活血化瘀法治疗慢性萎缩性胃炎研究现状

大量研究表明慢性萎缩性胃炎（CAG）的病变过程与瘀血密切相关。中医认为本病病程较长,久病入络,瘀血阻滞,脉络不通则见痛、痞、胀诸症,采用在辨证论治的基础上辅以活血化瘀法,或用活血化瘀的基本方加减,或用活血化瘀的专方专病治疗CAG,可以显著提高了临床疗效。活血化瘀法可疏通经络、破瘀散结,恢复脾胃正常气血运行及生理功能;可改善微循环,促进局部炎症吸收,使萎缩腺体复生。     

Operative link for gastritis assessment vs operative link on intestinal metaplasia assessment

AIM:To compare the reliability of gastritis staging sys-tems in ranking gastritis-associated cancer risk in a large series of consecutive patients.METHODS:Gastric mucosal atrophy is the precancer-ous condition in which intestinal-type gastric cancer(GC)most frequently develops.The operative link for gas-tritis assessment(OLGA)staging system ranks the GC risk according to both the topography and the severity of gastric atrophy(as assessed histologically on the ba-sis of the Sydney protocol for gastric mucosa...     

碱性成纤维细胞生长因子对皮肤萎缩性瘢痕中成纤维细胞的作用

目的探讨人碱性成纤维细胞生长因子(bFGF)对豚鼠皮肤萎缩性瘢痕中成纤维细胞的作用。方法取实验用成年豚鼠20只,于脊柱旁两侧A,B,C三处皮肤分别人工造成萎缩性瘢痕后,实验组在A处真皮层注射50μg/L的bFGF0.1mL,隔日1次,共4次;在C处真皮层注射同剂量生理盐水作阴性对照,B处不作任何处理做空白对照。术后第21天切取瘢痕组织行病理切片,应用鼠抗人ki-67单克隆抗体行免疫组化,显微镜下计算增殖成纤维细胞所占百分率。结果实验组、阴性对照组和空白对照组切口瘢痕增殖成纤维细胞百分率分别为(7.63±1.42)%,(0.98±0.33)%和(1.22±0.34)%。实验组增殖成纤维细胞百分率与阴性对照组及空白对照组比较显著增高,差异有统计学意义(P<0.05)。结论 bFGF可以促进豚鼠皮肤萎缩性瘢痕中的成纤维细胞增殖。     

胃蛋白酶原在萎缩性胃炎筛查中的临床应用价值评估

目的 评价血清胃蛋白酶原(pepsinogen,PG)用于萎缩性胃炎(atrophic gastritis,AG)筛查的临床价值,确定适合我国人群的最佳筛选临界值和筛查方案.方法 人选因消化道症状到我院消化门诊及病房就诊并行胃镜检查的患者,根据内镜检查和胃黏膜组织学检查结果对受试者进行分组,以病理结果为判断AG金标准,采用受试者工作曲线(receiver operator characteristic curve,ROC曲线)比较PG Ⅰ、PG Ⅰ/PG Ⅱ比值、CEA、CA72-4、CA19-9和CA242用于AG筛查中的价值.结果 共人选受试者323例,分为正常对照组(148例)、慢性非萎缩性胃炎组(53例)、萎缩性胃炎组(95例,分为轻度萎缩48例、中度萎缩34例和重度萎缩12例)、胃溃疡组(17例)及胃癌组(10例).因胃癌组病例数少,未对该组进行统计学分析,慢性非萎缩性胃炎组、萎缩性胃炎组及胃溃疡组与正常对照组间年龄、性别、血清CA72-4、CA242、CA19-9及CEA的差异均无统计学意义(P＞0.05).PG Ⅰ及PG Ⅰ/PG Ⅱ比值在萎缩性胃炎组显著低于正常对照组和慢性非萎缩性胃炎组(P＜0.05).随胃粘膜萎缩严重程度的增加PGⅠ及PG Ⅰ/PG Ⅱ比值逐渐降低,但组间比较差异无统计学意义(P=0.057和P=0.200).PG Ⅰ/PG Ⅱ比值和PG Ⅰ对AG具有较好的筛选价值,ROC曲线下面积(AUC)分别为0.871和0.725,大于目前常用的指标CA72-4、CA242、CEA和CA19-9的AUC,差异具统计学意义(P＜0.05).PGⅠ/PG Ⅱ比值和PG Ⅰ筛选AG的最佳临界值分别为＜5.72和＜58.6ng/mL,此时筛选的灵敏度和特异性分别为:PGⅠ/PGⅡ比值为91.4％和65.1％,PG Ⅰ为81％和52.8％.综合考虑,推荐采用PGⅠ/PG Ⅱ比值＜5.72作为判断标准筛选AG,灵敏度可达到91.4％,特异性为65.1％.结论 血清PG Ⅰ及PG Ⅰ/PG Ⅱ比值可用于临床筛选AG患者,不仅有助于早期识别胃癌高风险个体,还能减少不必要的侵人性检查对患者带来的伤害.与传统的胃部肿瘤标志物相比,血清PG Ⅰ及PG Ⅰ/PG Ⅱ比值在筛选AG上具有更高的灵敏度和特异性.     

