Wu Si-Ran, Liu Jie, Zhang Li-Feng, Wang Na, Zhang Lu-Yao, Wu Qiong, Liu Jun-Ye, Shi Yong-Quan
State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, Shaanxi Province, China.
Department of Clinical Nutrition, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, Shaanxi Province, China.
World J Clin Cases. 2021 Dec 6;9(34):10472-10483. doi: 10.12998/wjcc.v9.i34.10472.
Chronic atrophic gastritis (AG) with intestinal metaplasia (IM) significantly increases the risk of gastric cancer. Some medicines have showed definite therapeutic effects in AG and IM regression.
To validate the efficacy of Lamb's tripe extract and vitamin B capsule (LTEVB) initial therapy and celecoxib rescue therapy for IM and AG.
A total of 255 patients were included to receive LTEVB initial therapy (2 capsules each time, three times daily for 6 mo) in hospital in this study. The patients with failure of IM regression continued to receive celecoxib rescue therapy (200 mg, once daily for 6 mo). After each therapy finished, the patients underwent endoscopy and biopsy examination. The regression efficiency was assessed by the operative link on gastritis assessment (OLGA) and the operative link on the gastric intestinal metaplasia assessment (OLGIM) staging system. Logistic regression analysis was applied to identify factors associated with the curative effect.
For LTEVB initial therapy, the reversal rates of IM and AG were 52.95% and 48.24%, respectively. Analogously, for celecoxib rescue therapy, the effective rates for IM and AG were 56.25% and 51.56%, respectively. The IM regression rate of complete therapy was up to 85.03%. In different OLGA and OLGIM stages of IM patients, therapeutic efficiency showed a significant difference in each group ( < 0.05). For both therapies, patients with high stages (III or IV) of both the OLGA and OLGIM evaluation systems showed a higher IM or AG regression rate than those with low stages (I or II). Among patients with high stages (OLGIM III and IV), the IM regression rate was above 70% for each therapy. Eating habits, fresh vegetable intake, and high-salt diet were identified as independent factors for the IM reversal effect of LTEVB therapy, especially high-salt diet (odds ratio = 1.852, < 0.05).
Monotherapy could reverse IM and AG. LTEVB initial therapy and celecoxib rescue therapy significantly increase the regression effect. IM may not be the point of no return among gastric precancerous lesions.
伴有肠化生（IM）的慢性萎缩性胃炎（AG）显著增加胃癌风险。一些药物已显示出对AG及IM逆转有确切治疗效果。
验证羔羊肚提取物维生素B胶囊（LTEVB）初始治疗及塞来昔布挽救治疗对IM和AG的疗效。
本研究共纳入255例患者在医院接受LTEVB初始治疗（每次2粒，每日3次，共6个月）。IM逆转失败的患者继续接受塞来昔布挽救治疗（200mg，每日1次，共6个月）。每次治疗结束后，患者接受内镜及活检检查。通过胃炎评估手术链接（OLGA）和胃肠化生评估手术链接（OLGIM）分期系统评估逆转效率。应用逻辑回归分析确定与疗效相关的因素。
对于LTEVB初始治疗，IM和AG的逆转率分别为52.95%和48.24%。类似地，对于塞来昔布挽救治疗，IM和AG的有效率分别为56.25%和51.56%。完整治疗的IM逆转率高达85.03%。在IM患者的不同OLGA和OLGIM分期中，每组治疗效率显示出显著差异（<0.05）。对于两种治疗，OLGA和OLGIM评估系统高分期（III或IV期）的患者比低分期（I或II期）的患者显示出更高的IM或AG逆转率。在高分期（OLGIM III和IV期）患者中，每种治疗的IM逆转率均高于70%。饮食习惯、新鲜蔬菜摄入量和高盐饮食被确定为LTEVB治疗IM逆转效果的独立因素，尤其是高盐饮食（比值比=1.852，<0.05）。
单一疗法可逆转IM和AG。LTEVB初始治疗和塞来昔布挽救治疗显著提高逆转效果。IM在胃癌前病变中可能并非不可逆转。
