基于网络药理学和实验验证研究柴胡疏肝散治疗慢性萎缩性胃炎的作用机制＊

目的 通过网络药理学的方法进行预测，再深一步进行动物实验验证来研究柴胡疏肝散治疗CAG的作用机制。方法 首先在TCMSP数据库中检索柴胡疏肝散的所有活性成分与药物靶点；通过收集PharmGkb、OMIM、GeneCards和DrugBank数据库中收录的慢性萎缩性胃炎的相关靶点。将药物靶点与疾病靶点进行映射筛选出交集靶点，将得到的交集靶点构建PPI网络与活性成分-共同靶点网络，并对其进行GO和KEGG富集分析。最后利用Vina软件进行分子对接实验验证，并通过免疫印迹法验证柴胡疏肝散对两种受体蛋白EGFR和STAT1的影响。结果 最终筛选得到柴胡疏肝散活性成分104个，潜在靶点238个，与慢性萎缩性胃炎的交集靶点52个；GO与KEGG富集分析分别得到2166条目和148条目，主要涉及到JAK-STAT信号通路、TNF信号通路、HIF-1信号通路等；分子对接结果显示EGFR、STAT1两个靶点能够与核心活性成分能够自发结合成较为稳定的构像；免疫印迹法实验证明柴胡疏肝散能够降低大鼠胃黏膜组织EGFR和STAT1蛋白表达。结论 通过网络药理学和实验验证，发现柴胡疏肝散可能通过调节EGFR和STAT1蛋白表达来共同调控胃黏膜细胞增殖与凋亡，进而发挥着治疗慢性萎缩性胃炎的效果，为深入进行柴胡疏肝散治疗慢性萎缩性胃炎的作用机制研究提供新思路和新方法。     

Comparison of the effectiveness of i-scan and conventional endoscopy in the detection of the endoscopic signs of atrophic gastritis: A clinical trial

Background and study aimsThis study aimed to determine whether the use of i-scan endoscopy provides additional benefits to conventional endoscopy in the diagnosis of gastric precancerous lesions.Patients and methodsA total of 120 patients with histologically-verified intestinal metaplasia (IM) or atrophic gastritis (AG) were prospectively evaluated by esophagogastroduodenoscopy. Endoscopic examinations were performed using i-scan and high-definition white-light endoscopy (HD-WLE). The diagnostic yields of both techniques and the number of targeted biopsies per patient were compared.ResultsA total of 318 suspicious lesions were detected in 108 patients with i-scan (n = 186) and 81 patients with HD-WLE (n = 132). The diagnostic yields of i-scan and HD-WLE were 81.6% (98/120) versus 77.5% (93/120), respectively (p > 0.05). When only targeted biopsies were taken into account, the diagnostic yields of i-scan and HD-WLE were 89.8% versus 65.4%, respectively (p < 0.05). The mean number of biopsies per patient for i-scan and HD-WLE were 3.27 (393/120) and 7.3 (882/120), respectively (p < 0.05). The mean endoscopic procedure times were 16 and 17 min for i-scan and HD-WLE, respectively (p > 0.05).ConclusionsAlthough targeted biopsies with i-scan were not found to be significantly superior to either targeted or random biopsies with HD-WLE, the number of biopsies required to confirm these lesions was much lower.     

人参、白术有效组分群对慢性萎缩性胃炎大鼠口腔、肠道菌群的影响

目的研究人参、白术有效组分群对慢性萎缩性胃炎大鼠口腔、肠道菌群的影响。方法将大鼠随机分为空白组、模型组、给药(人参白术有效组分群)组,用主动免疫法复制慢性萎缩性胃炎模型。HE染色、扫描电子显微技术观察胃黏膜组织显微及超微结构,高通量测序技术检测肠道及口腔菌群,利用SPSS软件进行相关性分析。结果人参、白术有效组分群能改善慢性萎缩性胃炎大鼠胃组织病理形态(P<0.05);增加大鼠肠道、口腔菌群多样性及丰富度(P<0.05);减少肠道、口腔中致病菌群(普雷沃氏菌科_UCG-003、梭杆菌属)的数目(P<0.05)。其中,大鼠病理学评分与其口腔、肠道菌群的丰度、多样性以及门、属水平上的差异菌具有相关性(P<0.05)。结论人参、白术有效组分群对慢性萎缩性胃炎大鼠有良好的保护作用,缓解胃黏膜萎缩,其作用机制可能与改善肠道和口腔菌群有关。     

