荜铃胃痛颗粒联合三联疗法治疗慢性萎缩性胃炎合并幽门螺杆菌感染的临床研究

The clinical efficacy of BilingWeitong Granules combined with triple therapy in the treatment of chronic atrophic gastritis complicated with helicobacter pylori infection

[目的]探讨荜铃胃痛颗粒联合三联疗法治疗慢性萎缩性胃炎合并幽门螺杆菌(HP)感染的临床疗效及对血清胃蛋白酶原、炎症因子、胃肠激素及免疫功能的影响。[方法]选择2018年12月—2020年6月收治的64例慢性萎缩性胃炎合并HP感染患者作为研究对象,将患者按随机数字表分为对照组和观察组,每组各32例,对照组患者给予标准三联方案(雷贝拉唑、克拉霉素、替硝唑)治疗,观察组在对照组的基础上再口服荜铃胃痛颗粒,两组均治疗2周,治疗前及治疗2周结束时进行临床症状(纳差、恶心、腹胀、嗳气、上腹痛)评分,采用13C呼气实验检测HP根除情况,进行电子胃镜检查,同时进行胃黏膜病理检查,采用乳胶增强免疫比浊法检测胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ),放免法检测胃肠激素[胃泌素(GAS)、胃动素(MTL)、生长抑素(SS)],采用酶联免疫吸附(ELISA)方法检测血清炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],采用流式细胞仪检测T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)),记录不良反应发生情况。[结果]对照组和观察组治疗2周结束时纳差、呃逆、上腹部胀满、吞酸嗳气、上腹痛评分均较治疗前明显降低,差异具有统计学意义(P<0.05),观察组治疗2周结束时纳差、呃逆、上腹部胀满、吞酸嗳气、上腹痛评分明显低于对照组,差异具有统计学意义(P<0.05)。观察组治疗2周结束时HP阳性率为9.38%(3/32),对照组为37.5%(12/32),差异具有统计学意义(P<0.05)。观察组治疗2周结束时炎症反应、炎症活动度评分均较治疗前明显降低,差异具有统计学意义(P<0.05),且明显低于对照组,差异具有统计学意义(P<0.05)。对照组和观察组治疗2周结束时PGⅠ、PGⅡ、MTL、SS较治疗前明显升高,差异具有统计学意义(P<0.05),GAS较治疗前明显降低(P<0.05),观察组治疗2周结束时PGⅠ、PGⅡ、MTL、SS明显高于对照组,差异具有统计学意义(P<0.05),GAS明显低于对照组,差异具有统计学意义(P<0.05)。对照组和观察组治疗2周结束时IL-6、TNF-α、CD8^(+)较治疗前明显降低,差异具有统计学意义(P<0.05),CD4^(+)、CD4^(+)/CD8^(+)较治疗前明显升高,差异具有统计学意义(P<0.05),观察组治疗2周结束时IL-6、TNF-α、CD8^(+)明显低于对照组,差异具有统计学意义(P<0.05),CD4^(+)、CD4^(+)/CD8^(+)明显高于对照组,差异具有统计学意义(P<0.05)。[结论]荜铃胃痛颗粒联合三联疗法治疗慢性萎缩性胃炎合并HP感染疗效显著,能够提高HP根除率,有效调节胃肠激素分泌,促进胃蛋白酶原合成,抑制炎症反应、提高患者免疫功能,多途径共同作用促进疾病康复。

[Objective]To investigate the clinical efficacy of Biling Weitong Granules combined with triple therapy in the treatment of chronic atrophic gastritis complicated with helicobacter pylori infection and its effects on serum pepsinogen,inflammatory factors,gastrointestinal hormones and immune function.[Methods]A total of 64 patients with chronic atrophic gastritis complicated with helicobacter pylori infection admitted from December 2018 to June 2020 were selected as the research subjects.The patients were divided into control group and observation group according to a random number table,with 32 cases in each group.Control group patients were given the standard of sanlian(rabeprazole azole,clarithromycin,for indications)treatment,on the basis of the control group,the observation group was taken orally again with Biling Weitong Granules,and both groups were treated for 2 weeks,before and at the end of 2 weeks of treatment for clinical symptoms(such as anorexia,nausea,abdominal distention,belching,upper abdominal pain)score,the 13C breath test to detect helicobacter pylori(HP)eradication,electronic gastroscopy and gastric mucosa pathological examination at the same time,use latex-enhanced immunoturbidimetric method to detect pepsinogen Ⅰ and Ⅱ,radioimmunoassay to detect gastrointestinal hormones[gastrin(GAS),motilin(MTL),somatostatin(SS)],and ELISA method to detect serum inflammation Factors[Interleukin-6(IL-6),Tumor Necrosis Factor-α(TNF-α)],use flow cytometry to detect T lymphocyte subsets(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),and record the occurrence of adverse reactions.[Results]At the end of 2 weeks of treatment,the scores of inactivity,hiccup,epigastric distention,acid belching and epigastric pain in the control group and the observation group were significantly lower than those before treatment(P<0.05).The scores of inactivity,hiccup,acid belching and epigastric pain in the observation group were significantly lower than those in the control group(P<0.05).At the end of 2 weeks of treatment,the positive rate of Hp in the observation group was 9.38%(3/32),and that in the control group was 37.5%(12/32),the difference was statistically significant(P<0.05).At the end of 2 weeks of treatment,the inflammatory response and inflammatory activity scores in the observation group were significantly lower than those before treatment(P<0.05),and significantly lower than those in the control group(P<0.05).Control group and observation group after 2 weeks of treatment at the end of PG Ⅰ,PG Ⅱ,MTL and SS is significantly increased before treatment,P<0.05,GAS significantly lower than before treatment(P<0.05),the observation group after 2 weeks of treatment at the end of PGⅠ,PGⅡ,MTL and SS are significantly higher than the control group(P<0.05),GAS significantly lower than the control group(P<0.05).At the end of 2 weeks of treatment,IL-6,TNF-α and CD8^(+)in the control group and the observation group were significantly decreased compared with before treatment(P<0.05);CD4^(+)and CD4^(+)/CD8^(+)were significantly increased compared with before treatment,P<0.05;at the end of 2 weeks of treatment,IL-6,TNF-αand CD8^(+)in the observation group were significantly lower than that in the control group(P<0.05);CD4^(+)and CD4^(+)/CD8^(+)were significantly higher than that in the control group(P<0.05).[Conclusion]Biling Weitong Granules combined triple therapy treatment of helicobacter pylori infection in chronic atrophic gastritis with curative effect significantly,can improve the HP eradicate rate,regulate gastrointestinal hormone secretion,promote the synthesis of pepsin,inhibiting inflammatory response and improve immune function,patients with more ways to promote disease rehabilitation.