基于络病理论观察丹参饮加味治疗慢性萎缩性胃炎胃络瘀阻证的临床疗效及机制  

Clinical Effect and Mechanism of Modified Danshenyin Against Chronic Atrophic Gastritis with Syndrome of Stasis in Stomach Collateral:Based on Theory of Collateral Diseases

作　　者：王德芳 赵明 董笑一[2] 李晓艳 WANG Defang;ZHAO Ming;DONG Xiaoyi;LI Xiaoyan(Xining First People's Hospital,Xining,Qinghai,810000,China;Hebei Hospital of Traditional Chinese Medicine,Shijiazhuang,Hebei,050000,China)

机构地区：[1]西宁市第一人民医院,西宁810000 [2]河北省中医院,石家庄050000

出　　处：《中国实验方剂学杂志》2022年第23期122-127,共6页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河北省中医药管理局科研计划项目(2018053)。

摘　　要：目的:观察丹参饮加味治疗慢性萎缩性胃炎的临床效果,探讨其部分作用机制。方法:选择西宁市第一人民医院收治的慢性萎缩性胃炎患者152例,随机分为对照组和观察组,每组各76例。对照组患者给予常规西药治疗,观察组给予丹参饮加味方口服,连续治疗8周。比较两组的临床效果、中医证候总积分、胃黏膜病理评分,测定胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、免疫炎性状态[可溶性白细胞介素-2受体(sIL-2R)、肿瘤坏死因子-α(TNF-α)]、胃黏膜保护相关因子[前列腺素E(PGE_(2))、降钙素基因相关肽(CGRP)]含量,记录不良反应、复发率。结果:与对照组的有效率77.61%(52/67)比较,观察组的有效率91.18%(62/68)明显升高(χ^(2)=4.727,P<0.05);与对照组比较,观察组患者的中医证候总积分明显降低(P<0.05);与对照组比较,观察组腺体萎缩、肠上皮化生、异型增生的病理评分明显降低(P<0.05);与对照组比较,观察组患者的血清中PGⅠ分泌量、PGⅠ/PGⅡ值明显升高,PGⅡ分泌量明显降低(P<0.05);观察组患者的炎症相关指标sIL-2R、TNF-α含量均明显降低(P<0.05);观察组患者的胃黏膜保护相关因子PGE_(2)、CGRP含量均明显升高(P<0.05);与对照组的不良反应发生率14.93%(10/67)比较,观察组的不良反应发生率7.35%(5/68)明显降低,但差异无统计学意义;与对照组比较,观察组6、12个月的复发率均降低,但经Fisher精确检验,差异无统计学意义。结论:丹参饮加味治疗慢性萎缩性胃炎在缓解中医证候、调节PG分泌量、改善胃黏膜病变程度等方面有更好的效果,其机制可能与调节sIL-2R、TNF-α、PGE_(2)、CGRP以减轻胃黏膜的炎性损伤、保护胃黏膜有关,用药相对安全,不易于复发。Objective:To observe the clinical effect of Danshenyin on chronic atrophic gastritis and explore the mechanism.Method:A total of 152 patients with chronic atrophic gastritis who were treated in Xining No.1 People’s Hospital were selected and randomized into control group(76 cases)and observation group(76 cases).The control group was given conventional western medicine treatment,and the observation group was given Danshenyin(oral).The treatment lasted 8 weeks for both groups.The clinical effect,traditional Chinese medicine(TCM)syndrome score,and pathological score of gastric mucosa were compared between two groups.The content of pepsinogen Ⅰ(PGⅠ),pepsinogen Ⅱ(PGⅡ),proinflammatory cytokines[soluble interleukin-2 receptor(sIL-2R),tumor necrosis factor-α(TNF-α)],and gastric mucosa-proteting factors[prostaglandin E(PGE_(2)),calcitonin gene-related peptide(CGRP)]was determined,and the adverse reactions and recurrence rates were recorded.Result:The effective rate(91.18%,62/68)in the observation group was higher than that(7.61%,52/67)in the control group(χ^(2)=4.727,P<0.05).The TCM syndrome score in the observation group was lower than that in the control group(P<0.05).Compared with the control group,the observation group showed low pathological scores of glandular atrophy and intestinal metaplasia and dysplasia(P<0.05).The observation group had higher serum PGⅠ content and PGⅠ/PGⅡ value and lower PGⅡ content than the control group(P<0.05).The content of sIL-2R and TNF-α decreased(P<0.05)and that of PGE_(2)and CGRP increased(P<0.05)in the observation group as compared with those in the control group.The incidence of adverse reactions in the observation group was 7.35%(5/68),as compared with the 14.93%(10/67)in the control group.The recurrence rates in the 6-month and 12-month follow-up in the observation group were lower than those in the control group,but the difference was not statistically significant(Fisher’s exact test).Conclusion:Danshenyin shows satisfactory effect in relieving TCM syndrome

关 键 词：慢性萎缩性胃炎 胃络瘀阻证 丹参饮加味 络病理论 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学] R2-031R287