健脾祛邪汤治疗Hp感染合并慢性萎缩性胃炎的临床疗效及对IL-1β、IL-6、IL-8水平的影响

Clinical Efficacy of Jianpi Quxie Decoction in Treatment of Hp Infection Combined with Chronic Atrophic Gastritis and Its Influence on IL-1β,IL-6 and IL-8 Levels

目的探究健脾祛邪汤治疗幽门螺杆菌(Hp)感染合并慢性萎缩性胃炎(CAG)的临床疗效及对白细胞介素(IL)-1β、IL-6、IL-8水平的影响。方法选取2019年3月至2021年3月天津市西青医院收治的90例Hp感染合并CAG患者为研究对象,按照治疗方法不同分为对照组(45例)和观察组(45例)。两组患者入院后均进行健康宣教,规范饮食习惯、作息时间以及生活方式。对照组采用常规西药治疗,口服奥美拉唑钠肠溶胶囊(每次20 mg、每日1次)、阿莫西林胶囊(每次0.5 g、每日2次)、克拉霉素片(每次0.5 g、每日2次);观察组在对照组基础上采用健脾祛邪汤治疗,用水煎服150 ml,每日2次。两组均持续治疗4周。比较两组患者治疗前后的炎症因子(IL-1β、IL-6、IL-8)水平、病理组织学(萎缩、肠化生、上皮内瘤变)积分、中医证候(神疲懒言、食少呆纳、食后饱胀、胃脘隐痛)积分以及临床疗效。结果治疗后,两组患者IL-1β、IL-6、IL-8水平均低于治疗前(P<0.05),且观察组低于对照组[(61.6±6.6)ng/L比(69.5±6.8)ng/L、(19.9±2.9)ng/L比(29.6±3.6)ng/L、(7.8±1.1)ng/L比(9.9±1.8)ng/L](P<0.01)。治疗后,两组患者萎缩、肠化生、上皮内瘤变评分均低于治疗前(P<0.05),且观察组低于对照组[(2.93±0.29)分比(3.56±0.39)分、(2.45±0.25)分比(3.01±0.31)分、(2.51±0.25)分比(3.09±0.31)分](P<0.01)。治疗后,两组患者神疲懒言、食少呆纳、食后饱胀、胃脘隐痛均低于治疗前(P<0.05),且观察组低于对照组[(0.55±0.05)分比(0.75±0.08)分、(0.64±0.07)分比(0.89±0.09)分、(0.61±0.06)分比(0.81±0.09)分、(0.73±0.07)分比(1.38±0.39)分](P<0.01)。观察组患者Hp感染率低于对照组[33.33%(15/45)比60.00%(27/45)](χ^(2)=4.252,P=0.039),总有效率高于对照组[95.56%(43/45)比80.00%(36/45)](χ^(2)=5.075,P=0.024)。结论健胃祛邪汤可有效抑制Hp感染合并CAG患者的炎症,改善萎缩、肠化生、上皮内瘤变情况,减轻中医证候症状,提高临床疗效。

Objective To investigate the clinical effect of Jianpi Quxie decoction on Helicobacter pylori(Hp)infection combined with chronic atrophic gastritis(CAG)and its influence on the levels of interleukin(IL)-1β,IL-6 and IL-8.Methods A total of 90 patients with Hp infection and CAG admitted to Tianjin Xiqing Hospital from Mar.2019 to Mar.2021 were included,and divided into a control group(45 cases)and an observation group(45 cases)according to different treatment methods.All the patients in the two groups were given health education after admission to standardize the patients′diet,sleep time and life style.The control group was treated with routine western medicine,oral omeprazole sodium enteric-coated capsule(20 mg per time,once daily),amoxicillin capsule(0.5 g per time,twice daily)and clarithromycin tablet(0.5 g per time,twice daily).The observation group was added with Jianpi Quxie decoction,150 ml with water,twice a day.Both groups had continued treatment for 4 weeks.The levels of inflammatory factors(IL-1β,IL-6 and IL-8),the scores of histopathology(atrophy,intestinal metaplasia and intraepithelial neoplasia),the traditional Chinese medicine(TCM)syndromes scores(feeling fatigued and lazy,eating too little and being too lazy to eat,feeling full and bloated after eating,and experiencing dull pain in the epigastric region)and the clinical effects were observed before and after treatment in both groups.Results After treatment,the IL-1β,IL-6 and IL-8 levels of both groups were lower than before treatment(P<0.05),and the observation group were lower than those in the control group[(61.6±6.6)ng/L vs(69.5±6.8)ng/L,(19.9±2.9)ng/L vs(29.6±3.6)ng/L,(7.8±1.1)ng/L vs(9.9±1.8)ng/L](P<0.01).After treatment,the scores of atrophy,intestinal metaplasia and intraepithelial neoplasia of both groups were lower than those before treatment(P<0.05),and the observation group were lower than those in the control group(2.93±0.29 vs 3.56±0.39,2.45±0.25 vs 3.01±0.31,2.51±0.25 vs 3.09±0.31)(P<0.01).After treatment,the scores of feeling fatigued and lazy,eating too little and being too lazy to eat,feeling full and bloated after eating,and experiencing dull pain in the epigastric region of both groups were lower than before treatment(P<0.05),and the observation group were lower than those in the control group(0.55±0.05 vs 0.75±0.08,0.64±0.07 vs 0.89±0.09,0.61±0.06 vs 0.81±0.09,0.73±0.07 vs 1.38±0.39)(P<0.01).The Hp infection rate of the observation group was lower than that of the control group[33.33%(15/45)vs 60.00%(27/45)](χ^(2)=4.252,P=0.039),and the overall response rate was higher than that of the control group[95.56%(43/45)vs 80.00%(36/45)](χ^(2)=5.075,P=0.024).Conclusion Jianpi Quxie decoction can effectively inhibit inflammation in patients with Hp and CAG,improve atrophy,intestinal metaplasia and intraepithelial neoplasia,reduce the TCM syndrome symptoms,and improve the clinical efficacy.