| Objective:Chronic atrophic gastritis with intestinal metaplasia is a kind of gastric precancerous disease.Intestinal metaplasia is a key step in precancerous lesions,so the intervention of intestinal metaplasia is the key to reducing the incidence of gastric cancer.The main treatment of the disease is to eradicate H.pylori,promote gastric motility,protect the gastric mucosa,antioxidants,folic acid and other treatment.There is no clear and effective means.Traditional Chinese medicine in the intervention of chronic atrophic gastritis with intestinal metaplasia in clinical practice has made outstanding advantages.In the treatment of the disease,different Medical specialists have different understanding and clinical experience.Through the early on chronic atrophic gastritis with intestinal metaplasia of the syndromes survey results,we used Qi and activating blood detoxification treatment of the disease.It is necessary to confirm its efficacy and explore its mechanism.This study was used to observe the treatment of chronic atrophic gastritis with intestinal metaplasia in patients with liver and stomach heat,Qi deficiency and blood stasis in 39 cases.The expression of CDX2,MUC2,Ki-67,Bcl-2 and Bax in the patients with chronic atrophic gastritis and intestinal epithelium were evaluated by the method of treating Qi and activating blood detoxification of the possible mechanism of action,while enriching the theory and clinical diagnosis and treatment of the basis.This paper is divided into two parts:the first part of the preparation of Chinese and Western medicine review,summed up the understanding of the disease and progress.The first summary of chronic atrophic gastritis with intestinal metaplasia related to Chinese medicine.The second summarizes the progress of modern medicine on chronic atrophic gastritis with intestinal metaplasia.The second part of the clinical study by observing the clinical treatment of chronic atrophic gastritis before and after the symptoms,histopathology,immunohistochemistry and other indicators to observe the effect of Qi and activating blood detoxificationon the disease,to explore the mechanism of treatment of CAG with IM.Methods:This study observed from 2014.09-2016.12 treatment in Beijing University of Traditional Chinese Medicine Dongzhimen Hospital of chronic atrophic gastritis with intestinal metaplasia,liver and stomach heat,Qi deficiency and blood stasis in 39 patients,who conformed the case of inclusion criteria.We treated them with Qi and activating blood detoxification treatment,observation of symptoms before and after treatment,The expression of CDX2,MUC2,Ki-67,Bcl-2 and Bax in the treatment of CAG with IM was evaluated by the method of treating Qi and activating blood detoxification in the treatment of IM.Results:(1)Traditional Chinese Medicine symptom scores evaluation:7 cases were cured,accounting for 17.95%,markedly effective in 5 cases,accounting for 12.82%,effective in 22 cases,accounting for 56.41%,5 cases,accounting for 12.82%,the total effective rate of 87.18%.According to the symptoms of points,found that after treatment of stomach pain,fullness,acid reflux symptoms P<0.01,the difference was statistically significant.Belching,loss of appetite,fatigue symptoms P<0.05,the difference was statistically significant.There were no statistically significant differences in symptoms such as loose stools,dry mouths,heartburn,upset irritability,hiccups,nausea and vomiting.(2)Pathological evaluation:9 cases were cured,accounting for 23.08%,markedly effective in 6 cases,accounting for 15.38%,effective in 16 cases,accounting for 41.03%,8 cases,accounting for 20.51%,the total effective rate = cure rate + Efficiency = 79.49%.After treatment,the difference of intestinal metaplasia,heterosexual hyperplasia was statistically significant.(P<0.01).However,glandular atrophy,chronic inflammation was no significant difference.There was significant difference between the two groups.(P<0.01)(3)The difference of CDX2,MUC2,Ki67,Bcl-2 and Bax expression before and after treatment.The proportion of expression of CDX2 before treatment was the moderate group.(74.36%).And the proportion of MUC2 was mild and moderate groups.(35.90%,46.15%).After the treatment,the proportion of expression of CDX2 was the mild and moderate groups(46.9%,38.46%)and the expression of MUC2 was negative expression groups(43.59%).Before and after treatment Ki-67,Bcl-2 were higher proportion of moderate expression.Bax was significantly higher in the negative expression before and after treatment.There was no significant difference with Ki-67,Bcl-2 and Bax.(P>0.05).There was significant difference between the two groups with CDX2 and MUC2(P<0.05),and the difference was statistically significant differences in learning.In conclusion:(1)chronic atrophic gastritis with intestinal metaplasia of patients with age more than 40-70 years old,indicating that chronic atrophic gastritis with intestinal metaplasia more common in the elderly,in line with the epidemiology of chronic atrophic gastritis understanding.(2)through the symptom score,endoscopy and pathological diagnosis,can prove Qi and activating blood detoxification treatment of chronic atrophic gastritis with intestinal metaplasia and reliable.(3)Qi and activating blood detoxificationmethod may be likely to affect the expression of CDX2,and thus affect the expression of MUC2,thus affecting the gastric mucosal intestinal metaplasia process. |
