| 284 | 0 | 84 |
| 下载次数 | 被引频次 | 阅读次数 |
慢性萎缩性胃炎（CAG）起病隐匿，存在向胃癌转化的潜在风险。基于中医络病理论，系统阐述CAG“气虚→血瘀→络损→毒瘀”的病机演变规律，认为胃络损伤是CAG炎-癌转化的核心病机。据此提出补虚以荣络、通瘀以畅络、解毒以护络的基本治则，以扶正通络解毒方为基本处方，并根据虚寒、湿热、阴虚、痰瘀等不同病理因素进行动态辨证、随症加减，为CAG早期干预提供理论支撑。
Abstract：Chronic atrophic gastritis(CAG) has an insidious onset, and some patients carry a potential risk of progression to gastric cancer. Based on the theory of collateral disease in traditional Chinese medicine, this paper systematically elucidates the pathogenesis evolution of CAG, from qi deficiency to blood stasis, collateral impairment and then toxin-stasis. Gastric collateral injury is considered the core mechanism underlying the inflammation-cancer transformation in CAG. Accordingly, the fundamental therapeutic principles include tonifying deficiency to nourish collaterals, removing stasis to unblock collaterals, and resolving toxins to protect collaterals. Fuzheng Tongluo Jiedu Formula(扶正通络解毒方) is established as the basic prescription, with dynamic syndrome differentiation and flexible modifications made according to different pathological factors such as deficiency-cold, dampness-heat, yin deficiency, and phlegm-stasis. This provides theoretical support for early intervention in CAG and the prevention of malignant transformation.
[1]SUNG H, FERLAY J, SIEGEL RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin, 2021, 71(3):209-249.
[2]XIA CF, DONG XS, LI H, et al. Cancer statistics in China and United States, 2022:profiles, trends, and determinants[J]. Chin Med J(Engl), 2022, 135(5):584-590.
[3]SUN L, JIN X, HUANG L, et al. Risk of progression in patients with chronic atrophic gastritis:a retrospective study[J]. Front Oncol, 2022, 12:942091. doi:10. 3389/fonc. 2022. 942091.
[4]RUGGE M, MEGGIO A, PRAVADELLI C, et al. Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer:a 5-year prospective study of1755 patients[J]. Gut, 2019, 68(1):11-17.
[5]CHEN X, DAI YK, ZHANG YZ, et al. Efficacy of traditional Chinese medicine for gastric precancerous lesion:a meta-analysis of randomized controlled trials[J]. Complement Ther Clin Pract, 2020, 38:101075. doi:10. 1016/j. ctcp.2019. 101075.
[6]谢晓妹，冉静纯，赵唯含，等.基于“虚瘀毒”理论的中医药治疗慢性萎缩性胃炎的Meta分析[J].中华中医药学刊，2020, 38(2):108-114.
[7]刘伟，潘华峰，王奇，等.健脾益气化瘀解毒法治疗慢性萎缩性胃炎伴癌前病变的系统评价与Meta分析[J].中华中医药杂志，2017, 32(11):5122-5128.
[8]江晓涛，李培武，杨泽虹，等.刘凤斌对慢性萎缩性胃炎“炎-癌”转化的病机探索与辨治思路[J].广州中医药大学学报，2024, 41(7):1880-1885.
[9]李红蓉，吴以岭.络病研究的传承与创新[J].南京中医药大学学报，2022, 38(12):1075-1085.
[10]李奕，庞博，花宝金，等.基于络病理论探讨恶性肿瘤的病机[J].中医杂志，2022, 63(15):1427-1430.
[11]刘一颖，李军，李赵陵，等.从脉络学说探讨中医药治疗微血管性心绞痛研究进展[J].世界中西医结合杂志，2025, 20(7):1465-1469.
[12]黄兹高，黄律，黄胜，等.黄芪建中汤合良附丸对慢性萎缩性胃炎患者胃黏膜血流量及血清氧化应激指标的影响[J].现代中西医结合杂志，2020, 29(18):1998-2002.
[13]李明莉，魏红，刘义帅.胃蛋白酶原、胃泌素-17和幽门螺旋杆菌抗体与萎缩性胃炎的相关性[J].临床医学研究与实践，2024, 9(24):191-194.
[14]张乃霖，石芳，郑晓佳，等.基于“缓中补虚”论治慢性萎缩性胃炎[J].中医杂志，2021, 62(15):1374-1376.
[15]YAO W, YANG HW, DING GH. Mechanisms of Qiblood circulation and Qi deficiency syndrome in view of blood and interstitial fluid circulation[J]. J Tradit Chin Med, 2013, 33(4):538-544.
[16]CHEN Y, ZHANG Y. Interpretation of the pathological mechanism of blood stasis in traditional Chinese medicine in light of understanding of hypercoagulable states in modern medicine[J]. Chin Med Nat Pro, 2025,5(1):30-34.
[17]WANG YP, XUE XH, ZHAO Z, et al. Hypoxia induced apoptosis of rat gastric mucosal cells by activating autophagy through HIF-1α/TERT/mTORC1 pathway[J]. Biocell,2022,46(7):1651-1659.
