中药治疗慢性胃炎伴胃窦糜烂修复黏膜机制的探讨

目的通过蒲元和胃胶囊（PYHW）治疗幽门螺杆菌（Hp）阳性慢性胃炎（Chronic Gastritis）伴胃窦糜烂前后表皮生长因子（EGF）、微血管密度（MVD）的变化，初步探讨中药修复胃黏膜作用机制。方法：选择经胃镜及病理诊断明确的患者90例，按照对照、双盲、双模拟的原则随机分为蒲元和胃组（使用PYHw＋安慰剂）、替普瑞酮组（使用PYHw＋替普瑞酮胶囊）3和雷贝拉唑组（使用PYHW＋雷贝拉唑肠溶胶囊），每组30例。记录每组患者病情的改变情况，并通过定标活检获取治疗前后各组患者胃窦糜烂处及糜烂旁的黏膜标本，采用免疫组化技术分别测定所取标本的EGF、MVD的表达情况。结果：PYIIW组、替普瑞酮组、雷贝拉唑组糜烂处胃黏膜治疗前后EGF的阳性表达率分别为20．00％VS 56．70％，16．7％VS 46．7％，1 3．3％VS 43．3％，具有统计学意义（P〈0．05）；PYHW组、替普瑞酮组、雷贝拉唑组糜烂旁处胃黏膜治疗前后EGF的阳性表达率分别为10．00％VS 26．70％，13．30％VS 16．70％，16．70％VS 23．30％，没有统计学意义（P〉O．05）．PYHW组、替普瑞酮组及雷贝拉唑组治疗后均对糜烂处胃黏膜MVD比治疗前上调作用明显，治疗前后差异有统计学意义（P〈0．05）．对糜烂旁胃黏膜MVD有不同程度的上调作用，治疗前、后差异无统计学意义（P〉O．05）。结论：中药修复胃黏膜糜烂的作用机制与EGF及MVD相关，并能明显改善慢性胃炎伴胃窦糜烂患者的临床症状。

Objective To explore on the mechanism of traditional Chinese medicine （TCM） in the repair of gastric mucosa, the changes of epidermal growth factor （EGF）,microvessel density （MVD） with chronic gastritis with antra] erosion without Helicobacter pylori （Hp） infection before and after the treatment from puyuanhewei capsule（PYHW） preliminarily.Methods： The 90 experimental subject diagnosed by gastroscope and pathology are divided into PYHW group （PYHW＋placebo） 30 cases, Teprenone group （PYHW＋Teprenone） 30 cases and Rabeprazole group （PYHW＋Rabeprazole） 30 cases from the randomised, double-blind, placebo-controlled, double-dummy trials. These subject in PYHW group are treated by PYHW and placebo like Rabeprazole or Teprenone. The patient＇s condition of every group are recorded constantly. Specimens can be obtained in the erosion and erosion-adjacent normal mucosa by scaling biopsy before and after treatment in the three groups. Using immunohistochemical technology, the positive expression of EGF and MVD can be detected.Results： The positive expression rate of EGF of erosion of gastric rtlncosa was 20.00% vs 56.70%, 46.7% vs 16.7%, 43.3% vs 13.3% before and after treatment from PYHW group, teprenone group, rabeprazole group respectively, with statistical significance （P〈0.OS）.The positive expression rate of EGF of erosion-adjacent gastric mucosa was 10.00% vs 26.70%, 13.30% vs 16.70%, 16.70% vs 23.3% before and after treatment from PYHW group, teprenone group, rabeprazole group respectively, no statistical significance. （P〉0.05）.MVD of erosion of gastric mucosa were increased obviously after treatment from PYHW group, teprenone group, rabeprazole group than before treatment,the difference had statistical significance （P〈0.05）. MVD of erosion adjacent gastric mucosa were upregulated at different degrees before and after treatment, no significant difference （P〉0.05）. Conclusion： The mechanism of Traditional Chinese Medicine in the repair of gastric mueosal erosion is related to EGF and MVD, and it can improve theclinical symptoms and erosion of patients with chronic gastritis with antral erosion.