自拟15味健脾护膜汤加抗Hp四联方案治疗慢性消化性溃疡脾胃虚寒型效果及相关机制  

Effect and Related Mechanism of Self⁃prepared Shiwuwei Jianpi Humo De⁃coction Plus Anti⁃HP Quadruple Regimen in the Treatment of Chronic Pep⁃tic Ulcer of Spleen and Stomach Deficiency Cold Type

作　　者：王凌红 项梅 詹士宝 郭慧敏 WANG Linghong;XIANG Mei;ZHAN Shibao;GUO Huimin(Department of Internal Medicine,Tianchang Hospital of Traditional Chinese Medicine,Tianchang,Anhui 239300,China;Department of Gastroenterology,Nanjing Gulou Hospital,Nanjing 210036,China)

机构地区：[1]天长市中医院内科,安徽天长239300 [2]南京市鼓楼医院消化内科,南京210036

出　　处：《临床误诊误治》2023年第9期112-117,共6页Clinical Misdiagnosis & Mistherapy

基　　金：安徽省中央引导地方科技发展专项项目(2018080802D0080)。

摘　　要：目的 探讨自拟15味健脾护膜汤加抗幽门螺杆菌(Hp)四联方案治疗慢性消化性溃疡(PU)脾胃虚寒型效果及相关机制。方法 选取2019年3月—2022年10月收治的慢性PU 80例,根据治疗方法不同将其分为联合组和西医组2组各40例。联合组给予自拟15味健脾护膜汤加抗Hp四联方案治疗,西医组给予抗Hp四联方案治疗。比较2组临床疗效、Hp根除情况、复发情况、中医证候积分、溃疡愈合质量、胃酸分泌情况[基础胃酸分泌量(BAO)、最大胃酸分泌量(MAO)、高峰胃酸分泌量(PAO)、胃液pH值]、胃肠道功能[胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)、胃泌素(GAS)、胃动素(MTL)]及不良反应。结果 治疗结束停药4周后,联合组总有效率(39/40,97.50%)和Hp根除率(35/40,87.50%)高于西医组(32/40,80.00%;24/40,60.00%);治疗结束后随访3个月,联合组复发率(2/40,5.00%)低于西医组(8/40,20.00%)(P<0.05,P<0.01)。治疗2和4周后,2组胃痛、胃胀、疼痛喜按、空腹痛甚、纳呆、神疲懒言积分,BAO、MAO、PAO和PGⅠ、PGⅡ、GAS、MTL均低于治疗前,且联合组低于西医组;2组胃液pH值高于治疗前,且联合组高于西医组(P<0.01)。治疗结束后,联合组溃疡愈合优良率高于西医组(P<0.01)。治疗期间,2组不良反应发生率比较差异无统计学意义(P>0.05)。结论 自拟15味健脾护膜汤加抗Hp四联方案治疗慢性PU脾胃虚寒型效果显著、安全性好,可改善患者临床症状,抑制胃酸分泌,提高Hp根除率,促进溃疡修复,降低复发率;分析其可能与调节GAS、MTL表达有关。Objective To investigate the effect and related mechanism of self⁃prepared Shiwuwei Jianpi Humo Decoc⁃tion plus anti⁃Helicobacter pylori(Hp)quadruple regimen in treating chronic peptic ulcer(PU)of spleen⁃stomach deficiency cold type.Methods Eighty patients with chronic PU treated from March 2019 to October 2022 were selected and divided into two groups according to different treatment methods:combination group and Western medicine group with 40 cases in each group.The combination group was treated with Shiwuwei Jianpi Humo decoction plus anti⁃HP quadruple regimen,and the Western medicine group was treated with anti⁃HP quadruple regimen.Clinical efficacy,Hp eradication,recurrence,tradition⁃al Chinese medicine(TCM)syndrome score,ulcer healing quality,gastric acid secretion[maximum gastric acid secretion(MAO),basic gastric acid secretion(BAO),peak gastric acid secretion(PAO),gastric fluid pH values],gastrointestinal function[pepsinogen I(PGI),pepsinogen II(PGII),gastrin(GAS),motilin(MTL)]and adverse reactions of the two groups were compared.Results At 4 weeks after drug withdrawal following treatment,the total effective rate(39/40,9750%)and eradication rate of Hp(35/40,8750%)in combination group were higher than those in Western medicine group(32/40,8000%;24/40,6000%).The recurrence rate of the combination group(2/40,5.00%)was lower than that of the Western medicine group(8/40,20.00%)at 3⁃month follow⁃up after treatment(P<005,P<001).At 2 and 4 weeks after treatment,the scores of stomach pain,bloating,pain,excessive fasting pain,dizziness,fatigue and lazy speech,as well as BAO,MAO,PAO,PGⅠ,PGⅡ,GAS,and MTL,in both groups were lower than those before treat⁃ment,and lower in the combination group than in the Western medicine group.The pH value of gastric fluid in the two groups was higher than that before treatment,and higher in combination group than in the Western medicine group(P<001).The excellent and good rate of ulcer healing in the combination group after treatment was higher than that in t

关 键 词：消化性溃疡 15味健脾护膜汤 抗Hp四联方案 溃疡愈合质量 HP根除率 复发率 中医证候积分 胃肠道功能 

分 类 号：R574.1[医药卫生—消化系统]