养胃汤治疗萎缩性胃炎68例疗效观察

目的:探讨中医治疗萎缩性胃炎的治疗效果。方法:将68例患者随机分为两组,治疗组采用中医治疗,对照组采用传统的方法治疗,对比分析疗效。结果:治疗组治愈了31例,好转3例,对照组治愈22例,好转7例,无效5例。结论:中医治疗萎缩性胃炎效果显著,治愈率高。     

人参丹参对萎缩性胃炎鼠模型胃黏膜保护及对Bcl-xL、Bax、TLR4和NF-κB p65表达影响随机平行对照研究

[目的]观察人参丹参对萎缩性胃炎鼠模型胃黏膜保护及对Bcl-xL、Bax、TLR4和NF-κBp 65表达影响。[方法]通过乙醇+去氧胆酸钠+氨水+吲哚美辛+饥饱失常综合法复制萎缩性胃炎鼠模型,连续4周使用人参、丹参不同配比平行对照干预,鼠灌胃量均为2mL∕100g。免疫组织化学法检测胃黏膜组织Bcl-xL、Bax、TLR4和NF-κBp 65表达。[结果]不同配比对Bcl-xL、Bax、TLR4和NF-κB p65表达均有不同改善作用,其中1∶1配比效果最显著(P<0.01)。[结论]人参和丹参可调节萎缩性胃炎鼠模型胃黏膜细胞凋亡因子Bcl-XL和Bax间的失衡,同时也可调节TLR4→NF-κB信号通路的失常。     

加减一贯煎治疗慢性萎缩性胃炎对照研究

[目的]观察加减一贯煎治疗慢性萎缩性胃炎的临床疗效。[方法]将90例患者分为两组,治疗组45例采用加减一贯煎治疗,对照组45例口服枸橼酸铋钾颗粒、维霉素片治疗。两组均以20d为1个疗程,治疗1个疗程后进行疗效判定。[结果]治疗组治愈率62.22%,总显效率88.89%;对照组治愈率20.00%,总显效率48.89%。两组治愈率比较(χ2=16.568,P=0.000);总显效率比较(χ2=16.797,P=0.000),治疗组疗效优于对照组。[结论]加减一贯煎治疗慢性萎缩性胃炎具有良好治疗作用。     

Chronic Atrophic Gastritis and Metachronous Gastric Cancer in Japanese Alcoholic Men With Esophageal Squamous Cell Carcinoma

