养胃汤加减治疗幽门螺杆菌阳性胃癌前病变临床疗效及其对胃蛋白酶的影响

Clinical Effect of Modified Yangwei Decoction(养胃汤加减)on Helicobacter Pylori Positive Precancerous Lesions and Its Effect on Pepsin

目的观察养胃汤加减治疗幽门螺杆菌(Hp)阳性胃癌前病变的临床疗效及其对胃蛋白酶的影响。方法选择2020年6月—2022年6月就诊的80例幽门螺杆菌阳性的胃癌前病变患者,按照自愿原则分为常规治疗组和养胃汤组各40例,常规治疗组患者给予四联疗法根治Hp和胃黏膜保护治疗;养胃汤组在常规治疗组的基础上予以中药养胃汤加减治疗,两组疗程均为60 d。观察两组病人的临床疗效、主要症状积分变化以及幽门螺杆菌清除率,并比较治疗前、后胃蛋白酶水平和胃黏膜病理状态的变化。结果常规治疗组的有效率为80.00%(32/40),养胃汤组的有效率为95.00%(38/40),养胃汤组的有效率明显优于常规治疗组(P<0.05)。经过60 d治疗后,常规治疗组患者伴HP感染者6例,HP清除率为85.00%(34/40);养胃汤组患者伴HP感染者1例,HP清除率为97.50%(39/40),养胃汤组病人HP清除率明显升高(χ^(2)=3.914,P=0.048<0.05)。经过60 d治疗后,养胃汤组病人的病理状态和积分水平相较于常规治疗组显著改善(P<0.01)。经过60 d治疗,与常规治疗组比较,养胃汤组病人的8项关键临床表现均明显改善(P<0.001)。治疗开始前两组患者血清中胃蛋白酶原I(PGI)、胃蛋白酶原II(PGII)以及胃泌素17(G-17)水平无显著性差异(P>0.05)。治疗完成后,相较于常规治疗组,养胃汤组PGI含量和PGI/PGII显著上调,而PGII和G-17含量明显减少,差异均有统计学意义(P<0.05)。结论养胃汤加减能够减轻幽门螺杆菌阳性胃癌前病变患者的痞满、呕吐等症状,改善胃黏膜病理状态,提升幽门螺杆菌的清除率,且无不良反应增加,其作用机制可能与调节胃蛋白酶原水平相关。

Objective To observe the clinical efficacy of Yangwei Decoction(养胃汤)in the treatment of Helicobacter pylori(HP)positive precancerous lesions and its effect on pepsin.Methods From June 2020 to June 2022,80 patients with HP positive pregastric cancer who visited the Department of Gastroenterology,Tianshui Hospital of Integrated Traditional Chinese and Western Medicine Hospital were selected.According to the voluntary principle,they were divided into conventional treatment group and Yangwei Decoction group,40 patients in each group.The conventional treatment group was given quadruple therapy for radical treatment of HP and gastric mucosa protection.Yangwei Decoction group was treated with Yangwei Decoction on the basis of con-ventional treatment group.The treatment course of both groups was 60 days.The clinical efficacy,main symptom score and HP clearance rate of two groups were observed,and the changes of pepsin level and pathological status of gastric mucosa before and after treatment were compared.Results The effective rate of the conventional treatment group was 80.00%(32/40)and that of the Yangwei decoction group was 95.00%(38/40).The effective rate of the Yangwei Decoction group was significantly better than that of the conventional treatment group(P<0.05).After 60 days of treatment,there were 6 patients with HP infection in the conventional treatment group,and the HP clearance rate was 85.00%(34/40).There was 1 case with HP infection in the Yangwei Decoction group,and the HP clearance rate was 97.50%(39/40).The HP clearance rate in the Yangwei Decoction group was significantly higher(χ^(2)=3.914,P=0.048<0.05).After 60 days of treatment,the pathological status and score of patients in the Yangwei Decoction group were significantly improved compared with those in the conventional treatment group(P<0.01).After 60 days of treatment,compared with the those in the conventional treatment group,the key clinical manifesta-tions of patients in the Yangwei Decoction group were significantly improved(P<0.001).Before treatment,there were no signifi-cant differences in serum levels of pepsinogen I(PGI),pepsinogen II(PGII)or gastrin 17(G-17)between two groups(P>0.05).After treatment,PGI content and PGI/PGII in the Yangwei Decoction group were significantly up-regulated,while the contents of PGII and G-17 were significantly decreased(P<0.05)compared with those of the conventional treatment group,the difference is statistically significant.Conclusion Yangwei Decoction can reduce the symptoms of swelling and vomiting,improve the pathological status of gastric mucosa,and improve the clearance rate of HP without increasing adverse reactions.The mechanism of action may be related to the regulation of pepsinogen level.