studyA total of 282 patients who visited the Department of Gastroenterology of Guang’anmen Hospital from January 2019 to January 2022 and whose pathological diagnosis was clearly CAG,IM or GIN were extracted,screened and included in the study.After standardizing the names of symptoms and signs,the weight of syndrome elements was calculated according to Syndrome element Differentiation and the data was recorded.Results1.Literature researchThe syndrome element of disease location of precancerous state and lesions of gastric cancer in the existing research are mainly stomach,spleen and liver,and the syndrome element of disease characters include Qi stagnation,Qi deficiency,dampness,blood stasis,heat,etc.Quality of the literature review studies on the distribution of the syndrome element in precancerous state and lesions of gastric cancer are low because they often simply combine the data of the included clinical studies.Clinical case studies are lacking in sampling methods,sources of cases and diagnostic criteria.2.Questionnaire survey of expertsThe results of the first round of expert questionnaire show that most experts believe that the syndrome element of disease location of precancerous state and lesions of gastric cancer are stomach and spleen,and the syndrome elements of disease characters include qi stagnation,blood stasis,phlegm and qi deficiency,while experts had some differences on the syndrome elements of liver,Yin deficiency and Yang deficiency.In the second round of expert questionnaire survey,experts still did not reach consensus on the syndrome elements of liver(CV=0.44),Yin deficiency(CV=0.42)and Yang deficiency(CV=0.32).However,most experts believe that liver(90.32%experts),Yin deficiency(93.55%experts)and Yang deficiency(100%experts)can or should be included in the basic syndrome elements of the precancerous state or lesion of gastric cancer.3.Clinical case review study(1)The male to female ratio of patients with precancerous state and lesions of gastric cancer in the samples was 1:1.611,and the female was more than the male,the difference was statistically significant(P<0.05).The average age of the samples was 54.80±10.10,and the elderly who are elder than 40 years old were mainly(88.65%).(2)in the samples:CAG 67.73%,IM 93.97%and GIN 10.28%.The degree of CAG was positively correlated with the degree of IM(P<0.05,r≥0.3).(3)Syndrome elements of disease location:Stomach(95.39%)>spleen(13.83%)>liver(10.64%)>chest diaphragm(9.57%)>heart(1.42%)=mind(1.42%)>kidney(1.06%)=cell palace(1.06%)>large intestine(0.71%)=small intestine(0.71%)>lung(0.35%)=bladder(0.35%).Excess syndrome elements:Qi stagnation(81.91%)>food accumulation(32.98%)>dampness(21.99%)>blood stasis(9.93%)>phlegm(8.51%)=heat(5.32%)>Yang hyperactivity(1.06%)>blood heat(0.35%)=cold(0.35%)=drink(0.35%);Deficiency syndrome elements:Yang deficiency(17.73%)>Yin deficiency(12.41%)>Qi deficiency(9.93%)>blood deficiency(0.71%).Virtual-real(70.92%)>mixed virtual-real(21.63%)>virtual-real(7.45%).Stomach and qi stagnation,stomach and blood stasis,liver and qi stagnation,liver and Yin deficiency,qi stagnation and blood stasis,qi stagnation and Yin deficiency,food accumulation and blood stasis,Yang deficiency and qi deficiency syndrome element degree were positively correlated with statistical significance(P<0.05).ConclusionBased on literature,expert questionnaire and case review,we concluded that the main syndrome element of disease location of precancerous state and lesions of gastric cancer were stomach,spleen and liver,and the main syndrome element of disease characters were Qi stagnation,food accumulation,dampness,Yang deficiency,Yin deficiency,blood stasis and Qi deficiency.