降逆胃舒汤治疗萎缩性胃炎疗效及对患者病理评分的影响

目的:研究降逆胃舒汤对幽门螺杆菌感染致萎缩性胃炎病理评分的功效。方法:选取238例幽门螺杆菌感染致萎缩性胃炎患者作为本次研究观察对象,入选患者遵循随机数字表法平均分配入对照组与治疗组,对照组以常规西药四联疗法治疗,治疗组在对照组疗法的基础上给予降逆胃舒汤治疗; 治疗3个月后,观察两组患者HP清除率并随访6个月统计复发率,观察两组患者中医证候积分、胃黏膜胃镜征象积分、胃黏膜病理评分及血清胃泌素-17(G-17)、血清胃蛋白酶原Ⅰ、Ⅱ(PGⅠ、PGⅡ)、PGⅠ/PGⅡ比值(PGR)治疗前、后的变化情况。结果:治疗前两组患者各项中医证候、胃黏膜胃镜积分、病理评分及血清指标表达水平比较,差异无统计学意义(P>0.05); 治疗后两组患者各项中医证候、胃黏膜胃镜积分、病理评分及血清指标表达水平比较,差异有统计学意义(P<0.05),治疗组均优于对照组(P<0.05); 治疗后3个月时治疗组HP清除率为88.24%、对照组为73.11%,随访6个月治疗组复发率为3.81%,对照组为18.39%,两组HP根除率、复发率比较,差异有统计学意义(P<0.05)。结论:降逆胃舒汤能够提高幽门螺杆菌清除率并降低复发,更有效缓解幽门螺杆菌感染致萎缩性胃炎的各项中医证候,进一步改善患者胃黏膜病理评分与胃镜征象,更良好的调节患者血清指标。     

周晓虹教授治疗慢性萎缩性胃炎经验总结

周晓虹教授认为脾胃亏虚是慢性萎缩性胃炎发病的病机关键,而寒凝、气郁、血瘀及湿阻等则是重要的发病因素,采用健脾益气的方法治疗主证,兼用温阳、理气、活血、化湿等方法治疗兼证,同时结合辨病,宏观与微观互参,可以收到满意的疗效。     

Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology

BACKGROUND Helicobacter pylori(H.pylori)infection is known to prevent the occurrence of gastroesophageal reflux disease(GERD)by inducing gastric mucosal atrophy.However,little is known about the relationship between atrophic gastritis(AG)and GERD.AIM To confirm the inverse correlation between AG and the occurrence and severity of GERD.METHODS Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included.The grade of reflux esophagitis was evaluated according to the Los Angeles classification.Endoscopic AG(EAG)was categorized into six grades.Serologic AG(SAG)was defined as pepsinogen I≤70 ng/m L and pepsinogen I/II ratio≤3.0.The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.RESULTS In total,4684 individuals with GERD were compared with 21901 healthy controls.In multivariate logistic regression analysis,advanced age,male sex,body mass index>23 kg/m2,presence of metabolic syndrome,current smoking,and alcohol consumption were associated with an increased risk of GERD.Seropositivity for H.pylori immunoglobulin G antibodies was associated with a decreased risk of GERD.There was an inverse correlation between the extent of EAG and occurrence of GERD:Odds ratio(OR),1.01[95%confidence interval(CI):0.90-1.14]in C1,0.87(0.78-0.97)in C2,0.71(0.62-0.80)in C3,0.52(0.44-0.61)in O1,0.37(0.29-0.48)in O2,and 0.28(0.18-0.43)in O3.Additionally,the extent of EAG showed an inverse correlation with the severity of GERD.The presence of SAG was correlated with a reduced risk of GERD(OR=0.49,95%CI:0.28-0.87,P=0.014).CONCLUSION The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD.AG followed by H.pylori infection may be independently protect against GERD.     

