Ulcerative Colitis Carcinogenesis Risk Spleen Qi Deficiency Syndrome From The Clinical And Pathological Features

Objective:From the clinical, pathological features and cancer markers, deeply understand the scientific connotation of the spleen qi and stomach qi deficiency syndrome of ulcerative colitis (UC). At the same time comparing the clinical and pathological features of the two Chinese traditional medical syndromes of UC, so as to explore and evaluate the cancer risk of the spleen qi and stomach qi deficiency syndrome, meanwhile provide clinical data for the prediction of ulcerative colitis cancerization.Methods:71inpatients were diagnosed with ulcerative colitis in Guang’anmen Hospital and Wangjing Hospital, during the period from June1984to December2012. Patients are divided into two groups according to different Chinese medicine syndrome types:the spleen qi and stomach qi deficiency syndrome (35cases) and the internal accumulation of dampness-heat syndrome (36cases). The patients’personal data, clinical features, colonoscopy performance, histopathological features and genetic expression of p53、K-ras、 APC、KI-67are analyzed retrospectively.Result:1Personal data:There are21males and14females in the spleen qi and stomach qi deficiency syndrome group,27males and9females in the dampness-heat syndrome group. There is no obvious difference in the age distribution of the two groups.A significant difference in terms of duration, the average duration in the spleen qi and stomach qi deficiency syndrome group is69.3months and25.7%patients have been diagnosed with UC for more than10years, which is longer and higher than the dampness-heat syndrome group (24.7months,5.6%). In terms of those who happening all colitis and with a family history of colorectal cancer patients, the spleen qi and stomach qi deficiency syndrome group more than the dampness-heat syndrome group, but there is no statistically significant difference, and in the early onset and stress factors of two groups have no difference.2Clinical symptoms:The spleen qi and stomach qi deficiency syndrome group and the dampness-heat syndrome group have significant differences in symptom, both consisted with their respective characteristics of TCM syndrome type.3Clinical features:74.3%patients with spleen qi and stomach qi deficiency syndrome had chronic relapsing UC, however,55.6%patients with dampness-heat syndrome were initial onset UC. The UC lesions of the two groups mainly located at the rectum, rectosigmoid and left colon (respectively65.7%and72.2%). There have no difference between the two groups in Truelove severity degree and Southerland activity index.4Laboratory inspection:①ALT、AST、γ-GT、ALP、direct bilirubin、indirect bilirubin: the spleen qi and stomach qi deficiency syndrome group are all within the normal range; the dampness-heat syndrome group except2cases of ALT, AST, direct bilirubin on the high side,1cease of y-GT, ALP and indirect bilirubin on the high side, all normal; and there have no difference in two groups.②Hemoglobin (HB):In the spleen qi and stomach qi deficiency syndrome group,7patients are low and others are normal; In dampness-heat syndrome group9patients are on the low side, two groups have no difference.③Blood sedimentation (ESR):7cases of the spleen qi and stomach qi deficiency syndrome group are significantly higher and6cases are on the high side;7cases of the dampness-heat syndrome group are significantly higher and2cases are on the high side; there also no difference between two groups.5Colonoscopy performance:The extent of intestinal mucosal congestion, edema, erosion and bleeding was more severe in the dampness-heat syndrome group than in the spleen qi and stomach qi deficiency syndrome group with a statistically significant difference.6Histopathological features:Although no significant difference was detected, the number of pancolitis and dysplasia in the spleen qi and stomach qi deficiency syndrome group is larger than that in the another group. All patients with mucosal dysplasia are mild dysplasia.7Genetic expression:Between groups of p53genetic expression is not all the same, the positive rate of CAC positive control group> the CRC positive control group> UC spleen qi and stomach qi deficiency syndrome group associated with atypical hyperplasia group> UC dampness-heat syndrome group associated with atypical hyperplasia group> UC dampness-heat syndrome without the typical hyperplasia group> UC spleen qi and stomach qi deficiency syndrome without the typical hyperplasia group, and in addition to UC dampness-heat syndrome without the typical hyperplasia group, all were statistically difference than normal control group, but no statistical difference between the observation groups.Groups of Ki-67proliferation index is not all equal, which UC spleen qi and stomach qi deficiency syndrome group associated with atypical hyperplasia group and UC spleen qi and stomach qi deficiency syndrome without the typical hyperplasia group is highest.Except the CAC、CRC group has some positive expression, the expression of APC and K-ras are all negative.Conclusion:Patients with the spleen qi and stomach qi deficiency syndrome have more risk factors for ulcerative colitis associated colorectal carcinoma (CAC) than those with the dampness-heat syndrome. There is a certain reference value for Chinese medical syndrome to assess the risk of CAC in patients with ulcerative colitis.