本文選題：CAG + 脾虛血瘀　； 參考：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:采取隨機、對照的方法,觀察健脾活血法治療慢性萎縮性胃炎(CAG)脾虛血瘀證的臨床療效及對轉化生長因子(TGF-β1),Smad3表達的影響,探討可能的作用機制。方法:根據(jù)本研究的納入標準,收集就診于江蘇省中醫(yī)院普內科門診符合CAG脾虛血瘀證診斷標準的患者共78例。采用數(shù)字隨機法將患者分為兩組,治療組40例,脫落2例,對照組38例,脫落3例,治療組予口服健脾活血方(炙黃芪15克,炒白術10克,炒苡仁15克,莪術10克,炒枳殼10克,佛手10克,雞內金10克,石見穿15克,每日1劑,水煎服,200ml,早晚各一次),共治療3個月;對照組予口服胃復春片(每次4片,每天3次),共治療3個月。觀察兩組患者治療前后的臨床癥狀、病理變化及治療組治療前后TGF-β1、Smad3表達的情況,進行統(tǒng)計學分析。結果:1.癥候療效比較:治療組患者38例,其中臨床治愈13例,顯效10例,有效11例,無效4例,總有效率達89.50%;對照組患者35例,其中臨床治愈2例,顯效6例,有效14例,無效13例,總有效率為62.86%。經(jīng)統(tǒng)計學分析P0.01,兩組癥候療效之間存在高度顯著性差異。說明治療組療效明顯優(yōu)于對照組。2.胃黏膜病理檢查比較:在改善患者胃黏膜萎縮、腸上皮化生的程度上,兩組治療前后積分對比具有高度顯著性差異(P0.01),且治療后兩組組間對比亦具有高度顯著性差異(P0.01),說明兩組均可以明顯改善患者胃黏膜萎縮及腸上皮化生,治療組明顯優(yōu)于對照組。3.治療組治療前后胃黏膜免疫組化病理比較:治療后TGF-β1及Smad3的表達比治療前顯著下降,具有顯著性差異(P0.05),且TGF-β1與Smad3的表達在治療前(r=0.793)與治療后的表達(r=0.735)均呈正相關(P0.05)。4.兩組在治療過程中,均無發(fā)現(xiàn)任何不良反應。結論:運用健脾活血法治療CAG脾虛血疲證可顯著改善患者的臨床癥狀,減輕萎縮、腸化的程度,并可以降低患者TGF-β1及Smad3蛋白的表達,提示健脾活血法可能通過改善胃黏膜血流量、誘導細胞分化、調節(jié)細胞增殖與凋亡、調節(jié)細胞免疫等機制達到治療CAG的目的。
[Abstract]:Objective: to observe the clinical effect of invigorating spleen and activating blood circulation in treating chronic atrophic gastritis with deficiency of spleen and blood stasis and its effect on the expression of TGF- 尾 1 and Smad3 in chronic atrophic gastritis (CAG). Methods: according to the inclusion criteria of this study, 78 patients with CAG spleen deficiency and blood stasis syndrome were collected from Department of General Medicine, Jiangsu Provincial Hospital of traditional Chinese Medicine. The patients were randomly divided into two groups with 40 cases in the treatment group, 2 cases in the control group and 38 cases in the control group. The treatment group was given orally the decoction of invigorating spleen and activating blood circulation (15 grams of Radix Astragali, 10 grams of Atractylodes macrocephala, 15 grams of fried lachrymine, 10 grams of zedoary curcuma, 10 grams of Rhizoma Curcumae). Fried Fructus Aurantii 10 grams, Buddhist hand 10 grams, chicken Neijin 10 grams, stone see wear 15 grams, daily 1 dose, decoction of water 200ml, morning and evening, once in the morning and evening, a total of 3 months, the control group was given oral Weifuchun tablet (4 tablets per day, 3 times a day, a total of 3 months). The clinical symptoms, pathological changes and the expression of TGF- 尾 1 Smad3 before and after treatment in two groups were observed and analyzed statistically. The result is 1: 1. There were 38 cases in the treatment group, including 13 cases of clinical cure, 10 cases of remarkable effect, 11 cases of effective and 4 cases of ineffectiveness, and the total effective rate was 89.50 cases, while in the control group, there were 2 cases of clinical cure, 6 cases of remarkable effect, 14 cases of effective and 13 cases of ineffectiveness. The total effective rate was 62.86. By statistical analysis P 0.01, there was a significant difference between the two groups. It shows that the curative effect of the treatment group is obviously superior to that of the control group. Comparison of pathological examination of gastric mucosa: in improving the degree of gastric mucosal atrophy and intestinal metaplasia in patients, The scores of the two groups were significantly different before and after treatment, and there was also a significant difference between the two groups after treatment, indicating that both groups could obviously improve the gastric mucosal atrophy and intestinal metaplasia, and the treatment group was obviously superior to the control group (.3). The expression of TGF- 尾 1 and Smad3 in the treatment group was significantly lower than that before and after treatment (P 0.05), and the expression of TGF- 尾 1 and Smad3 was positively correlated with the expression of TGF- 尾 1 and Smad3 before and after treatment. No adverse reactions were found in both groups during the course of treatment. Conclusion: the method of invigorating spleen and activating blood circulation can significantly improve the clinical symptoms, reduce the degree of atrophy and intestinal metaplasia, and decrease the expression of TGF- 尾 1 and Smad3 protein in patients with CAG. It is suggested that the method of invigorating spleen and activating blood circulation may be used to treat CAG by improving gastric mucosal blood flow, inducing cell differentiation, regulating cell proliferation and apoptosis, and regulating cellular immunity.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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