Background: The risk of metachronous gastric cancer is high in Japanese with esophageal squamous cell carcinoma (SCC), especially in alcoholic men, suggesting a common background underlying the gastric and esophageal cancers. Methods: Endoscopic follow‐up ranging from 7 to 160 months (median, 47 months) after the initial diagnosis was performed in 99 Japanese gastric‐cancer‐free alcoholic men (56.8 ± 6.4 years) with esophageal SCC detected by an endoscopic screening examination. Chronic atrophic gastritis (CAG) assessed by the serum pepsinogen test and Helicobacter pylori status was compared between 90 of the 99 esophageal SCC cases and 180 age‐matched Japanese gastric‐ and esophageal‐cancer‐free alcoholic men. Results: The serum pepsinogen test showed a higher seroprevalence of severe CAG among the cases than among the age‐matched controls (35.4% vs. 14.2% for H. pylori‐seropositive, 71.4% vs. 7.7% for H. pylori‐indeterminate, and 17.1% vs. 9.8% for H. pylori‐negative, respectively; H. pylori status‐adjusted p = 0.0008), whereas their H. pylori status was similar. The accelerated progression of severe CAG observed in the Japanese alcoholic men with esophageal SCC suggests the existence of common mechanisms by which both esophageal SCC and H. pylori‐related severe CAG develop in this population. Metachronous gastric adenocarcinoma was diagnosed in 11 of the 99 gastric‐cancer‐free patients, and the cumulative rate of metachronous gastric cancer within 5 years was estimated to be 15% according to the Kaplan–Meier method. The age‐adjusted hazard ratios were 7.87 (95% confidence interval: 1.43 to 43.46) and 4.84 (1.16 to 20.21), respectively, in the patients with severe CAG in comparison with those without CAG and those without severe CAG. Inactive heterozygous aldehyde dehydrogenase‐2, a very strong risk factor for esophageal SCC in the alcoholics, was not associated with an increased risk of metachronous gastric cancer. Conclusions: Accelerated development of severe CAG at least partially explained the very high frequency of development of metachronous gastric cancer in this population.     

MEBO治疗萎缩性鼻炎20例报告

目的：探讨湿润烧伤膏治疗萎缩性鼻炎的疗效。方法：对２０例萎缩性鼻炎患者采用湿润烧伤膏治疗。结果：有效率１００％、优于以往传统的药物治疗方法。结论：湿润烧伤膏治疗萎缩性鼻炎起效快，使用方便，无任何毒副作用。     

Evolution of the Correa's cascade steps: A long-term endoscopic surveillance among non-ulcer dyspepsia and gastric ulcer after H. pylori eradication

BackgroundThis study is aimed toward investigating the evolution of each Correa's step after Helicobacter pylori eradication in a long-term follow-up and exploring the factors correlated with a high-risk of gastric cancer.MethodsA total of 1824 H. pylori-infected subjects were enrolled to receive screening endoscopy. Among them, 491 received surveillance endoscopy. The patients were divided into Correa's steps I to VI, from normal to gastric cancer. A group-based trajectory model was used to classify patients as persistent high-risk status or not.ResultsThe prevalence rates of positive corpus-predominant gastritis index (CGI) were 20%–40% in all age groups and Correa's steps IV-V increased >35% after 50 years based on screening endoscopy. Successful eradication of H. pylori regressed CGI after the 1st year-and-thereafter (P < 0.05) and decreased Correa's step progression (Relative risk 0.66 [95% CI 0.49–0.89], P = 0.01); however, it did not regress OLGA and OLGIM. Not only in steps IV-V, but also in step III, the patients had a risk of developing gastric cancer (11.13–76.41 and 4.61 per 1000 person-years). Age (Hazard ratio 1.012 [1.003–1.020], P = 0.01), OLGA stages ≥ I (2.127 [1.558–2.903], P < 0.001), and OLGIM stages ≥ I (1.409 [1.119–1.774], P = 0.004) were correlated independently with a persistent high-risk status.ConclusionThe patients in Correa's steps III-V, but not I-II, were at risk of gastric cancer after H. pylori eradication. Age, OLGA stages ≥ I, and OLGIM stages ≥ I were independent factors correlated to a persistent high-risk of gastric cancer. The data may be useful when scheduling surveillance endoscopy for subjects in each Correa's step (NCT04527055).