利胆祛湿汤加减联合四联疗法治疗Hp阳性胆汁反流性胃炎的临床效果观察

Clinical Observation on the Treatment of Hp Positive Bile Reflux Gastritis with Addition and Addition of Li-Chang Qu-Di Decoction Combined with Tetra therapy

目的:观察利胆祛湿汤加减联合四联疗法治疗幽门螺旋杆菌(Helicobacter pylori,Hp)阳性胆汁反流性胃炎的临床效果,为临床治疗提供参考。方法:选取我院于2017年8月~2020年7月收治的Hp阳性胆汁反流性胃炎患者114例,随机分为两组,每组57例。两组患者均给予四联疗法进行抗Hp治疗,辨证加减组加用利胆祛湿汤加减治疗。记录两组治疗前后胃黏膜病理组织评分的变化,检测两组治疗前后胆酸、胃酸、胃饥饿素(Stomach hunger,Ghrelin)、胃动素(Motilin,MLT)、C反应蛋白(C reactive proteins,CRP)、血管活性肠肽(Vascular active intestinal peptide,VIP)的变化,并统计两组总有效率和Hp根除率。结果辨证加减组的总有效率为94.74%,高于四联组的82.46%,组间比较有统计学意义(P<0.05)。治疗后两组血管扩张和炎症程度逐渐下降(P<0.05),胃小凹增生和黏膜肌增生程度较治疗前比较无统计学意义(P>0.05),进一步组间比较发现,辨证加减组血管扩张和炎症程度低于四联组(P<0.05),胃小凹增生和黏膜肌增生程度与四联组比较,无统计学意义(P>0.05)。治疗后两组胆酸、胃酸逐渐下降(P<0.05),进一步组间比较发现,辨证加减组胆酸、胃酸低于四联组(P<0.05)。治疗前组间比较无统计学意义(P>0.05),治疗后两组Ghrelin、MLT逐渐上升(P<0.05),CRP、VIP逐渐下降(P<0.05),进一步组间比较发现,辨证加减组Ghrelin、MLT高于四联组(P<0.05),CRP、VIP低于四联组(P<0.05)。四联组Hp根除50例,Hp根除率为87.72%,辨证加减组Hp根除52例,Hp根除率为91.23%,组间比较无统计学意义(P>0.05)。结论:利胆祛湿汤加减联合四联疗法治疗Hp阳性胆汁反流性胃炎可有效减轻胃黏膜的组织学改变,调节相关因子的表达,减少胆酸、胃酸的分泌,提高疗效。

Objective Clinical effects of Lidan Qudai decoction combined with quadruple therapy on Helicobacter pylori(Helicobacter pylori,Hp)positive bile reflux gastritis were observed,which provided reference for clinical treatment.Methods A total of 114patients with HP-positive bile reflux gastritis admitted to our hospital from August 2017to July 2020were randomly divided into two groups,with 57patients in each group.Both groups were treated with quadruple therapy for anti-HP,and the dialectical plus and minus group was treated with Lidan Qushi Decoction.The changes of gastric mucosal pathological tissue score before and after treatment were recorded,and bile acid,gastric acid,Ghrelin,Motilin(MLT)and C reactive proteins were detected before and after treatment in the two groups.Changes of CRP and Vascular active intestinal peptide(VIP),and total effective rate and Hp eradication rate of the two groups were analyzed.Results The total effective rate of the dialectical addition and subtraction group was 94.74%,which was higher than that of the quadruple group(82.46%),with statistical significance(P<0.05).After treatment,the degree of vasodilation and inflammation of the two groups gradually decreased(P<0.05),and the degree of gastric fovea hyperplasia and mucosal muscle hyperplasia had no statistical significance compared with that before treatment(P>0.05).Further comparison between groups showed that the degree of vasodilation and inflammation of the dialectical addition and reduction group was lower than that of the four-group group(P<0.05),and the degree of gastric fovea hyperplasia and mucosal muscle hyperplasia was compared with that of the four-group group.There was no statistical significance(P>0.05).After treatment,the cholic acid and gastric acid of the two groups gradually decreased(P<0.05).Further comparison between the two groups showed that the cholic acid and gastric acid of the dialectical addition and reduction group were lower than those of the four-group group(P<0.05).Before treatment,there was no statistical significance(P>0.05).After treatment,Ghrelin and MLT in the two groups gradually increased(P<0.05),while CRP and VIP gradually decreased(P<0.05).Further comparison between the two groups showed that Ghrelin and MLT in the dialectical addition and reduction group were higher than those in the four-group group(P<0.05).CRP and VIP were lower than those in quadruple group(P<0.05).The eradication rate of Hp was 87.72%in 50cases in the four-group group,and 91.23%in 52cases in the dialectical addition and subtraction group.There was no statistical significance between groups(P>0.05).Conclusion Addition and subtraction of Lidan Qudai decoction combined with quadruple therapy in the treatment of Hp positive bile reflux gastritis can effectively reduce the histological changes of gastric mucosa,regulate the expression of related factors,reduce the secretion of cholic acid and gastric acid,and improve the curative effect.