制萎汤加减方联合四联法治疗慢性萎缩性胃炎患者的临床疗效及对其中医证候评分、胃蛋白酶原和炎症因子的影响

Clinical Efficacy of Modified Zhiwei Decoction Combined with Quadruple Therapy in Treatment of Chronic Atrophic Gastritis and Its Influence on TCM Syndrome Score,Pepsinogen,and Inflammatory Factors

目的观察制萎汤加减方联合四联法治疗慢性萎缩性胃炎(Chronic atrophic gastritis,CAG)患者的临床疗效及对其中医证候评分、胃蛋白酶原和炎症因子的影响。方法选取2021年4月—2022年4月期间广元市中医医院消化科收治的CAG患者100例,采用随机数字法分为对照组和治疗组,每组各50例。对照组采用四联法治疗,治疗组在对照组治疗基础上联合制萎汤加减治疗。治疗6个疗程后,观察比较两组患者临床疗效、不良反应情况,治疗前后中医证候评分、血清炎症因子[白细胞介素-4(Interleukin 4,IL-4)、白细胞介素-10(Interleukin 10,IL-10),肿瘤坏死因子-α(Tumor necrosis factor alpha,TNF-α)]、血清[胃蛋白酶原Ⅰ(Pepsinogen I,PGⅠ)、胃蛋白酶原Ⅱ(PepsinogenⅡ,PGⅡ)、胃泌素(Gastrin,GAS)、表皮生长因子(Epidermal growth factor,EGF)、血管细胞黏附分子-1(Vascular cell adhesion molecule 1,VCAM-1)]水平。结果治疗后治疗组临床总有效率92.00%(46/50)明显高于对照组76.00%(38/50),差异有统计意义(P<0.05)。治疗后两组患者IL-4、IL-10、TNF-α水平均较治疗前降低,差异有统计学意义(P<0.05);且治疗组血清IL-4、IL-10、TNF-α水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者主症、次症及总积分均低于治疗前,差异有统计学意义(P<0.05);且治疗组主症、次症及总积分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清PGⅠ、GAS水平均较治疗前降低,血清PGⅡ水平均较治疗前升高,差异有统计学意义(P<0.05);且治疗组血清PGⅠ、GAS水平均明显低于对照组,血清PGⅡ水平明显高于对照组,差异有统计学意义(P<0.05)。治疗后治疗组血清EGF水平较治疗前升高,VCAM-1水平较治疗前降低,差异有统计学意义(P<0.05);且治疗组血清EGF水平较对照组明显升高,VCAM-1水平较对照组明显降低,差异有统计学意义(P<0.05)。治疗期间,两组患者均无不良反应情况发生。结论制萎汤加减方联合四联法治疗CAG可明显改善患者临床症状、有效调节患者血清炎症因子、PGⅠ、PGⅡ、EGF及VCAM-1水平。

Objective To observe the clinical efficacy of modified Zhiwei Decoction combined with the quadruple therapy in treating patients with chronic atrophic gastritis(CAG)and its effect on traditional Chinese medicine(TCM)syndrome scores,serum pepsinogen levels,and inflammatory factors.Methods A total of 100 CAG patients admitted to the Gastroenterology Department of Guangyuan Traditional Chinese Medicine Hospital from April 2021 to April 2022 were enrolled and randomly divided into a control group and a treatment group according to a random number table,with 50 cases in each group.The control group received quadruple therapy,while the treatment group was additionally treated with the modified Zhiwei Decoction based on the treatment of the control group.After six treatment cycles,the clinical efficacy,adverse reactions,TCM syndrome scores,and serum inflammatory factors[interleukin 4(IL-4),interleukin 10(IL-10),tumor necrosis factor-alpha(TNF-α)],as well as serum levels of pepsinogen I(PG I),pepsinogen II(PG II),gastrin(GAS),epidermal growth factor(EGF),and vascular cell adhesion molecule-1(VCAM-1)before and after treatment were compared between the two groups.Results After treatment,the total effective rate in the treatment group was 92.00%(46/50),significantly higher than 76.00%(38/50)in the control group(P<0.05).Both groups showed a significant decrease in IL-4,IL-10,and TNF-αlevels after treatment compared with those before treatment(P<0.05),with the treatment group exhibiting significantly lower levels of IL-4,IL-10,and TNF-αthan the control group(P<0.05).The primary symptom scores,secondary symptom scores,and total scores in both groups were lower after treatment than those before treatment(P<0.05).The primary symptom score,secondary symptom score,and total score in the treatment group were significantly lower than those of the control group(P<0.05).In both groups,serum PG I and GAS levels decreased after treatment,while PG II levels increased(P<0.05).The PG I and GAS levels of the treatment group were significantly lower than those of the control group,while PG II levels were significantly higher(P<0.05).The treatment group showed increased serum EGF levels and decreased VCAM-1 levels after treatment(P<0.05).Serum EGF levels in the treatment group were significantly higher and VCAM-1 levels were significantly lower than those in the control group(P<0.05).No adverse reactions occurred in either group during the treatment period.Conclusion Modified Zhiwei Decoction combined with quadruple therapy significantly improves clinical symptoms in CAG patients and effectively regulates serum inflammatory factors,PG I,PG II,EGF,and VCAM-1 levels.