基于胃黏膜COX和血清TFF2、SOD变化评价“以痈论治”治疗HP阳性胃溃疡的临床疗效

Clinical Efficacy Evaluation of “Treating HP Positive Gastric Ulcer with Carbuncle” Based on the Changes of Gastric Mucosa Cox,Serum TFF2 and SOD

目的:观察以“以痈论治”理论做指导,应用中药芪连清胃方治疗幽门螺杆菌(Hp)阳性胃溃疡的临床疗效。方法:选择本院2019年12月~2020年10月收治的胃溃疡患者86例,所有患者按照就诊顺序编号,按照随机数字表法分为两组,每组43例,对照组予以四联疗法(包括埃索美拉唑肠溶片、阿莫西林分散片、克拉霉素分散片、胶体果胶铋胶囊),治疗组在对照组用药基础上予以中药芪连清胃方口服,疗程均为8周。比较两组治疗前后中医证候评分、胃黏膜组织评分、胃黏膜环氧化酶(COX)评分和血清三叶因子2(TFF2)、超氧化物歧化酶(SOD)水平,并比较两组Hp根除率和溃疡愈合率。结果:治疗后治疗组胃脘胀痛、恶心呕吐、嗳气反酸、嘈杂评分低于对照组(P<0.01);胃黏膜厚度、黏膜形态及炎性细胞浸润程度评分低于对照组(P<0.01);胃黏膜COX-1、COX-2表达评分和血清TFF2、SOD水平均高于对照组(P<0.01),HP根除率、溃疡愈合率均高于对照组(P<0.05),差异均有统计学意义。结论:基于“以痈论治”理论应用芪连清胃方治疗HP阳性胃溃疡可改善中医证候,提高HP根除率,增加黏膜COX-1、COX-2表达,促进黏膜修复和溃疡愈合,其机制可能与调节TFF2、SOD分泌有关。

Objective:To observe the clinical efficacy of using Qilian Qingwei Decoction in the treatment of Helicobacter pylori(HP)positive gastric ulcer under the guidance of“carbuncle theory”.Methods:86 cases of gastric ulcer patients addmitted to our hospital from December 2019 to October 2020 were selected.All patients were numbered according to the order of treatment and divided into two groups according to the digital random table method,with 43 cases in each group.The controlled group were given quadruple therapy(including Esomeprazole Enteric Coated Tablets,Amoxicillin Dispersible Tablets,Clarithromycin Dispersible Tablets,Colloidal Bismuth Pectin Capsules),and the treatment group were given Qilian Qingwei Decoction on the basis of the controlled group.The course of treatment was for 8 weeks.The TCM syndrome score,gastric mucosal tissue score,gastric mucosal cyclooxygenase(COX)score,serum trefoil factor 2(TFF2)and superoxide dismutase(SOD)levels were compared between the two groups before and after treatment,and HP eradication rate and ulcer healing rate were compared between the two groups.Results:The scores of epigastric distension pain,nausea and vomiting,belching acid and noise of the treatment group were lower than those of the controlled group(P<0.01).The score of gastric mucosa thickness,mucosa morphology and infiltration degree of inflammatory cells was lower than that of the controlled group(P<0.01).Gastric mucosa Cox-1 and COX-2 expression scores and serum TFF2 and SOD levels were all higher than those of the controlled group(P<0.01).The rate of HP eradication and gastric ulcer healing rate of the treatment group was significantly lower than that of the controlled group(P<0.01).The differences were statistically significant.Conclusion:Based on the theory of“treating HP with carbuncle”,Qilian Qingwei Decoction can improve TCM syndrome,improve HP eradication rate,increase the expression of COX-1 and COX-2 in mucosa,and promote mucosal repair and ulcer healing.The mechanism may be related to the regulation of TFF2 and SOD secretion.