化痰消瘀方治疗慢性萎缩性胃炎临床研究

Clinical Research on Phlegm-Dissipating and Stasis-Eliminating Prescription in Treating Chronic Atrophic Gastritis

目的:观察化痰消瘀方治疗慢性萎缩性胃炎伴肠上皮化生、或(和)者伴有低级别上皮内瘤变的临床疗效。方法:入选经胃镜及病理确诊为慢性萎缩性胃炎伴肠上皮化生、或(和)者伴有低级别上皮内瘤变的患者122例,按随机数字表法分为治疗组60例和对照组42例。治疗组采用化痰消瘀方加减治疗,具体方药:陈皮12 g,法半夏10 g,鸡内金10 g,丹参15 g,薏苡仁30 g,蒲黄粉10 g,半枝莲15 g,仙鹤草15 g,猫爪草15 g,白花蛇舌草15 g。随证加减:胃痛或腹痛甚者加娑罗子10 g,延胡索10 g;反酸甚者加锻瓦楞子20 g;腹胀甚者加木香10 g,砂仁(后下)3 g;饱胀者加焦山楂、焦神曲各10g,炒谷芽、炒麦芽各15 g,莱菔子10 g;心下痞满者加枳实10 g,瓜蒌皮10 g;嗳气者加降香6 g,旋覆花10 g;瘀血内阻明显者加莪术15 g;阴虚者加北沙参10 g,麦冬10 g;有低级别上皮内瘤变者加仙鹤草15 g,藤梨根20 g。每次100 m L,分早晚2次服用,治疗疗程为6个月。对照组42例,给予胃复春片治疗,每次3片,每天3次。治疗后比较两组患者的临床疗效。结果:治疗组痊愈9例,显效33例,有效13例,无效5例,有效率为91.67%;对照组痊愈3例,显效6例,有效21例,无效12例,有效率为71.43%。两组比较,差异有统计学意义(P<0.05)。结论:化痰消瘀方加减对逆转慢性萎缩性胃炎伴肠上皮化生,或(和)轻度上皮内瘤变这一癌前病变疗效显著。

Objective： To observe the clinical effect of phlegm-dissipating and stasis-eliminating prescription in treating chronic atrophic gastritis,accompanied by intestinal metaplasia and/or low grade intraepithelial neoplasia. Methods： 122 patients diagnosed as chronic atrophic gastritis accompanied by intestinal metaplasia and/or low grade intraepithelial neoplasia by gastroscope and pathology were randomly divided into two groups,with 62 patients in the control group and 60 patients in the treatment group. Patients in the treatment group were treated by the phlegm-dissipating and stasis-eliminating prescription： Chenpi（ Pericarpium Citri Reticulatae） 12 g,Fabanxia（ Rhizoma Pinellinae Praeparata） 10 g,Jineijin（ Endothelium Corneum Gigeriae Galli） 10 g,Zidanshen（ Purple Salvia Miltiorrhizae） 15 g,Yiyiren（ Semen Coicis） 30 g,Puhuangfen（ Cattail Pollen） 10 g,Banzhilian（ Sculellaria Barbata） 15 g,Xianhecao（ Hairyvein Agrimony Herb） 15 g,Maozhuacao（ Radix Ranunculi Ternati） 15 g and Baihuasheshecao（ Oldenlandia Diffusa） 15 g. The prescription was modified by the following according to the symptoms： added Suoluozi（ Semen Aesculi） 10 g and Yanhusuo（ Corydalis Tuber） 10 g for patients who had stomachache or abdominal pain; added Duanwalengzi（ Arca Subcrenata Lischke） 20 g for patients who had sour regurgitation; added Muxiang（ Radices Saussureae） 10 g and Sharen（ FructusAmomi,put later） 3 g for patients who had abdominal distension; added Jiaoshanzha（ Charred Fructus Crataegi） 10 g and jiaoshenqu（ Charred Massa Medicata Fermentata Fujianensis） 10 g,Chaoguya（ Stir-Baked Rice） 15 g and Chaomaiya（ Stir-Baked Malt）15 g or Laifuzi（ Radish Seed） 10 g for patients who had the feeling of repletion; added Zhishi（ Fructus Aurantii Immaturus） 10 g and Gualoupi（ Pericarpium Trichosanthis） 10 g for patients who had the fullness of the upper abdomen; added Jiangxiang（ Lignum Acronychiae） 6 g and Xuanfuhua（ Inula Flower） 10 g for patients who had belching; added Ezhu（ Curcuma Zedoary） 15 g for patients who had the stagnation of blood stasis; added Beishashen（ Radices Glehniae） 10 g,Maidong（ Radix Ophiopogonis） 10 g for patients who had Yin deficiency; added Tengligen（ Chinese Actinidia Root） and Xianhecao（ Hairyvein Agrimony Herb） 15 g for patients who had the low grade intraepithelial neoplasia. Drink 100 mL each time and twice a day,i. e.,respectively in the morning and in the evening with the treatment course of 6 months. 42 patients in the control group were treated with Weifu Chunpian（ stomach restoring pills）,3 times a day with 3 pills per time. After treatment,the clinical effects between patients of the two groups were compared. Results： in the treatment group,9 patients recovered,33 patients received obvious curative effect,13 patients received curative effect,5 patients received no effect,and the effective rate was 91. 67%; in the control group,3 patients recovered,6 patients received obvious curative effect,21 patients received curative effect,12 patients received no effect,and the effective rate was71. 43%. By comparison,the differences of the two groups before and after the treatment were of statistical significance（ P〈0. 05）. Conclusion： The phlegm-dissipating and stasis-eliminating prescription with modification has significant curative effect on chronic atrophic gastritis,accompanied by intestinal metaplasia and/or low grade intraepithelial neoplasia,the precancerous lesion.