Abstract:

Objective　To investigate the efficacy of Jianpi Huoxue formula combined with acupuncture and moxibustion for patients with precancerous lesions of chronic atrophic gastritis. Methods　Eighty patients with precancerous lesions of chronic atrophic gastritis treated at Xi'an Hospital of Traditional Chinese Medicine from December 2023 to December 2024 were selected for the randomized controlled trial. These patients were divided into a control group, treated with western medicine, and an observation group, treated with Jianpi Huoxue formula, acupuncture, and moxibustion, by the random number table method, with 40 cases in each group. There were 22 males and 18 females in the control group; they were (54.63±6.58) years old; their disease course was (5.63±2.54) years. There were 21 males and 19 females in the observation group; they were (55.10±7.52) years old; their disease course was (5.60±2.65) years. The scores of traditional Chinese medicine symptoms, gastric mucosal function, TLR4 inflammatory pathway, and serum tumor markers were compared between the two groups. ｔ and χ² tests were used for the statistical analysis. Results　After the treatment, the scores of major and minor symptoms and total score in the observation group were 4.01±0.12, 3.10±0.21, and 7.11±1.23, which were lower than those in the control group (5.10±0.66, 4.00±0.52, and 9.10±2.01) (t=10.276, 10.149, and 5.340; all P<0.05). The scores of gastric mucosal inflammation, glandular atrophy, intestinal metaplasia, and dysplasia in the observation group were 0.98±0.13, 0.35±0.03, 0.48±0.12, and 0.35±0.06, which were lower than those in the control group (1.91±0.31, 1.55±0.23, 1.34±0.24, and 1.23±0.17) (t=17.497, 32.720, 20.270, and 30.872; all P<0.05). The levels of Toll-like receptor 4 (TLR4), nuclear factor kappa B (NF-κB), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) in the observation group were (10.70±0.06)%, (620.90±10.44) ng/L, (30.78±3.90) ng/L, and (25.11±2.52) ng/L, which were lower than those in the control group [(15.98±0.31)%, (730.00±10.15) ng/L, (44.31±5.48) ng/L, and (35.97±3.31) ng/L] (t=105.758, 47.388, 12.722, and 16.510; all P<0.05). The levels of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 72-4 (CA72-4), and carbohydrate antigen 125 (CA125) in the observation group were (9.10±1.23) mg/L, (30.02±3.10) U/ml, (4.37±1.30) U/ml, and (17.58±2.37) U/ml, which were lower than those in the control group [(13.11±2.14) mg/L, (42.01±4.17) U/ml, (6.38±2.34) U/ml, and (25.35±3.41) U/ml] (t=10.274, 14.594, 4.748, and 11.833; all P<0.05). The overall incidence rate of adverse reactions in the observation group was lower than that in the control group (χ²=5.164; P<0.05). Conclusion　Jianpi Huoxue formula combined with acupuncture and moxibustion in the treatment of patients with precancerous lesions of chronic atrophic gastritis can effectively improve their gastric mucosal function, optimize the TLR4 inflammatory pathway, and reduce the risk of adverse reactions.

Key words:

Chronic atrophic gastritis, Precancerous lesions, Jianpi Huoxue , formula, Acupuncture and moxibustion, TLR4 inflammatory pathway, Gastric mucosal function

摘要：

目的　探讨健脾活血方联合针灸治疗慢性萎缩性胃炎癌前病变患者的效果。方法　选取2023年12月至2024年12月西安市中医医院收治的80例慢性萎缩性胃炎癌前病变患者进行随机对照试验。采用随机数字表法将其分为对照组（西药治疗）和观察组（健脾活血方联合针灸治疗），各40例。对照组男22例，女18例，年龄（54.63±6.58）岁，病程（5.63±2.54）年。观察组男21例，女19例，年龄（55.10±7.52）岁，病程（5.60±2.65）年。比较两组中医症状积分、胃黏膜功能、Toll样受体4（Toll-like receptor 4，TLR4）炎症通路以及血清肿瘤标志物等指标水平。采用ｔ检验和χ²检验进行统计分析。结果　治疗后，观察组主要症状积分、次要症状积分、总积分分别为（4.01±0.12）分、（3.10±0.21）分、（7.11±1.23）分，均低于对照组的（5.10±0.66）分、（4.00±0.52）分、（9.10±2.01）分（t=10.276、10.149、5.340，均P<0.05）。观察组胃黏膜炎症、腺体萎缩、肠上皮化生、异型增生评分分别为（0.98±0.13）分、（0.35±0.03）分、（0.48±0.12）分、（0.35±0.06）分，均低于对照组的（1.91±0.31）分、（1.55±0.23）分、（1.34±0.24）分、（1.23±0.17）分（t=17.497、32.720、20.270、30.872，均P<0.05）。观察组TLR4、核转录因子KB（nuclear factor kappa B，NF-κB）、白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor alpha，TNF-α）水平分别为（10.70±0.06）%、（620.90±10.44）ng/L、（30.78±3.90）ng/L、（25.11±2.52）ng/L，均低于对照组的（15.98±0.31）%、（730.00±10.15）ng/L、（44.31±5.48）ng/L、（35.97±3.31）ng/L（t=105.758、47.388、12.722、16.510，均P<0.05）。观察组癌胚抗原（carcinoembryonic antigen，CEA）、糖类抗原19-9（carbohydrate antigen 19-9，CA19-9）、糖类抗原72-4（carbohydrate antigen 72-4，CA72-4）、糖类抗原125（carbohydrate antigen 125，CA125）水平分别为（9.10±1.23）mg/L、（30.02±3.10）U/ml、（4.37±1.30）U/ml、（17.58±2.37）U/ml，均低于对照组的（13.11±2.14）mg/L、（42.01±4.17）U/ml、（6.38±2.34）U/ml、（25.35±3.41）U/ml（t=10.274、14.594、4.748、11.833，均P<0.05）。观察组不良反应总发生率低于对照组（χ²=5.164，P<0.05）。结论　健脾活血方联合针灸治疗慢性萎缩性胃炎癌前病变患者可有效改善患者胃黏膜功能，优化其TLR4炎症通路，降低不良反应发生风险。

关键词:

慢性萎缩性胃炎, 癌前病变, 健脾活血方, 针灸, TLR4炎症通路, 胃黏膜功能