慢性萎缩性胃炎藏医证型分类与生物标记的相关性研究

The goals of this project are to differentiate syndrome types, and facilitate early detection and early diagnosis of chronic atrophic gastritis (CAG). CAG is a commonly-occuring disease in the digestive system.Western medical literature has reported that incidence increases by age and high altitude exposure, and is linked to Helicobacter pylori infection. In Tibetan medicine, it is called "phori" gastric disease, and affliates with badkan disease. The disease is highly prevalent among Tibetan populations, and is listed as one of the common precancerous lesions among gastric diseases on the Tibetan plateau. From empirical evidence, Tibetan medicine has demonstrated high effectivity in the prevention and treatment of CAG. Tibetan medical theoretical foundations and accumulated clinical experiences detail the distinctly unique treatment protocol, approach and medicine regiment for this gastric disease. However, differentiating syndrome types of chronic atrophic gastritis engenders significant dispute among physicians in the Tibetan medical field, which, consequently, hinders the establishment of a national standardized set of diagnostic criteria for each syndrome. This project will be based on Tibetan medical diagnostics, such as sphygmology, tongue analysis and patient query methods. Additionally, it will employ Western scientific methods, such as Delphi consultation methods, epidemiological analysis, and serum laboratory tests. This study will recruit at least 300 CAG patients with clinical symptoms, gastroscopic data, blood and urine laboratory biomarkers and other disease-related patient data. Then the study will statistically analyze the collected biomarkers and clinical data and examine the correlations between the Tibetan medical phori syndrome types and diagnostic assessments of chronic altrophic gastritis with the associated biological markers (e.g., Helicobacter pylori presence, serum gastrin G17, pepsinogen I, II) for each syndrome. Ultimately, the study will provide a basis for establishing correlations between the Tibetan medical and Western medical diagnostic criteria for each syndrome type for the more effective clinical diagnosis and treatment of chronic atrophic gastritis in the future. Through uncovering the relationships between syndrome types and biomarkers, this study is the first of its kind to offer scientific and measurable criteria for Tibetan medical diagnosis. This model study can promote the integratation of Western and Tibetan medicine, facilitate Tibetan medical modernization, and create a new era for studying clinical disease in Tibetan medicine.

慢性萎缩性胃炎（CAG）是高原地区最常见的一种消化道疾病，藏医称为"普如病"，属于"剑突培根病"、"胃铁锈症"、"胃衰症"等培根疾病范畴。其发病率在高原地区相对较高，随年龄增长而升高的趋势，具有很高的癌变率，被列为胃癌前主要疾病之一。 藏医药对CAG的疗效取得了良好的效果，积累了丰富的经验，发挥着藏医药的优势和特色。但藏医界对该病的证型分类方面有着不同的看法，这对进一步深入研究CAG的诊疗标准起着很大的阻碍。为了规范化藏医对CAG的认识，确定证型和证候分布规律，对制定CAG的诊断标准化提供科学依据。本课题将依据藏医诊断三诊（望、切、闻）辩证理论，采用文献调研、专家咨询、流行病学、检验方法，搜集300多名患者的体征、症状、以及相关的生物标记，对这些临床信息与检验指标的对应性进行数理统计。研究CAG的藏医证型，与临床证候和相关性生物标记的分布规律，对藏医药学现代化的进程将起到重要作用。

项目背景：为了规范化藏医对慢性萎缩性胃炎的认识，确定证型和证候分布规律，对制定慢性萎缩性胃炎的诊断标准化提供科学依据。本课题将依据藏医辩证理论，采用文献调研、专家咨询、流行病学、检验方法，搜集320多名患者的体征、症状、以及相关的生物标记，对这些临床信息与检验指标的对应性进行数理统计。研究慢性萎缩性的藏医证型，与临床证候和相关性生物标记的分布规律，对藏医药学现代化的进程将起到重要作用。.主要研究内容：采集被试患者Hp幽门螺旋杆菌,血清胃泌素G17， 胃蛋白酶原I、Ⅱ等慢性萎缩性胃炎的关键生物标记，研究慢性萎缩性胃炎即藏医“普如”病不同证型所表达的生物标记分布情况，对这些生物指标的表达与临床征候信息进行数理统计分析，进一步分析不同证型症候信息的分布规律与慢性萎缩性胃炎生物标记的对应分布情况，依据症候信息分布与生物标记表达的对应关系，确定慢性萎缩性胃炎藏医证型分类。.重要结果：已培养2名硕士研究生、2名博士研究生，公开出版博士研究生毕业论文1 篇，公开发表学术期刊论文9篇，颁布1项诊断标准（藏文），获得2项优秀论文奖，1项教学竞赛优秀奖，项目负责人于2015 年被聘任为世界中联藏医药专业委员会藏医药专业委员会副会长兼秘书长，项目组成员2 人晋升副主任医师职称，课题组人员参加国内外学术会议12次，负责人被邀请国内外学术会议大会主题发言4次。.关键数据及其科学意义：.关键数据：已完成320名患者的临床四诊信息数据、胃镜图像信息数据、胃粘膜病理变化信息数据、血清生物标记（Hp幽门螺旋杆菌、胃泌素G17， 胃蛋白酶原I、Ⅱ）数据，并建立不同模块的数据库。 .科学意义：（1）藏医“普如病”（慢性萎缩性胃炎）的命名来源及认识过程的历史演变进行总结；（2）确定普如病由培根增盛所致，属于“培根胃病”范畴，胃“三火”功能失衡为藏医学基本病机；（3）研究其中“味”“功效”“剂量”的组方规律，分析了藏药复方治疗CAG的用药配伍规律，揭示其配伍理论；（4）采用TCMISS平台软件对CAG藏药方剂组方规律分析；（5）揭示普如病藏医四诊信息与微观指标间的相关性，为其诊疗规范提供科学依据；（6）首次确定普如病的藏医证型分为隆型、赤巴型、培根型、混合型、赤巴隆型、赤巴培根型、培根隆型七种，该分型特征符合藏医学临床疾病分型规律；（7）颁布慢性萎缩性胃炎藏西医结合诊断标准。