活血化瘀、健脾疏肝法治疗慢性萎缩性胃炎胃络瘀阻证的临床研究  

Clinical study on the treatment of chronic atrophic gastritis with gastric collateral stasis syndrome by activating blood and removing blood stasis,invigorating the spleen and soothing the liver

作　　者：杨天翼 宗湘裕[1] Yang Tianyi;Zong Xiangyu(Department of Gastroenterology,Huairou Hospital of Traditional Chinese Medicine,Beijing 101400,China)

机构地区：[1]北京市怀柔区中医医院消化科,北京101400

出　　处：《国际中医中药杂志》2023年第5期558-562,共5页International Journal of Traditional Chinese Medicine

基　　金：全国基层名老中医药专家杜长海传承工作室建设项目(国中医药人教发〔2016〕41号)。

摘　　要：目的评价活血化瘀、健脾疏肝法治疗慢性萎缩性胃炎胃络瘀阻证的疗效。方法随机对照试验设计。将符合入选标准的2018年1月-2021年1月本院患者68例,采用随机数字表法分为2组,每组34例。对照组予抑酸、保护胃黏膜对症治疗,观察组予活血化瘀、健脾疏肝法治疗,2组均连续治疗12周。分别于治疗前后进行中医症状评分,采用ELISA法检测胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)水平,计算PGⅠ/PGⅡ比值。行胃镜活检,观察胃部黏膜肠上皮化生、腺体萎缩的变化,评价临床疗效。结果观察组总有效率为85.3%(29/34)、对照组为58.8%(20/34),2组比较差异有统计学意义(χ^(2)=9.35,P=0.030)。观察组治疗后胃脘痛、痞满积分低于对照组(t值分别为2.97、3.80,P<0.05)。治疗后,观察组血清PGⅠ[(76.21±17.35)mg/L比(66.80±18.77)mg/L,t=2.15]水平及PGⅠ/PGⅡ[(4.67±0.99)比(3.90±1.25),t=2.81]比值高于对照组(P<0.05),PGⅡ[(16.36±1.85)mg/L比(17.42±2.05)mg/L,t=2.24]水平低于对照组(P<0.05)。与同组治疗前比较,观察组治疗后肠上皮化生明显改善或逆转(χ^(2)=20.67,P<0.01),腺体萎缩情况明显改善或逆转(χ^(2)=9.33,P=0.030)。结论活血化瘀、健脾疏肝法可逆转慢性萎缩性胃炎胃络瘀阻证患者的癌前病变,预后较好。Objective To evaluate the clinical effect of treatment of activating blood and removing blood stasis,invigorating the spleen and soothing the liver for the patients with gastric collateral stasis syndrome and chronic atrophic gastritis(CAG).Methods Randomized controlled trial.A total of 68 CAG patients admitted to the Huairou Hospital of Traditional Chinese Medicine from January 2018 to January 2021 who met the selection criteria were divided into 2 groups according to the random number table method,with 34 in each group.The control group received conventional western medicine treatment,such as inhibition of acid,protecting the gastric mucosa,and the observation group was treated with Traditional Chinese Medicine(TCM)herbal prescription of activating blood and removing blood stasis,invigorating the spleen and soothing the liver.Both groups were treated for 12 weeks.TCM symptom scores were performed before and after treatment.The serum level of pepsinogenⅠ(PGⅠ),pepsinogenⅡ(PGⅡ)were detected by ELISA,and the PGⅠ/PGⅡratio was calculated.Gastroscopic biopsy was performed to observe the changes of intestinal metaplasia of gastric mucosa and glandular atrophy,and to evaluate the clinical efficacy.Results The total responsive rate was 85.3%(29/34)in the study group and 58.8%(20/34)in the control group.There was significant difference between the two groups(χ^(2)=9.35,P=0.030).After treatment,the scores of stomachache,fullness of feeling in the observation group were significantly lower than those in the control group(t=2.97,3.80,P<0.05).After treatment,the level of serum PGⅠ[(76.21±17.35)mg/L vs.(66.8±18.77)mg/L,t=2.15]and PGⅠ/PGⅡ[(4.67±0.99)vs.(3.90±1.25),t=2.81]in the study group were significantly higher than those in the control group(P<0.05),and PGⅡ[(16.36±1.85)mg/L vs.(17.42±2.05)mg/L,t=2.24]was significantly lower than that of the control group(P<0.05).After treatment,intestinal metaplasia and glandular atrophy was significantly more improved or reversed than those in the control group(

关 键 词：胃炎 萎缩性 活血化瘀、健脾疏肝法 胃络瘀阻证 幽门螺杆菌 癌前病变 疗效分析 

分 类 号：R259[医药卫生—中西医结合]