【作者】 赵强；

【导师】 袁红霞；

【作者基本信息】 天津中医学院 ， 中医内科学， 2005， 硕士

【摘要】 【目的】 胃癌是危害我国人民生命健康、发病率最高的恶性肿瘤之一,而胃癌前期病变的研究对胃癌的预防和治疗具有十分重要的意义。但由于本病病因尚未完全阐明,现代医学尚无令人满意的治疗手段,虽然中医药在本领域的研究取得了令人瞩目的进展,但尚无重大突破,对该病的研究仍存在很多问题,以往的研究大多停留在临床报道阶段,未进行严格的科研设计,尤其将分子生物学手段运用于该病的中医药研究,急需进一步深入探讨。 本论文拟通过进行临床观察和实验研究,对胃癌前期病变患者的临床症状、胃镜征相等进行观察,并对胃癌前期病变组织的相关基因蛋白等指标进行监测,为胃癌前期病变的中医诊治和临床用药提供指导。 【方法】 将60例胃癌前期病变患者随机分为2组,即治疗组和猴头菌片对照组(以下简称对照组),其中治疗组30例,对照组30例。治疗组给予善胃方冲剂,对照组应用市售成药猴头菌片,3个月为1疗程,服药2个疗程。治疗期间停服一切影响本临床研究的药物。观察治疗前后临床症状、内镜征象、组织病理学、胃粘膜组织相关基因蛋白(ras原癌基因P21蛋白和抑癌基因P16蛋白)表达的变化情况。 【结果】 1.临床实验结果表明,治疗组治疗后总体疗效优于对照组。 2.内镜疗效评定发现,治疗组胃镜征象改善有效率明显高于对照组。其中,治疗组对胆汁返流的改善更为明显。病理疗效评定发现,治疗组粘膜萎缩、肠化及异型增生积分经治疗后显著降低,与对照组相比,有显著性差异。 3.幽门螺杆菌感染情况比较发现,治疗组治疗后Hp感染阳性率较对照组明显降低,两组间有显著性差异,与病理逆转具一致性。 4.治疗组治疗后结果与治疗前相比,ras癌基因p21的表达水平显著降低,而对照组治疗前后相比无明显变化。可见胃癌前病变患者的ras癌基因p21的表达水平较高,中药善胃系列方可以明显降低其表达水平。更多还原

【Abstract】 Objective:As one of highest morbidity of malignant tumor, gastric cancer endangers people’s health in China. The research on precancerous lesions of gastric cancer will be significant both in prevention and treatment of the disease. Because of the unknown of the cause of the disease, there is no satisfactory therapeutic way in modern medicine so far. Although TCM has made an impressive progress in the research of this field, there still remains a lot of problems, and without any break-through. Further TCM research needs to be carried out, especially through molecular biology, since most of the previous researches remain only in clinical reports or without any strict scientific designs.Through clinical observation and experimental research, the clinical symptoms and endoscope’s signs have been observed, and the relevant gene proteins of the precancerous lesions of gastric cancer have been measured which guided the diagnosis and medicine in clinic of precancerous lesions of gastric cancer in TCM.60 cases of precancerous lesions of gastric cancer are divided into 2 groups at random, that is, Chinese herbal therapy group (observation group blow) and Hericium tablet on market sell in control group (control group blow), among which, 30 cases in observation group, and 30 cases in control group. Three month for one treat range, two treat ranges are observed. During being treated, the patiences were asked to stop using any medicines that can affect the clinical study. The clinical symptoms, endoscope’s signs, tissue pathogenesis and the expressive condition of relative gene of stomach mucous membrane tissue ( ras primary cancer gene p21 and cancer suppressor gene p16), before and after treatment have been observed respectively. Result:1. The results of clinical experiment illustrate that the general effect of Chinese herbal therapy group is better than that of the control group.2. The evaluation on effect of endoscope discovered that in Chinese herbal therapy group the effective rate in the improvement of the sign of endoscope isobviously higher than those in control group, among which the improvement of granular proliferation and bill regurgitation becomes more obvious. The evaluation on pathogenic effect also discovered that in therapy group the atrophy of mucous membrane, enteromalacia, and the integral of parahyperplasia are obviously lower after treatment, which there is significant difference compared with that of the control group.3. The comparison with the infectious condition of pylorus spirilum found out that the positive rate of Hp infection after treatment in Chinese herbal therapy group decreased obviously, and with the significant difference compared with the control groups, which coincide with pathogenic reversion.4. In Chinese herbal therapy group, there is significant decrease in the expressive level of ras cancer gene p21 after treatment comparing with that before treatment, and also obviously decreased comparing with that in control group after treatment, which clearly illustrated the patients suffering from prophase of carcinoma of stomach had higher expressive level of ras cancer gene p21, and Chinese herb benefiting stomach prescriptions can obviously decrease its expressive level.5. In Chinese herbal therapy group, there is significant increase in the expressive level of cancer suppressor gene pi6 after treatment comparing with that before treatment, while there was no significant change in the control group, which clearly showed the expressive level of cancer suppressor gene pi6 in patients suffering from prophase of carcinoma of stomach decreased, and Chinese herb benefiting stomach prescriptions can obviously increase its expressive level.Conclusion:1. Advance the hypothesis of traditional Chinese medicine symptom to change regularity in the prophase of stomach cancer .According to the relation of healthy qi > pathogenic factors, asthenia, sthenia, we regard, the disease is developing by sthenia of pathogenic factors - asthenia of helthy qi and sthenia of pathogenic factors-asthenia of helthy qi , in the prophase of the disease ,it is mainly blood stasis and pathogenic heat and toxin(sthenia of pathogenic factors); in metaphase ,the character of the disease is mostly asthenia of yin and pathogenic heat (asthenia of helthy qi and更多还原