替普瑞酮改良四联疗法治疗幽门螺旋杆菌阳性胃溃疡患者效果及对胃黏膜形态、TGF-β、Smad 3、胃肠激素影响  

Clinical Effect of Modified Teprenone-containing Quadruple Therapy in the Treatment of Patients with Helicobacter Pylori Positive Gastric Ulcer and Its Effect on the Morphology of Gastric Mucosa, Expression of TGF-β, Smad 3 and Gastrointestinal Hormones

作　　者：刘慧 郁磊 张诒凤 代拥军[4] LIU Hui;YU Lei;ZHANG Yi-feng;DAI Yong-jun(Department of Gastroenterology,Central Hospital of Xinwen Mining Group Co.,Ltd,Xintai,Shandong 271219,China;Department of Clinical Laboratory,Central Hospital of Xinwen Mining Group Co.,Ltd,Xintai,Shandong 271219,China;Department of Gastroenterology,the Second Affiliated Hospital of the First Shandong Medical University,Tai'an,Shandong 271000,China;Department of Gastroenterology,the First Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]新汶矿业集团有限责任公司中心医院消化内科,山东新泰271219 [2]新汶矿业集团有限责任公司中心医院检验科,山东新泰271219 [3]山东第一医科大学第二附属医院消化内科,山东泰安271000 [4]河北医科大学第一医院消化内科,石家庄050000

出　　处：《临床误诊误治》2020年第5期38-43,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划(20160675)。

摘　　要：目的探讨替普瑞酮改良四联疗法治疗幽门螺旋杆菌(Hp)阳性胃溃疡的效果及对胃黏膜形态、转化生长因子β(TGF-β)、Smad 3、胃肠激素的影响。方法选取Hp阳性胃溃疡118例作为研究对象,根据治疗方法不同将其分为观察组(63例)和对照组(55例)两组。观察组给予替普瑞酮改良四联疗法(阿莫西林+奥美拉唑+克拉霉素+替普瑞酮)治疗,对照组给予铋剂四联疗法(阿莫西林+奥美拉唑+克拉霉素+果胶泌)治疗,疗程均为4周。观察比较两组治疗4周后临床效果、Hp转阴率,治疗前及治疗4周后胃黏膜指标、血清胃肠激素,以及治疗期间不良反应发生情况。结果治疗4周后,观察组总有效率90.48%高于对照组总有效率72.73%,Hp转阴率90.48%高于对照组Hp转阴率76.36%,差异有统计学意义(P<0.05)。治疗前,两组胃黏膜指标及血清胃肠激素比较差异均无统计学意义(P>0.05)。治疗4周后,两组炎性细胞浸润程度、黏膜厚度、腺体密度、黏膜形态评分,胃黏膜TGF-β和Smad 3表达阳性率,以及血清胆囊收缩素(CCK)、胃泌素(GAS)水平均较治疗前下降;血清胃动素(MTL)水平均较治疗前升高,差异有统计学意义(P<0.05或P<0.01)。治疗4周后,观察组炎性细胞浸润程度、黏膜厚度、腺体密度、黏膜形态评分,胃黏膜TGF-β和Smad 3表达阳性率,以及血清CCK、GAS水平均低于对照组;血清MTL水平高于对照组,差异有统计学意义(P<0.05或P<0.01)。治疗期间,两组均未出现严重不良反应。结论替普瑞酮改良四联疗法较铋剂四联疗法治疗Hp阳性胃溃疡效果好,可提高Hp转阴率,促进胃黏膜形态恢复,抑制TGF-β与Smad 3表达,并可调节胃肠激素水平,且安全性良好。Objective To investigate the clinical effect of modified teprenone-containing quadruple therapy on Helicobacter pylori(Hp)-positive gastric ulcer and its effect on gastric mucosa morphology, expression of transforming growth factor β(TGF-β), Smad 3 and gastrointestinal hormones. Methods A total of 118 cases of Hp-positive gastric ulcer were selected as the subjects. According to different treatment methods, they were divided into two groups: the observation group(n=63) and the control group(n=55). The observation group was treated with modified teprenone-containing quadruple therapy(Amoxicillin+Omeprazole+Clarithromycin+Teprenone), and the control group was treated with bismuth-containing quadruple therapy(Amoxicillin+Omeprazole+Clarithromycin+Pectin Secretion) for 4 weeks. The clinical effect and the negative conversion rate of Hp at 4 weeks after treatment, the index of gastric mucosa and the serum gastrointestinal hormone before and at 4 weeks after treatment, and the occurrence of adverse reactions were observed and compared between the two groups. Results At 4 weeks after treatment, the total effective rate of the observation group was 90.48%, which was higher than that of the control group(72.73%), and the negative conversion rate of Hp was 90.48% higher than that of the control group(76.36%)(P<0.05). Before treatment, there was no significant difference between the two groups in gastric mucosa index and serum gastrointestinal hormone index(P>0.05). At 4 weeks after treatment, the degree of inflammatory cell infiltration, mucosal thickness, gland density, mucosal morphology score, the positive rates of TGF-β and Smad 3 expression in gastric mucosa, as well as the levels of serum cholecystokinin(CCK) and gastrin(GAS) in the two groups were significantly lower than those before treatment, and the level of serum motilin(MTL) was significantly higher than that before treatment(P<0.05 or P<0.01). At 4 weeks after treatment, the degree of inflammatory cell infiltration, mucosal thickness, density of glands, mu

关 键 词：胃溃疡 幽门螺旋杆菌 替普瑞酮 胃黏膜形态 转化生长因子β SMAD 3 胃肠激素 

分 类 号：R573.1[医药卫生—消化系统] R975.6[医药卫生—内科学]