【目的】 探讨基于“毒垢理论”研制的萎胃汤治疗虚瘀夹浊型胃癌前病变（PLGC）患者的临床疗效及作用机制。【方法】 选取 2021年 8月至 2023年 8月就诊于广东省第二中医院消化内科，经中医辨证、电子胃镜检查及病理组织学检查确诊为虚 瘀夹浊型慢性萎缩性胃炎伴轻、中度异型增生的PLGC患者，共60例。采用随机数字表法将患者随机分为治疗组和对照组， 每组各30例。对照组给予口服胃复春片治疗，治疗组在辨证基础上给予萎胃汤加减治疗，疗程为24周。观察2组患者治疗 前后中医证候积分、胃镜及病理积分分级以及胃黏膜组织癌相关成纤维细胞（CAFs）标志物表达水平积分的变化情况，并评 价2组患者的中医证候疗效及用药安全性。【结果】（1）疗效方面，治疗24周后，治疗组的的总有效率为93.33%（28/30），对照组 为63.33%（19/30），组间比较（χ2 检验），治疗组的中医证候疗效明显优于对照组（P＜0.05）。（2）中医证候积分方面，治疗后， 2组患者的中医证候积分均较治疗前明显降低（P＜0.01），且治疗组的降低作用明显优于对照组（P＜0.05）。（3）病理组织学分 级方面，治疗后，治疗组患者的胃黏膜萎缩、肠上皮化生、异型增生等病理组织学分级情况均较治疗前明显改善（P＜0.05）， 而对照组均无明显改善（P＞0.05）；组间比较，治疗组对胃黏膜萎缩、肠上皮化生、异型增生等病理组织学分级情况的改善 作用均明显优于对照组（P＜0.05或P＜0.01）。（4）胃黏膜组织CAFs标志物表达方面，治疗后，治疗组的胃黏膜组织成纤维细 胞活化蛋白（FAP）、α-平滑肌肌动蛋白（α-SMA）表达水平积分均较治疗前降低（P＜0.05），而对照组的胃黏膜组织 FAP、 α-SMA表达水平积分均较治疗前升高（P＜0.05）；组间比较，治疗组对胃黏膜组织FAP、α-SMA表达水平积分的降低作用均明 显优于对照组（P＜0.01）。（5）安全性方面，治疗期间，2组患者均未发生药物不良事件，具有较高的安全性。【结论】 萎胃汤对虚 瘀夹浊型PLGC患者治疗效果明显，其作用机制可能与下调FAP、α-SMA的水平，抑制胃癌成纤维细胞表达有关。

Objective To investigate the clinical efficacy and mechanism of Weiwei Decoction in treating patients with precancerous lesions of gastric cancer（PLGC） differentiated as deficiency-stasis-turbidity syndrome. Methods From August 2021 to August 2023， a clinical observation was performed on 60 patients diagnosed as chronic atrophic gastritis accompanied by mild to moderate dysplasia and differentiated as deficiency-stasis-turbidity syndrome through traditional Chinese medicine（TCM） syndrome differentiation， electronic gastroscopy， and histopathological examination at the Department of Gastroenterology， Guangdong Second Traditional Chinese Medicine Hospital. The patients were randomly divided into a treatment group and a control group using a random number table，with 30 patients in each group. The control group was treated with oral use of Weifuchun Tablets， while the treatment group was given modified Weiwei Decoction according to syndrome differentiation. The treatment course lasted 24 weeks. Before and after treatment， the changes in TCM syndrome scores， gastroscopy and histopathological grading， and expression levels of markers of cancer-associated fibroblasts （CAFs） in gastric mucosal tissues of the two groups were observed. After treatment，the efficacy of TCM syndromes and medication safety were evaluated in both groups. Results （1） After 24 weeks of treatment， the total effective rate in the treatment group was 93.33%（28/30）， and that in the control group was 63.33%（19/30）. The TCM syndrome efficacy in the treatment group was significantly superior to that in the control group （P＜0.05）.（2）After treatment， the TCM syndrome scores in both groups were significantly decreased compared to those before treatment （P＜ 0.01），and the decrease in the treatment group was significantly superior to that in the control group （P＜0.05）. （3） After treatment， the histopathological grading of gastric mucosal atrophy， intestinal metaplasia， and dysplasia in the treatment group was significantly improved compared to that before treatment （P＜0.05），while no significant improvement was presented in the control group （P＞0.05）. The improvement in histopathological grading of gastric mucosal atrophy，intestinal metaplasia，and dysplasia in the treatment group was significantly superior to that in the control group （P＜0.05 or P＜0.01）.（4） After treatment，the expression levels of CAFs markers of fibroblast activation protein （FAP） and α-smooth muscle actin （α-SMA） in the treatment group were significantly decreased （P＜0.05）， while the expression levels of FAP and α -SMA in the control group were significantly increased （P＜0.05） compared to those before treatment. The decrease in FAP and α-SMA expression levels of the treatment group was significantly greater than that of the control group （P＜0.01）.（5） During the treatment period， no adverse drug events occurred in either group， indicating high safety. Conclusion Weiwei Decoction has significant therapeutic effect on PLGC patients with deficiency-stasis-turbidity syndrome. Its mechanism may be related to the down-regulation of FAP and α-SMA levels and inhibition of the expression of CAFs.

R259.733

广州市科学技术局2022年基础研究计划项目（编号：202201011782）