目的 探讨幽门螺杆菌（Helicobacter pylori,Hp）感染阳性萎缩性胃炎患者的微环境治疗策略,验证清化除幽汤联合铋剂四联疗法对其免疫功能、血清炎症因子水平及临床疗效的协同效应。方法 收集于2021年7月至2023年7月就诊于邯郸市中医院的Hp阳性萎缩性胃炎患者112例,随机分为对照组（铋剂四联疗法）和观察组（铋剂四联+清化除幽汤）,每组各56例。治疗结束后对比两组患者的Hp根除率和复发率、中医症状积分、胃镜黏膜评分、炎症因子[白细胞素（interleukin,IL）-8、IL-1β、IL-6、肿瘤坏死因子（tumor necrosis factor-α,TNF-α）]、免疫功能指标（CD4+、CD8+、CD4+/CD8+）、胃功能指标[血清胃蛋白酶原I（pepsinogen,PGI）、PGII、PGR比值、胃泌素-17（Gastrin-17,G-17）]、临床疗效、焦虑自评量表评分、抑郁自评量表评分以及药物不良反应发生率。结果 治疗后,与对照组相比,观察组的Hp根除率和临床总有效率显著提高,且复发率及不良反应发生率无显著增加。观察组在改善患者胃脘灼痛、两肋胀痛、心烦易怒、嗳气、反酸、大便不畅中医症状（Cohen's d：0.509~0.611）、胃镜黏膜表现及焦虑、抑郁情绪方面均展现出显著优势。此外,观察组表现出更强的免疫调节和抗炎作用,CD4+ T细胞比例及CD4+/CD8+比值显著升高,促炎因子（IL-8,IL-1β,IL-6,TNF-α）水平显著降低,其中IL-1β和TNF-α的抑制效应尤为突出（Cohen's d>1.0）。胃功能指标（PGI,PGR,PGII,G-17）较对照组明显改善。结论 清化除幽汤可协同增强铋剂四联疗法治疗脾胃湿热型Hp阳性萎缩性胃炎的免疫调节及抗炎效果,最终实现促进胃黏膜修复,是中西医协同治疗Hp阳性萎缩性胃炎的有效策略。
Abstract
Objective To explore the microenvironment treatment strategy for patients with positive atrophic gastritis infected by Helicobacter pylori (Hp), and to verify the synergistic effect of Qinghua Chuyou decoction combined with bismuth quadruple therapy on their immune function, serum inflammatory factors and clinical efficacy. Methods 112 patients with HP-positive atrophic gastritis who were treated in Handan Hospital of Traditional Chinese Medicine from July 2021 to July 2023 were randomly divided into control group (bismuth quadruple therapy) and observation group (bismuth quadruple plus Qinghua Chuyou decoction), with 56 cases in each group. After the treatment, the eradication rate and recurrence rate of Hp, TCM symptom score, gastroscope mucosa score, inflammatory factors [IL-8(Interleukin-8), IL-1β (Interleukin-1β), IL-6 (Interleukin-6), TNF-α (Tumor Necrosis Factor-α)], and immune function index (CD4+、CD8+、CD4+/CD8+), gastric function indicators [serum I (Pepsinogen I, PGI), pepsinogen II (PGII), PGR ratio, gastrin-17(G-17)], clinical efficacy and self-rating anxiety scale (SAS). Results After treatment, compared with the control group, the observation group can significantly improve the eradication rate of Hp and the total clinical effective rate, the recurrence rate and the incidence of adverse reactions have no significant increase (P>0.05). The observation group improved the symptoms of Chinese medicine such as burning pain in the stomach, swelling pain in both ribs, upset and irritable, belching, acid regurgitation and poor stool. (Cohen's d: 0.509-0.611), gastroscopic mucosal manifestations and anxiety and depression (SAS/SDS score). In addition, the observation group showed stronger immunomodulation and anti-inflammatory effects, the CD4+ T cell ratio and CD4+/CD8+ ratio increased significantly, and the levels of proinflammatory factors (IL-8, IL-1β, IL-6, TNF-α) decreased significantly, especially the inhibitory effects of IL-1β and TNF-α (Cohen's d>1.0). The gastric function indexes (PGI, PGR, PGII, G-17) also were significantly improved compared with the control group. Conclusion Qinghua Chuyou Decoction can synergistically enhance the immune regulation and anti-inflammatory effect of bismuth quadruple therapy in treating Hp-positive atrophic gastritis of spleen and stomach damp-heat type, and ultimately promote the repair of gastric mucosa and the rehabilitation of patients, which is an effective strategy for treating Hp-positive atrophic gastritis in cooperation with traditional Chinese and western medicine.
关键词
清化除幽汤 /
微环境 /
铋剂四联疗法 /
幽门螺杆菌 /
萎缩性胃炎
Key words
qinghua chuyou decoction /
microenvironment /
bismuth quadruple therapy /
helicobacter pylori /
positive atrophic gastritis
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基金
河北省中医药管理局科研计划项目“清化除幽汤联合四联疗法治疗幽门螺杆菌相关性胃炎的临床疗效研究”（2022653）
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