中药分期治疗脾胃湿热型慢性萎缩性胃炎伴低级别上皮内瘤变患者的疗效观察

Efficacy of Staged Traditional Chinese Medicine Treatment in Patients with Chronic Atrophic Gastritis of Spleen-stomach Damp-Heat Type Accompanied by Low-Grade Intraepithelial Neoplasia

目的探讨中药分期治疗脾胃湿热型慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)伴低级别上皮内瘤变(Low-grade gastric intraepithelial neoplasia,LGIN)患者的临床疗效。方法选取2021年3月—2023年5月期间河北省中医院收治的脾胃湿热型CAG伴LGIN患者120例,按照随机数字表法分为对照组和研究组,每组各60例。对照组给予CAG伴LGIN常规治疗,研究组采用清热化湿通络方治疗4周,随后采用健脾益气和胃化湿方治疗4周,两组患者均治疗8周。观察比较两组患者治疗前后中医证候积分、胃黏膜病理学评分、血清b胃蛋白酶原Ⅰ(PepsinogenⅠ,PGⅠ)、b胃蛋白酶原Ⅱ(PepsinogenⅡ,PGⅡ)水平、PGⅠ/PGⅡ、血清炎症因子[白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-8(Interleukin-8,IL-8)、白细胞介素-10(Interleukin-10,IL-10)、肿瘤坏死因子α(Tumor necrosis factor-α,TNF-α)]水平、血清肿瘤标志物[血清癌胚抗原(Carcinoembryonic antigen,CEA)、糖类抗原724(Carbohydrate antigen 724,CA724)、糖类抗原199(Carbohydrate antigen 199,CA199)、糖类抗原125(Carbohydrate antigen 125,CA125)]水平、免疫功能指标[免疫球蛋白A(Immunoglobulin A,IgA)、免疫球蛋白M(Immunoglobulin M,IgM)、免疫球蛋白G(Immunoglobulin G,IgG)、白细胞介素-2(Interleukin-2,IL-2)、干扰素γ(Interferon-γ,IFN-γ)、抑制性T细胞(Inhibitory T cells,CD8^(+))、成熟T淋巴细胞(Mature T lymphocytes,CD3^(+))、诱导性T细胞(Induced T cells,CD4^(+))、CD4^(+)/CD8^(+)]、临床疗效及不良反应情况。结果治疗后研究组临床总有效率96.67%(58/60)明显高于对照组85.00%(51/60),差异有统计学意义(P<0.05)。治疗后两组患者各项中医证候积分及总积分均较治疗前降低,差异有统计学意义(P<0.05);且研究组各项中医证候积分及总积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者胃黏膜病理学评分均较治疗前降低,差异有统计学意义(P<0.05);且研究组胃黏膜病理学评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者PGⅠ、PGⅡ水平及PGⅠ/PGⅡ均较治疗前升高,差异有统计学意义(P<0.05);且研究组PGⅠ、PGⅡ水平及PGⅠ/PGⅡ均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清TNF-α、IL-8、IL-6、IL-10水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组血清炎症因子水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者CA199、CEA、CA724、CA125水平均较治疗前降低,差异有统计学意义(P<0.05);且研究组血清肿瘤标志物水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IgA、IgM、IgG、IL-2、IFN-γ指标均较治疗前升高,CD8^(+)均较治疗前降低,差异有统计学意义(P<0.05);且研究组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IgA、IgM、IgG、IL-2、IFN-γ指标均明显高于对照组,CD8^(+)明显低于对照组,差异有统计学意义(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)。结论中药分期治疗脾胃湿热型CAG伴LGIN疗效确切,可通过抑制炎症反应,提升免疫功能,减轻临床症状及胃黏膜损伤,阻断疾病进展,降低胃癌发生风险。

Objective To investigate the clinical efficacy of staged traditional Chinese medicine(TCM)treatment in patients with chronic atrophic gastritis(CAG)of the spleen-stomach damp-heat type accompanied by low-grade gastric intraepithelial neoplasia(LGIN).Methods From March 2021 to May 2023,120 patients with CAG of the spleen-stomach damp-heat type accompanied by LGIN,administered at Hebei Provincial Hospital of Traditional Chinese Medicine,were selected as the research subjects.The patients were randomly divided into a control group and a study group according to the random number table method,with 60 patients in each group.The control group was treated with conventional treatment for CAG with LGIN,while the study group was treated with the Qingre Huashi Tongluo formula for 4 weeks,followed by the Jianpi Yiqi Hewei Huashi formula for another 4 weeks.Both groups were treated for a total of 8 weeks.TCM symptom scores,gastric mucosal pathology scores,serum levels of pepsinogenⅠ(PGⅠ),pepsinogen Ⅱ(PGⅡ),the PGI/PGⅡ ratio,serum inflammatory cytokines[Interleukin-6(IL-6),Interleukin-8(IL-8),Interleukin-10(IL-10),tumor necrosis factor-α(TNF-α)],serum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 724(CA724),carbohydrate antigen 199(CA199),carbohydrate antigen 125(CA125)],immune function indicators[Immunoglobulin A(IgA),Immunoglobulin M(IgM),Immunoglobulin G(IgG),Interleukin-2(IL-2),Interferon-γ(IFN-γ),inhibitory T cells(CD8^(+)),mature T lymphocytes(CD3^(+)),induced T cells(CD4^(+)),CD4^(+)/CD8^(+)ratio],clinical efficacy and adverse reactions were observed and compared before and after treatment.Results After treatment,the total clinical efficacy rate in the study group was 96.67%(58/60),significantly higher than the 85.00%(51/60)in the control group,with a statistically significant difference(P<0.05).After treatment,TCM symptom scores and total scores in both groups significantly decreased compared to before treatment,with statistically significant differences(P<0.05);the study group showed significantly lower scores than the control group,with statistically significant differences(P<0.05).The pathological scores of gastric mucosal also decreased significantly in both groups after treatment,with a statistically significant difference(P<0.05);the study group showed significantly lower scores than the control group,with a statistically significant difference(P<0.05).Additionally,the levels of PGI,PGⅡ,and the PGI/PGⅡ ratio increased significantly in both groups after treatment,with statistically significant differences(P<0.05);the study group showed significantly higher levels compared to the control group,with statistically significant differences(P<0.05).Serum levels of TNF-α,IL-8,IL-6,and IL-10 decreased significantly in both groups,with statistically significant differences(P<0.05);the study group showed significantly lower levels compared to the control group,with statistically significant differences(P<0.05).Tumor markers CA199,CEA,CA724,and CA125 also significantly decreased in both groups after treatment,with statistically significant differences(P<0.05);the study group showed significantly lower levels than the control group,with statistically significant differences(P<0.05).Immune function indicators(CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IgA,IgM,IgG,IL-2,and IFN-γ)increased significantly in both groups after treatment,while CD8^(+)levels decreased,with statistically significant differences(P<0.05).The study group had significantly higher levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IgA,IgM,IgG,IL-2,and IFN-γ,and significantly lower CD8^(+)levels compared to the control group,with statistically significant differences(P<0.05).During the treatment period,there was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Staged TCM treatment for spleen-stomach damp-heat type CAG with LGIN is highly effective.It alleviates clinical symptoms,reduces gastric mucosal damage,inhibits inflammatory responses,enhances immune function,blocks disease progression,and lowers the risk of gastric cancer.