加味逍遥散对肝郁脾虚型慢性萎缩性胃炎临床疗效观察及机制探讨  

Clinical Observation and Mechanism of Jiawei Xiaoyao Powder(加味逍遥散)on Chronic Atrophic Gastritis of Liver Depression and Spleen Deficiency Type

作　　者：刘军[1] 沈灵娜 钱赟达 徐瑾[1] 陈洁[1] 黄永宏 LIU Jun;SHEN Lingna;QIAN Yunda;XU Jin;CHEN Jie;HUANG Yonghong(Jiaxing Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University,Jiaxing 314001,Zhejiang,China)

机构地区：[1]浙江中医药大学附属嘉兴市中医医院,浙江嘉兴314001

出　　处：《中华中医药学刊》2022年第6期238-242,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：浙江省医学会临床科研基金(2017ZYC-A79)。

摘　　要：目的探究加味逍遥散对肝郁脾虚型慢性萎缩性胃炎(CAG)临床疗效,对其部分作用机制进行研究,以丰富治疗方法。方法纳入2018年1月1日—2020年11月30日医院收治符合纳入条件肝郁脾虚型慢性萎缩性胃炎患者168例,按照就诊顺序编号随机分为对照组(84例)和研究组(84例)。对照组常规西药治疗,研究组加用加味逍遥散治疗,均治疗8周。观察两组治疗前、完成治疗后在胃镜积分、病理积分(包括萎缩、肠化、异型增生、炎性)变化并比较;观察两组治疗前、完成治疗后在磷酸化细胞外信号调节激酶(p-ERK)、细胞外调节蛋白激酶(ERK)变化并比较;观察两组治疗前、完成治疗后在胃动素(MOT)、促胃液素(GAS)、胃蛋白酶原Ⅰ(PGⅠ)、PGⅠ/PGⅡ变化并比较;观察两组治疗前、完成治疗后临床症状胃脘痛、胸胁胀痛、嗳气泛酸、大便稀溏、口苦干积分变化并比较;完成治疗后进行不良反应比较。结果①治疗前两组胃镜积分、病理积分(包括萎缩、肠化、异型增生、炎性)比较差异无统计学意义(P>0.05),完成治疗后两组各积分较治疗前均显著下降(P<0.05),完成治疗后研究组以上积分显著低于对照组(P<0.05)。②治疗前两组p-ERK、ERK比较差异无统计学意义(P>0.05),完成治疗后研究组p-ERK、ERK显著高于治疗前(P<0.05),对照组治疗前、完成治疗后则差异无统计学意义(P>0.05),完成治疗后研究组以上指标均显著高于对照组(P<0.05)。③治疗前两组MOT、GAS、PGⅠ、PGⅠ/PGⅡ比较差异无统计学意义(P>0.05),完成治疗后两组以上指标较治疗前均显著升高(P<0.05),完成治疗后研究组以上指标均显著高于对照组(P<0.05)。④治疗前两组胃脘痛、胸胁胀痛、嗳气泛酸、大便稀溏、口苦干比较差异具有可比性(P>0.05),完成治疗后两组以上症状积分较治疗前均显著下降(P<0.05),完成治疗后研究组以上各指标均显著低于对照组(P<0.0Objective To explore the clinical effect of Jiawei Xiaoyao Powder(加味逍遥散)on chronic atrophic gastritis(CAG)of liver depression and spleen deficiency type and study some of its mechanism of action in order to enrich the treatment methods.Methods A total of 168 patients with CAG of liver depression and spleen deficiency were enrolled in the hospital from January 1,2018 to November 30,2020.They were randomly divided into the control group(84 cases)and the study group(84 ca-ses)according to the order of visiting.The control group was treated with routine western medicine and the study group was trea-ted with Jiawei Xiaoyao Powder for 8 weeks.The changes of gastroscopic score,pathological score(including atrophy,intestinal metaplasia,dysplasia and inflammation)before and after treatment were observed and compared between the two groups.The changes of phosphorylated extracellular signal-regulated kinase(p-ERK)and extracellular regulated protein kinase(ERK)be-fore and after treatment were observed and compared between the two groups.Before and after treatment,the changes of motilin(MOT),gastrin(GAS),pepsinogen I(PGI)and PGI/PGII were observed and compared.The clinical symptoms of epigastralgia,chest and hypochondria pain,pantothenic acid,feces dilution and mouth bitterness scores were observed and compared before and after treatment.The adverse reactions were compared.Results The gastroscopic and pathological scores(including atrophy,intes-tinal metaplasia,dysplasia and inflammation)of the two groups before treatment were not significantly different(P>0.05).After treatment,the scores of the two groups were significantly lower than those before treatment(P<0.05).And the scores of the study group were significantly lower than those of the control group(P<0.05).(2)There were significant differences in p-ERK or ERK between the two groups before and after treatment(P>0.05).After treatment,p-ERK and ERK in the study group were significantly higher than those before treatment(P<0.05),while there was no significant dif

关 键 词：加味逍遥散 肝郁脾虚型 慢性萎缩性胃炎 病理积分 胃动素 促胃液素 磷酸化细胞外信号调节激酶 细胞外调节蛋白激酶 疗效 

分 类 号：R259.733.2[医药卫生—中西医结合]