胃复春联合复方尿囊素、多维片对萎缩性胃炎伴肠上皮化生逆转治疗的效果评估

Therapeutic effect of Weifuchun tablets combined with compound allantoin and multi-vitamin B tablets on chronic atrophic gastritis with intestinal metaplasia

目的探讨胃黏膜萎缩伴肠上皮化生与慢性胃炎的关系,同时评价药物联合治疗对逆转萎缩和肠上皮化生的效果。方法选择2014年2月至2015年9月上海市黄浦区东南医院/上海市瑞金康复医院内镜病理活检诊断为慢性胃炎伴萎缩和肠上皮化生的患者(共114例),随机化分为2组,对照组(n=56)单用胃复春治疗,治疗组(n=58)采用胃复春、多维片、复方尿囊素联合治疗,疗程均为6个月,之后复查胃镜及病理活检,比较治疗前后黏膜炎症程度、萎缩、肠化缓解程度,采用SPSS 20.0软件进行分析,计量资料采用均值±标准差表示,差异显著性采用t检验,计数资料采用χ~2检验,以P<0.05为差异具有统计学意义。结果复查胃镜及活检显示,治疗后,治疗组、对照组分别有10例(17.24%)、3例(5.36%)萎缩阳性转为阴性,治疗组萎缩逆转率显著高于对照组(χ~2=3.983,P=0.046)。治疗组、对照组分别有20例(34.48%)、8例(14.29%)肠上皮化生转阴性,治疗组肠化逆转率显著高于对照组(χ~2=6.272,P=0.012)。进一步按照萎缩程度、肠化程度比较,治疗组胃黏膜萎缩程度、肠化程度和对照组相比均显著减轻(χ~2=14.856,P=0.002;χ~2=11.469,P=0.009)。对照组治疗后胃黏膜肠化程度较治疗前显著减轻(χ~2=8.949,P=0.030),但萎缩程度差异无统计学意义(χ~2=4.308,P=0.230)。结论恰当的药物治疗有助于逆转慢性胃炎的萎缩和肠上皮化生,同时胃复春联合使用多维片、复方尿囊素的治疗效果明显优于胃复春的单药治疗,部分病例有显著的效果。

Objective To investigate the relationship between gastric mucosal atrophy with intestinal metaplasia and chronic gastritis,and to evaluate the therapeutic effect of combined drug therapy on chronic atrophic gastritis with intestinal metaplasia.Methods One hundred and fourteen patients who were diagnosed with chronic gastritis with atrophy and intestinal metaplasia by endoscopic pathological biopsy at our hospital from February2014to September2015were randomly divided into two groups:a control group(treated with Weifuchun tablets alone;n=56)and a combination treatment group(treated with Weifuchun tablets combined with compound allantoin and multi-vitamin B tablets;n=58).Six months after treatment,gastroscopic biopsy was performed to assess the degree of mucosal inflammation,atrophy,and intestinal metaplasia.SPSS20.0software was used for statistical analysis.Results After treatment,gastroscopic biopsy revealed that atrophy was reversed in ten(17.24%)cases in the combination treatment group and three(5.36%)cases in the control group,and the cure rate of atrophy was significantly higher in the combination treatment group than in the control group(χ2=3.983,P=0.046);and that intestinal metaplasia was reversed in20(34.48%)cases in the combination treatment group and eight(14.29%)cases in the control group,and the cure rate of intestinal metaplasia was significantly higher in the combination treatment group than in the control group(χ2=6.272,P=0.012).After treatment,the degree of atrophy and intestinal metaplasia in the combination treatment group was significantly lower than that of the control group(χ2=14.856,P=0.002;χ2=11.469,P=0.009).The degree of atrophy and intestinal metaplasia in the combination treatment group was significantly reduced after treatment compared with before treatment(χ2=41.970,P=0.000;χ2=32.253,P=0.000).The degree of intestinal metaplasia in the control group was significantly reduced after treatment compared with before treatment(χ2=8.949,P=0.03),but atrophy showed no significant improvement(χ2=4.308,P=0.230).Conclusion Appropriate drug therapy is useful to treat atrophy and intestinal metaplasia in chronic gastritis.Combined Weifuchun tablets,multi-vitamin B tablets,and compound allantoin have significantly better therapeutic effect than Weifuchun tablets alone,especially in some cases.