半夏泻心汤加味治疗HP阳性型消化道溃疡的临床疗效及对炎性因子、胃泌素的影响

Effect of Modified Banxie Xiexin Decoction in Treatment of Duodenum Ulcer Complicating HP Infection and Influence on Inflammatory Factors and Gastrin

目的:观察半夏泻心汤加味治疗HP阳性型消化道溃疡的临床疗效及对炎性因子、胃泌素的影响。方法:将医院2014年3月—2016年6月收治的100例符合入组标准的HP阳性型消化道溃疡患者随机分为对照组和观察组,每组各50例,对照组给予四联疗法治疗,即给予奥美拉唑、克拉霉素、阿莫西林、胶体果胶铋联合治疗,观察组在对照组的基础再口服半夏泻心汤加味,1天1剂,两组均治疗2周,治疗前后观察上腹部疼痛、嗳气、反酸、胃部灼热、上腹饱胀、恶心呕吐变化情况,采用单切面超声方法进行胃运动功能检查,观察胃排空时间(T)、胃窦收缩频率(F)、胃窦收缩幅度(△A/A),采用14C-UBT方法进行幽门螺旋杆菌检测,算出根除率,空腹抽血5 mL,采用放射免疫法检测白介素-6(IL-6)、胃泌素(GAS),比较两组临床疗效。结果:观察组和对照组的HP根除率为90%和54%,差异具有统计学意义(χ~2=16.071,P<0.05),观察组临床总有效率为94%和76%,差异具有统计学意义(Z=-3.178,P<0.01)。观察组和对照组治疗后上腹部疼痛、嗳气、反酸、胃部灼热、上腹饱胀、恶心呕吐评分均较治疗前明显下降(P<0.05),观察组治疗后上腹部疼痛、嗳气、反酸、胃部灼热、上腹饱胀、恶心呕吐评分明显低于对照组(P<0.05)。观察组和对照组治疗后IL-6、GAS较治疗前明显下降(P<0.05),观察组治疗后IL-6、GAS明显低于对照组(P<0.05)。观察组和对照组治疗后T明显缩短,F明显降低,△A/A明显升高,观察组治疗后T明显短于对照组,F明显低于对照,△A/A明显高于对照组,均P<0.05。结论:半夏泻心汤加味能够提高四联疗法治疗HP阳性型消化道溃疡的临床疗效,能有效缓解临床症状、提高HP根除率,作用机制与其改善胃排空功能、抑制局部炎症损伤及调节血胃泌素有关。

Objective： To observe the effect of Modified Banxie Xiexin Decoction in the treatment of duodenum ulcer complicating HP infection and influence on inflammatory factors and gastrin. Methods： A total of 100 patients with duodenum ulcer complicating HP infection from March 2014 to June 2016 in our hospital were selected as the study objects. All the patients were randomly divided into 50 cases of observation group and 50 cases of control group according to random number table generated by SPSS19. 0. The control group was treated with Quadruple therapy（ omeprazole,clarithromycin,amoxicillin,Colloidal pectin bismuth） and the observation group was given Modified Banxie Xiexin Decoction on the basis of the control group,14 d as a course. Before and after treatment,the HP eradication rate was calculated. The Upper abdominal pain,belching,acid reflux,stomach burning,abdominal fullness,nausea and vomiting score were measured. The gastric motility function was inspected to analyze gastric emptying time（ T）,gastric antrum contraction frequency（ F）,gastric antrum contraction amplitude（ △ A/A） by Single-section ultrasound method. 5 mL fasting blood was exsanguinated to test IL-6 and GAS. The clinical efficacy was compared. Results： The eradication rate of HP in the observation group was 90%,which was significantly higher than that in the control group（ 54%）. The difference was statistically significant（ χ^2= 16. 071,P〈0. 05）. The total effective rate of the observation group was 94%,which was significantly higher than that of the control group（ 76%）. The difference was statistically significant（ Z =-3. 178,P〈0. 01）. The upper abdominal pain,belching,acid reflux,stomach burning,abdominal fullness,nausea and vomitingscore of the observation group and the control group after treatment were lower than those before treatment（ P〈0. 05）.The upper abdominal pain,belching,acid reflux,stomach burning,abdominal fullness,nausea and vomiting score of the observation group after treatment were lower than those of the control group（ P〈0. 05）. The IL-6 and GAS of the observation group and the control group after treatment were significantly lower than those before treatment（ P〈0. 05）. The IL-6 and GAS of the observation group after treatment was significantly lower than those of the control group（ P〈0. 05）.After treatment,the T of observation group and control group significantly shortened,F decreased significantly. △A/A was significantly higher. The T of observation group after treatment T was significantly shorter than the control group＇s. F was significantly lower than the control and △A/A was significantly higher than the control group＇s,P〈0. 05. Conclusion： Modified Banxia Xiexin Decoction can improve the clinical curative effect of Quadruple therapy in the treatment of duodenum ulcer complicating HP infection,improve the clinical symptoms and improve the eradication rate of HP. The mechanism of action is related to the improvement of gastric emptying function,inhibition of local inflammatory injury and regulation of blood gastrin.