三七白及散联合四联疗法对血瘀型十二指肠溃疡的疗效及影响Hp根除的因素分析

Effect of Sanqi Baiji Powder Combined with Quadruple Therapy on Duodenal Ulcer with Blood Stasis Syndrome and Analysis of Factors Affecting Helicobacter pylori Eradication

目的探讨三七白及散联合四联疗法对血瘀型十二指肠溃疡(Duodenal ulcer,DU)的疗效及影响幽门螺杆菌(Helicobacter pylori,Hp)根除的因素。方法选取2018年1月—2021年1月期间在南京中医药大学附属如皋市中医院门诊和住院收治的合并Hp感染的DU患者98例,按照随机数字表法分为对照组和观察组,每组各49例。对照组给予四联疗法,观察组给予三七白及散联合四联疗法。治疗28 d后,观察比较两组患者的溃疡愈合质量、中医证候积分减少率及Hp根除情况。采用单因素分析影响DU患者Hp根除的因素,包括人口学资料(性别、年龄、吸烟、饮酒、民族、受教育程度)、实验室检测指标[血压、胃泌素、白细胞介素(Interleukin-10,IL-10)、肿瘤坏死因子(Tumor necrosis factorα,TNF-α)、血细胞比容、血沉]、治疗方法(四联疗法/三七白及散+四联疗法)等,对单因素分析存在统计学意义的因素代入Logistics回归模型分析影响瘀血型DU患者Hp根除的影响因素。结果治疗后观察组溃疡愈合质量优于对照组,差异有统计学意义(P<0.05)。治疗后观察组中医证候积分减少率优于对照组,差异有统计学意义(P<0.05)。治疗后观察组Hp根除率63.27%(31/49)明显高于对照组40.82%(20/49),差异有统计学意义(χ^(2)=4.947,P=0.026,P<0.05)。单因素分析显示吸烟、饮酒、胃泌素、IL-10、TNF-α、血细胞比容、血沉及四联疗法/三七白及散+四联疗法可影响血瘀型DU患者Hp根除率(P<0.05)。Logistics回归模型分析显示血细胞比容和血沉是血瘀型DU患者Hp根除的危险因素(P<0.05),三七白及散联合四联疗法是血瘀型DU患者Hp根除的保护性因素(P<0.05)。治疗期间,两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论三七白及散联合四联疗法可显著改善血瘀型DU患者病情并提升Hp根除率,改善血液流变学参数效果,且具有良好的治疗安全性,可能是一种较优的治疗方案。

Objective To observethe effect of Sanqi Baiji Powder combined with quadruple therapy on duodenal ulcer(DU)with blood stasis syndrome and analyze the factors affecting Helicobacter pylori(Hp)eradication.Methods Ninty-eight DU patients with Hp infection who received outpatient and inpatient treatment in Rugao Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from January 2018 to January 2021 were divided into a control group and an observation group by the random number table method,with 49 patients in each group.The control group received quadruple therapy,and the observation group received Sanqi Baiji Powder based on the control group.Both groups underwent treatment for 28 days.The quality of ulcer healing,traditional Chinese medicine(TCM)syndrome score reduction rate,and Hp eradication rate in the two groups were compared.The single factor analysis was used to analyze the factors affecting Hp eradication in DU patients,including demographic data(sex,age,smoking,drinking,ethnicity,and educational level),laboratory test indicators[blood pressure,gastrin,interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),hematocrit,and erythrocyte sedimentation rate],treatment methods(quadruple therapy/Sanqi Baiji Powder+quadruple therapy),and so on.The factors with statistical significance analyzed by the single factor analysis were substituted into the Logistic regression model to analyze the factors affecting Hp eradication in DU patients with blood stasis syndrome.Results After treatment,the quality of ulcer healing and TCM syndrome score reduction rate in the observation group were better than those in the control group(P<0.05),and the Hp eradication rate of the observation group was 63.27%(31/49),which was superior to that of the control group[40.82%(20/49)](I^(2)=4.947,P=0.026,P<0.05).The results of single factor analysis showed that smoking,drinking,gastrin,IL-10,TNF-α,hematocrit,erythrocyte sedimentation rate,and quadruple therapy/Sanqi Baiji Powder+quadruple therapy all influenced Hp eradication rate in DU patients with blood stasis syndrome(P<0.05).The results of Logistic regression model analysis showed that hematocrit and erythrocyte sedimentation rate were risk factors affecting Hp eradication in DU patients with blood stasis syndrome(P<0.05),and quadruple therapy/Sanqi Baiji Powder+quadruple therapy were protective factors(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Sanqi Baiji Powder combined with quadruple therapy can significantly improve the condition of DU patients with blood stasis syndrome,increase the Hp eradication rate,improve the effect of hemorheological parameters,and have good treatment safety,which may be a relatively good method.