慢性非萎缩性胃炎研究的知识图谱分析——基于VOSviewer和CiteSpace的计量分析＊

目的 本研究利用可视化工具VOSviewer和可视化工具CiteSpace对慢性非萎缩性胃炎的研究进行直观可视化分析，通过对该领域的主要研究热点、研究机构以及作者共被引分析，绘制出慢性非萎缩性胃炎研究发展的知识图谱。方法 检索中国知网（CNKI）近十年收录的相关期刊文献，采用VOSviewer和CiteSpace绘制其知识图谱。结果 共检索出1190条文献，其中符合纳入标准研究文献233篇。通过可视化表明，“幽门螺杆菌”“临床研究”和“临床观察”是突显强度最高的3个关键词。结论 通过知识图谱可视化分析，本研究得到慢性非萎缩性胃炎研究领域的具有影响力的作者、重要研究机构，进一步展示出慢性非萎缩性胃炎研究的热点领域。     

Adult‐onset inflammatory linear verrucous epidermal nevus: Immunohistochemical studies and review of the literature

Adult‐onset inflammatory linear verrucous epidermal nevus (ILVEN) is an uncommon cutaneous disease compared to childhood‐onset ILVEN. The typical histopathologic features are alternating parakeratosis and orthokeratosis with an absent granular layer underneath parakeratosis, in contrast to a thickened granular layer below the foci of orthokeratosis in psoriasiform epidermal hyperplasia. Herein, we present a 49‐year‐old woman with typical clinical and histopathologic characteristics of adult‐onset ILVEN, including linear arrangement of thick scaly papules and plaques localized on the medial side of her right leg, ankle, and foot. Immunohistochemical studies included involucrin, Ki‐67, and keratin‐10. Compared to the staining pattern in psoriasis, the expression of involucrin in this case was of lower intensity and localized to upper epidermal layers with relatively less extensive staining beneath regions of parakeratosis as compared to orthokeratosis; Ki‐67 showed lower basal layer proliferative activity; and keratin‐10 showed a greater intensity of staining within suprabasal epidermis.     

化肝煎合金铃子散加减治疗胆汁反流性胃炎肝胃郁热证的临床观察

目的 评价化肝煎合金铃子散加减治疗胆汁反流性胃炎（BRG）肝胃郁热证的疗效及对炎症因子和胃肠激素的影响。方法 按随机数字表法将150例患者分为对照组和观察组各75例。对照组脱落、失访5例，剔除2例，完成68例；观察组脱落、失访3例，剔除4例，完成68例。对照组口服达立通颗粒，1袋/次，3次/d，饭前服用。观察组给予化肝煎合金铃子散加减内服，1剂/d。两组疗程均为4周。进行治疗前胃镜检查，评价胆汁反流程度和胃镜下黏膜情况；进行治疗前后肝胃郁热证、慢性胃肠疾病患者报告临床结局（PRO）评价量表、焦虑自评量表（SAS），抑郁自评量表（SDS）评分；进行6个月随访，记录临床复发情况；检测治疗前后胃泌素（GAS），胃动素（MTL），胆囊收缩素（CCK），前列腺素E₂（PGE₂），肿瘤坏死因子-α（TNF-α），白细胞介素-8（IL-8）水平；进行安全性评价。结果 观察组胆汁反流程度评分、胃镜下黏膜评分和肝胃郁热证积分均低于对照组（P<0.01）；观察组PRO量表6个维度（消化不良、反流、排便、社会、心理、全身状态）评分均低于对照组（P<0.01）；观察组SAS和SDS评分均低于对照组（P<0.01）；观察组CCK水平低于对照组（P<0.01），GAS和MTL均高于对照组（P<0.01）；观察组PGE₂水平高于对照组（P<0.01），TNF-α和IL-8水平均低于对照组（P<0.01）；观察组中医证候疗效优于对照组（Z＝2.083，P<0.05）；观察组胃镜疗效优于对照组（Z＝2.104，P<0.05）；观察组临床复发率为20.37%（11/54），低于对照组的40.82%（20/49）（χ2＝5.105，P<0.05）。没有发现服用中药不良反应。结论 化肝煎合金铃子散加减治疗BRG肝胃郁热证患者，可改善临床症状，减轻焦虑、抑郁，提高患者生活质量，改善胆汁反流程度，促进胃黏膜的愈合，并可减轻炎症反应，调节胃肠激素，近期有较好的中医证候疗效和胃镜疗效，远期可降低复发率，且安全。