慢性萎缩性胃炎胃黏膜癌前病变病理变化与中医证型及TRPV1、TRPM8的相关性研究

目的观察慢性萎缩性胃炎(CAG)癌前病变的病理变化与中医证型及瞬时电位受体(TRPV1、TRPM8)表达的相关性,为慢性萎缩性胃炎中医辨证提供更多的客观依据。方法选取内镜确诊CAG及病理确诊为CAG伴不典型增生或不同程度肠上皮化生患者317例,选取常规体检发现的无症状性浅表性胃炎10例作为对照,并进行TRPV1、TRPM8受体表达检测及CAG中医证型辨证,分析CAG的病理变化与中医证型及TRPV1、TRPM8表达的相关性。结果 1CAG前病变中医证型按照所占比率排序为脾虚气滞脾胃湿热脾胃虚弱肝胃不和胃阴不足胃络瘀阻。26种证型在TRPV1、TRPM8表达上存在显著性差异。TRPV1的表达的中医证型排序为脾胃湿热胃阴亏虚肝胃不和胃络瘀阻、浅表性胃炎脾虚气滞脾胃虚弱;TRPM8表达的中医证型排序为脾胃虚弱脾虚气滞胃络瘀阻、浅表性胃炎肝胃不和胃阴亏虚脾胃湿热。TRPV1以脾胃湿热表达最为明显(415 bp),TRPM8表达以脾胃虚弱最明显(387 bp)。胃络瘀阻型近似于浅表性胃炎胃黏膜表达。3同一证型在不同程度肠上皮化生分布上具有非常显著性差异(P均0.01);不同证型在同一程度肠上皮化生差异有显著性(P0.05);各证型在轻度异型增生分布上无显著性差异,在中、重度分布上有显著性差异(P均0.05),且以脾胃虚弱、胃阴不足及胃络瘀阻三型在重度异型增生时分布较高;各证型在轻、中、重度萎缩程度分布上具有显著性差异(P0.05或0.01)。结论 CAG癌前病变与中医证型之间及瞬时电位受体(TRPV1、TRPM8)表达之间存在一定相关性,病理程度较轻时以实证为主,并伴有TRPV1受体表达增高;病理程度中、重度时以虚为主,虚实夹杂表现多见,并伴有TRPM8表达增高。本研究为该病发病机制及治疗提供理论依据,为CAG中医辨证提供了更多的客观依据。

Study on correlation of pathological changes of chronic atrophic gastritis gastric mucosai precancerous lesions with TCM syndrome type and TRPV1, TRPM8

Objective It is to observe the correlation of pathological changes of chronic atrophic gastritis （ CAG） precan-cerous lesions with TCM syndrome type and transient receptor potential （TRPV1, TRPM8）, and provide more objective basis of TCM syndrome differentiation for CAG .Methods317 patients with CAG diagnosed by endoscopy and CAG with atypical hy-perplasia or different levels intestinal metaplasia diagnosed by pathology were selected ;10 cases with asymptomatic superficial gastritis found by regular physical examination were selected as a control .The detection of TRPV1 receptors , TRPM8 expres-sion and the CAG syndrome types of TCM syndrome differentiation were done , and the correlation of pathological changes of CAG with TCM syndrome type and the correlation of TRPV 1, TRPM8 expression were analyzed ,Results①The TCM syndrome type of CAG precancerous lesions were accorded to the sort of spleen deficiency and Qi stagnation 〉Spleen stomach damp heat 〉weakness of spleen and stomach 〉Liver stomach disharmony 〉Stomach yin deficiency 〉stomach collaterals stasis resistance .②There were significant difference in the expression of TRPV 1 and TRPM8 between the six TCM syndrome types . The syndrome types were sorted to Spleen stomach damp heat 〉Stomach yin deficiency 〉Liver stomach disharmony 〉stom-ach collaterals stasis resistance 〉spleen deficiency and Qi stagnation 〉weakness of spleen and stomach for TRPV 1 expres-sion and sorted to weakness of spleen and stomach 〉spleen deficiency and Qi stagnation 〉stomach collaterals stasis resist-ance 〉Liver stomach disharmony 〉Stomach yin deficiency 〉Spleen stomach damp heat for TRPM 8 expression .TRPV1 was expressed obviously in Spleen stomach damp heat type at 415 bp, TRPM8was expressed obviously in weakness of spleen and stomach type at387 bp.stomach collaterals stasis resistance type was similar the expression of superficial gastritis gastric mu -cosa.③There was significant difference in the same syndrome among different degrees of i