CAJ | 학술논문

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。 TR-PV1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（P＜0．05）；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（ P＜0．05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。目的：觀察慢性萎縮性胃炎（ CAG）癌前病變的病理變化與中醫證型及瞬時電位受體（TRPV1、TRPM8）錶達的相關性，為慢性萎縮性胃炎中醫辨證提供更多的客觀依據。方法選取內鏡確診CAG及病理確診為CAG伴不典型增生或不同程度腸上皮化生患者317例，選取常規體檢髮現的無癥狀性淺錶性胃炎10例作為對照，併進行TRPV1、TRPM8受體錶達檢測及CAG中醫證型辨證，分析CAG的病理變化與中醫證型及TRPV1、TRPM8錶達的相關性。結果①CAG前病變中醫證型按照所佔比率排序為脾虛氣滯＞脾胃濕熱＞脾胃虛弱＞肝胃不和＞胃陰不足＞胃絡瘀阻。②6種證型在TRPV1、TRPM8錶達上存在顯著性差異。 TR-PV1的錶達的中醫證型排序為脾胃濕熱＞胃陰虧虛＞肝胃不和＞胃絡瘀阻、淺錶性胃炎＞脾虛氣滯＞脾胃虛弱；TRPM8錶達的中醫證型排序為脾胃虛弱＞脾虛氣滯＞胃絡瘀阻、淺錶性胃炎＞肝胃不和＞胃陰虧虛＞脾胃濕熱。 TRPV1以脾胃濕熱錶達最為明顯（415 bp），TRPM8錶達以脾胃虛弱最明顯（387 bp）。胃絡瘀阻型近似于淺錶性胃炎胃黏膜錶達。③同一證型在不同程度腸上皮化生分佈上具有非常顯著性差異（P均＜0．01）；不同證型在同一程度腸上皮化生差異有顯著性（P＜0．05）；各證型在輕度異型增生分佈上無顯著性差異，在中、重度分佈上有顯著性差異（P均＜0．05），且以脾胃虛弱、胃陰不足及胃絡瘀阻三型在重度異型增生時分佈較高；各證型在輕、中、重度萎縮程度分佈上具有顯著性差異（ P＜0．05或0．01）。結論 CAG癌前病變與中醫證型之間及瞬時電位受體（ TRPV1、TRPM8）錶達之間存在一定相關性，病理程度較輕時以實證為主，併伴有TRPV1受體錶達增高；病理程度中、重度時以虛為主，虛實夾雜錶現多見，併伴有TRPM8錶達增高。本研究為該病髮病機製及治療提供理論依據，為CAG中醫辨證提供瞭更多的客觀依據。
목적：관찰만성위축성위염（ CAG）암전병변적병리변화여중의증형급순시전위수체（TRPV1、TRPM8）표체적상관성，위만성위축성위염중의변증제공경다적객관의거。방법선취내경학진CAG급병리학진위CAG반불전형증생혹불동정도장상피화생환자317례，선취상규체검발현적무증상성천표성위염10례작위대조，병진행TRPV1、TRPM8수체표체검측급CAG중의증형변증，분석CAG적병리변화여중의증형급TRPV1、TRPM8표체적상관성。결과①CAG전병변중의증형안조소점비솔배서위비허기체＞비위습열＞비위허약＞간위불화＞위음불족＞위락어조。②6충증형재TRPV1、TRPM8표체상존재현저성차이。 TR-PV1적표체적중의증형배서위비위습열＞위음우허＞간위불화＞위락어조、천표성위염＞비허기체＞비위허약；TRPM8표체적중의증형배서위비위허약＞비허기체＞위락어조、천표성위염＞간위불화＞위음우허＞비위습열。 TRPV1이비위습열표체최위명현（415 bp），TRPM8표체이비위허약최명현（387 bp）。위락어조형근사우천표성위염위점막표체。③동일증형재불동정도장상피화생분포상구유비상현저성차이（P균＜0．01）；불동증형재동일정도장상피화생차이유현저성（P＜0．05）；각증형재경도이형증생분포상무현저성차이，재중、중도분포상유현저성차이（P균＜0．05），차이비위허약、위음불족급위락어조삼형재중도이형증생시분포교고；각증형재경、중、중도위축정도분포상구유현저성차이（ P＜0．05혹0．01）。결론 CAG암전병변여중의증형지간급순시전위수체（ TRPV1、TRPM8）표체지간존재일정상관성，병리정도교경시이실증위주，병반유TRPV1수체표체증고；병리정도중、중도시이허위주，허실협잡표현다견，병반유TRPM8표체증고。본연구위해병발병궤제급치료제공이론의거，위CAG중의변증제공료경다적객관의거。
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 intestinal metaplasia ( all P<0. 01), and was significant difference in the degrees of intestinal metaplasia among the different syndrome type (all P<0.05);there was no significant difference in mild hyperplasia and were significant difference in medium and heavy hyperplasia among the different TCM syndrome type (all P<0.05).The type of weakness of spleen and stomach , Stomach yin deficiency and stomach collaterals stasis resistance were higher distribution in severe hyperplasia .There were significant difference in atrophy degrees among different TCM syndrome type (P<0.05 or 0.01).Conclusion there is a correlation between CAG precancer-ous lesions and TCM syndrome type or transient receptor potential (TRPV1, TRPM8) expression.Lesser extent of pathology is sthenic zheng mainly and with increasing of TRPV 1 receptors expression;moderate to severe pathological degree are deficiency zheng mainly, the inclusion of sthenic zheng and deficiency zheng is frequent , and with the increasing TRPM8 expression. This study provides a theoretical basis for the disease pathogenesis and treatment of TCM syndrome differentiation to the CAG provides a more objective basis .