对幽门螺杆菌相关性胃癌前病变的监测及中西医结合干预治疗

【作者】 卢娜；

【导师】 孔庆志；

【作者基本信息】 湖北中医学院 ， 中西医结合临床， 2007， 硕士

【摘要】 目的(1)探讨胃癌前病变、胃癌患者之间血清与胃组织HP、CEA表达的差异，为胃癌前病变的监测和治疗提供依据，为早期发现、诊断和治疗胃癌提供参考指标；(2)观察以黄芩为主的中药组方联合传统的三联疗法与三联疗法治疗胃癌前病变患者的疗效差异，了解黄芩组方对胃癌前病变患者HP感染的协同抑菌作用和胃黏膜保护作用，为根除胃癌前病变患者HP感染探索新的思路。方法(1)采用免疫层析一步法、蛋白芯片法测定血清HP、CEA，免疫组化S-P法测定胃组织HP、CEA；(2)将83例胃癌前病变患者随机分为三联疗法组和中药+三联疗法组。三联组胃溃疡患者予以奥美拉唑+阿莫西林+甲硝唑，萎缩性胃炎予以枸橼酸铋钾+阿莫西林+甲硝唑连用7天。联合治疗组在此基础上加用黄芩组方煎服，每日一利，连用3周。观察治疗前后临床症状的改善和胃组HP、CEA的改变。结果(1)癌前病变的各阶段及胃癌患者的血清及胃组织中均可检测到HP，血清及胃组织中HP的检出率以胃癌前病变组最高，胃癌组次之，浅表性胃炎中检出率较低。三组之间比较差异均有统计学意义(P＜0.05)，各组与正常组之间差异也均有统计学意义(P＜0.05)。胃组织HP检出率明显高于血清。(2)血清及胃组织CEA检测显示，胃癌组最高，其次为癌前病变组，浅表性胃炎中CEA的检出率较低，正常胃黏膜中未检出。胃癌组分别与癌前病变组及对照组比较差异有统计学意义(P＜0.01)。(3)对CEA阳性患者的阳性程度分析时发现，胃癌组++—+++的阳性率明显高于癌前病变组及浅表性胃炎组。此外，癌前病变组+—+++的阳性率均明显高于浅表性胃炎组。(4)中药+三联疗法组在症状的改善、根除HP感染和减低胃组织CEA等方面优于三联疗法组结论(1)HP参与了胃癌前病变和胃癌的发病过程，可把血清及胃组织Hp检测作为对癌前病变的初步监测及治疗观察指标之一。(2)血清及组织CEA检测可协助胃癌的诊断，并对慢性萎缩性胃炎、胃黏膜肠上皮化生、胃溃疡等癌前病变患者的监测有较为重要的价值。胃组织CEA检测明显优于血液中CEA的检测。血清与胃组织CEA协同检测可提高临床诊断率。(3)对Hp阳性的癌前病变患者动态检测血清及组织CEA更有助于对胃癌的早期发现、早期诊断和早期治疗。(4)以黄芩为主的中药组方联合三联疗法在治疗胃癌前病变可提高疗效。更多还原

【Abstract】 Objective (1) (?)o p(?)o(?)ide the basis for early de(?)eec(?)ion and treatment of preeanceous lesions of gastric carcinom. and reference for early discovery. diagnosis and treatment of gastric cancer. by examining the differences of expression of the CEA and Hp between precancerous lesions of gastric carcinoma patients and gastric cancer patients. (2)To understand synergism of fungistasis and protection of gastric mucosa on precancerous lesions patients, who were treated by the prescription mianly of Chinese traditional baical skullcap root, by observing the therapeutic effect of precancerous lesions of gastric carcinoma patients, who were treated by triple therapy or jointing traditional chinese medicine. Through this study we wanted to explore new ideas.Methods (1)Detected the expression of helicobacter pylori and carcinoembryonic antigen in blood serum by immunochromatographic method and Protein Chip System. Useing immunohistochemistray to detect the expression of helicobacter pylori and carcino-embryonic antigen in gastric mucosa. (2) 83 patients with precancerous lesions were classified triple therapy group and jointing traditional chinese medicine group. The modern medicine group was treated with omeprazole, amoxicillin and colloidal bismuth subcitrate for 7 days. The jointing traditional chinese medicine group on the basis of triple therapy group was treated with the prescription mianly of Chinese tr-aditional baical skullcap root for 21days. After treatment. observed the change on clinical symptoms, Hp and CEA.Results (1) The expression of Hp was deteced on every stages of precancerous lesions and gastric cancer. compared by the detection rate of Hp. precancerous lesions group was higher than gastric cancer group and superficial gastritis group, superficial gastritis group was the lolowest. The differences of the three groups were significant (P＜0.05). The detection rate of Hp in gastric mucosa was obviously higher than in blood serum. (2) Compared by the expression of CEA, the highest group was gastric cancer group. the lowest was superficial gastritis group, both in blood serum and gastric mucosa. The expression of CEA was not detected in nemal stomach mucosa.(3) Through analysis of the positive patients of CEA.found that the positive degree of gastriic cancer group was highest.and the preeancerous lesions group is obviously higher than superficial gastritis group.(4) Jointing traditional chinese medicine group was better than triple therapy group in the improvement of symptoms, the eradication of Hp,and reduction of the expression of Hp andCEA.Conclusion: (1)Hp participate the process of the precancerous lesions and gastric cancer.The expression of Hp could be one of the index ,which monitor the process and curative effect of the precancerous lesions. (2) The expression of CEA could help diagnosis of gastric cancer.It is important to moniitor the precancerous lesions. The expression of CEA in gastric mucosawas better than in blood serum.Detected CEA both in gastric mucosa and blood serum,which could raise the rate of clinical diagnosis.(3)Observering CEA of Hp positive patients was benefit for early discovery, diagnosis and treatment of stomach cancer.(4)jointing traditional chinese medicine could elevate curative effect ofprecancerous lesion.更多还原