[18]ZHANG SX, SHEN Y, LIU H, et al. Inflammatory microenvironment in gastric premalignant lesions:implication and application[J]. Front Immunol, 2023, 14:1297101. doi:10. 3389/fimmu. 2023. 1297101.
[19]MACIP S, IGARASHI M, BERGGREN P, et al. Influence of induced reactive oxygen species in p53-mediated cell fate decisions[J]. Mol Cell Biol, 2003, 23(23):8576-8585.
[20]ZUO W, YANG H, LI NS, et al. Helicobacter pylori infection activates Wnt/β-catenin pathway to promote the occurrence of gastritis by upregulating ASCL1 and AQP5[J]. Cell Death Discov, 2022, 8(1):257.
[21]WAN YY, FLAVELL RA.'Yin-Yang'functions of transforming growth factor-beta and T regulatory cells in immune regulation[J]. Immunol Rev, 2007, 220:199-213. doi:10. 1111/j. 1600-065X. 2007. 00565. x.
[22]YANG Y, LI SJ, TO KKW, et al. Tumor-associated macrophages remodel the suppressive tumor immune microenvironment and targeted therapy for immunotherapy[J]. J Exp Clin Cancer Res, 2025, 44(1):145.
[23]GROTH C, HU XY, WEBER R, et al. Immunosuppression mediated by myeloid-derived suppressor cells(MDSCs)during tumour progression[J]. Br J Cancer,2019, 120(1):16-25.
[24]吕宾.慢性胃炎OLGA/OLGIM分期及其临床意义[J].胃肠病学，2019,24(10):577-580.
[25]杨泽虹，麦紫涵，陈彦彤，等.扶正通络解毒方对慢性萎缩性胃炎“炎-癌”转化小鼠的作用及机制研究[J].中药新药与临床药理，2025, 36(3):338-348.
[26]YüCEL?，G?KARATOPRAK, A??KARA?B, et al.Immunomodulatory and anti-inflammatory therapeutic potential of gingerols and their nanoformulations[J]. Front Pharmacol, 2022, 13:902551. doi:10. 3389/fphar. 2022.902551.
[27]黄方，黄莉璇，吴彬，等.肉桂醛调节Shh/Gli1信号通路对幽门螺旋杆菌胃炎大鼠胃黏膜损伤的影响[J].安徽医学，2024, 45(2):135-141.
[28]ZHANG H, SHAN Y, WU Y, et al. Berberine suppresses LPS-induced inflammation through modulating Sirt1/NF-κB signaling pathway in RAW264. 7 cells[J]. Int Immunopharmacol, 2017, 52:93-100. doi:10. 1016/j.intimp. 2017. 08. 032.
[29]FU YJ, XU B, HUANG SW, et al. Baicalin prevents LPS-induced activation of TLR4/NF-κB p65 pathway and inflammation in mice via inhibiting the expression of CD14[J]. Acta Pharmacol Sin, 2021, 42(1):88-96.
[30]HUANG CC, CHEN YM, WANG DC, et al. Cytoprotective effect of American ginseng in a rat ethanol gastric ulcer model[J]. Molecules, 2013, 19(1):316-326.
[31]XUE ZY, SHI GG, FANG YY, et al. Protective effect of polysaccharides from Radix Hedysari on gastric ulcers induced by acetic acid in rats[J]. Food Funct, 2019, 10(7):3965-3976.
[32]WU ZW, ZHAO XK, MIYAMOTO A, et al. Effects of steroidal saponins extract from Ophiopogon japonicus root ameliorates doxorubicin-induced chronic heart failure by inhibiting oxidative stress and inflammatory response[J].Pharm Biol, 2019, 57(1):176-183.
[33]杨萍，黄清杰，李喜香，等.橙皮苷药理作用及机制的研究进展[J].中草药，2023, 54(21):7222-7231.
[34]耿晓桐，刘琦，花娇娇，等.半夏化学成分及药理作用研究进展[J].山西化工，2023, 43(9):53-54,61.
[35]黄礼闯，赵梦亭，桑夏楠，等.三棱-莪术药对化学成分及药理作用研究进展[J].中华中医药杂志，2021,36(11):6612-6616.
[36]杜芳，鱼麦侠，胡博帆，等.三棱-莪术药对抗肿瘤临床应用及作用机制研究进展[J].中国医药导报，2023, 20(2):39-42.
基本信息:
DOI：10.13288/j.11-2166/r.2025.20.006
中图分类号:R259
引用信息:
[1]安金琪,汪颖琦,吴慧,等.基于络病理论探讨慢性萎缩性胃炎炎-癌转化的防治[J].中医杂志,2025,66(20):2103-2108.DOI:10.13288/j.11-2166/r.2025.20.006.
基金信息:
国家自然科学基金（82474408,82474404）; 广东省自然科学基金（2023A1515011019,2024A1515012532）; 广州中医药大学第一附属医院国家中医药传承创新中心科研专项（2022ZD01）; 广州中医药大学中医学学科中医基础理论研究“揭榜挂帅”项目（2022JB04）; 广东省中医药局科研项目（20254027）