柴枳平肝汤合消痞宽胃汤治疗肝胃不和型慢性胃炎的临床疗效

doi:10.3760/cma.j.issn.1007-1245.2024.16.027

摘要/Abstract

摘要：

目的　评估柴枳平肝汤合消痞宽胃汤治疗肝胃不和型慢性胃炎的临床疗效。方法　本研究为随机对照试验。纳入2020年1月至2023年4月期间陕西省核工业二一五医院收治的94例肝胃不和型慢性胃炎患者，采用分层随机抽样法分为研究组和对照组，每组47例。对照组男24例，女23例，年龄（44.81±5.62）岁，病程（2.60±1.35）年；研究组男23例，女24例，年龄（45.20±5.47）岁，病程（2.56±1.24）年。对照组接受标准的四联疗法，艾司奥美拉唑镁肠溶片、阿莫西林片、呋喃唑酮片和枸橼酸铋钾胶囊连续用药2周后，停止使用阿莫西林片、呋喃唑酮片和枸橼酸铋钾胶囊，继续服用艾司奥美拉唑镁肠溶片2周；研究组接受柴枳平肝汤合消痞宽胃汤治疗。两组疗程均为4周。对比两组患者临床疗效，中医症状积分，胃肠功能指标［生长抑素（SST）、胃泌素（GAS）、胃动素（MTL）、血管活性肠肽（VIP）］、炎性因子［白细胞介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子（TNF-α）］水平，腹痛、反酸、嗳气消失时间，幽门螺杆菌（Hp）根除率。统计学方法采用t检验、χ²检验。结果　研究组的临床治疗总有效率高于对照组［97.87%（46/47）比85.11%（40/47）］，差异有统计学意义（χ²=4.919，P=0.027）。治疗4周后，研究组中医症状积分总分为（3.70±0.53）分，对照组为（5.52±0.79）分，差异有统计学意义（t=13.116，P<0.001）；研究组的SST、GAS、MTL、VIP水平分别为（299.60±20.18）ng/L、（81.38±6.15）ng/L、（51.60±6.28）ng/L、（22.35±2.79）ng/L，对照组分别为（200.19±17.96）ng/L、（70.18±5.62）ng/L、（43.57±5.65）ng/L、（26.16±4.15）ng/L，差异均有统计学意义（t=25.228、9.216、6.517、5.223，均P<0.001）；研究组的IL-6、hs-CRP、TNF-α水平分别为（22.52±7.16）µg/L、（10.65±1.46）mg/L、（1.50±0.28）µg/L，均低于对照组的（35.51±7.74）µg/L、（15.88±2.18）mg/L、（1.94±0.34）µg/L，差异均有统计学意义（t=8.446、13.666、6.849，均P<0.001）。研究组患者的腹痛、反酸、嗳气消失时间分别为（3.57±2.02）d、（3.01±1.11）d、（3.47±1.33）d，对照组分别为（7.72±3.57）d、（8.07±3.64）d、（7.02±4.02）d，差异均有统计学意义（t=6.936、9.116、5.748，均P<0.001）；停药30 d后，研究组的Hp根除率高于对照组［95.74%（45/47）比82.95%（39/47）］，差异有统计学意义（χ²=4.029，P=0.045）。结论　柴枳平肝汤合消痞宽胃汤治疗肝胃不和型慢性胃炎临床疗效显著，能有效改善患者的症状和生理指标，并提高Hp根除率，是一种安全且有效的治疗选择。

关键词:

慢性胃炎, 肝胃不和型, 柴枳平肝汤, 消痞宽胃汤, 胃肠功能, Hp根除率

Abstract:

Objective　To evaluate the clinical efficacy of Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction in the treatment of liver-stomach disharmony type chronic gastritis. Methods　A total of 94 patients with liver-stomach disharmony type chronic gastritis admitted to No.215 Hospital of Shaanxi Nuclear Industry from January 2020 to April 2023 were included and were divided into a study group and a control group by stratified random sampling method, with 47 cases in each group. In the control group, there were 24 males and 23 females, aged (44.81±5.62) years, with a duration of disease of (2.60±1.35) years. In the study group, there were 23 males and 24 females, aged (45.20±5.47) years, with a duration of disease of (2.56±1.24) years. The control group received standard quad therapy, esomeprazole magnesium enteric-coated tablets, amoxicillin tablets, furazolidone tablets, and bismuth potassium citrate capsules for 2 weeks, after stopping the use of amoxicillin tablets, furazolidone tablets, and bismuth potassium citrate capsules, and continued to take esomeprazole magnesium enteric-coated tablets for 2 weeks. The study group received Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction treatment. The treatment course of both groups was 4 weeks. The clinical efficacy, traditional Chinese medicine (TCM) symptom score, gastrointestinal function indexes [somatostatin (SST), gastrin (GAS), motilin (MTL), and vasoactive intestinal peptide (VIP)], inflammatory markers [interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor α (TNF-α)], disappearance time of abdominal pain, acid reflux, and belching, and eradication rate of Helicobacter pylori (Hp) of the two groups were compared. Statistical methods used were t test and χ² test. Results　The total effective rate of clinical treatment in the study group was higher than that in the control group [97.87% (46/47) vs. 85.11% (40/47)], with a statistically significant difference (χ²=4.919, P=0.027). After 4 weeks of treatment, the total TCM symptom score in the study group was (3.70±0.53), and that in the control group was (5.52±0.79), with a statistically significant difference (t=13.116, P<0.001); the levels of SST, GAS, MTL, and VIP in the study group were (299.60±20.18) ng/L, (81.38±6.15) ng/L, (51.60±6.28) ng/L, and (22.35±2.79) ng/L, and those in the control group were (200.19±17.96) ng/L, (70.18±5.62) ng/L, (43.57±5.65) ng/L, and (26.16±4.15) ng/L, with statistically significant differences (t=25.228, 9.216, 6.517, and 5.223, all P<0.001); the levels of IL-6, hs-CRP, and TNF-α in the study group were (22.52±7.16) µg/L, (10.65±1.46) mg/L, and (1.50±0.28) µg/L, which were lower than those in the control group [(35.51±7.74) µg/L, (15.88±2.18) mg/L, and (1.94±0.34) µg/L], with statistically significant differences (t=8.446, 13.666, and 6.849, all P<0.001). The disappearance time of abdominal pain, acid reflux, and belching in the study group were (3.57±2.02) d, (3.01±1.11) d, and (3.47±1.33) d, and those in the control group were (7.72±3.57) d, (8.07±3.64) d, and (7.02±4.02) d, with statistically significant differences (t=6.936, 9.116, and 5.748, all P<0.001). Within 30 d after withdrawal, the eradication rate of Hp in the study group was higher than that in the control group [95.74% (45/47) vs. 82.95% (39/47)], with a statistically significant difference (χ²=4.029, P=0.045). Conclusion　Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction shows significant clinical efficacy in the treatment of liver-stomach disharmony type chronic gastritis, effectively improves the patients' symptoms and physiological indicators, and increases the Hp eradication rate, proving to be a safe and effective treatment choice.

Key words:

Chronic gastritis, Liver-stomach disharmony type, Chai-Zhi Ping-Gan decoction, Xiao-Pi Kuan-Wei decoction, Gastrointestinal function, Hp eradication rate

周彩彩苏垠旭.

柴枳平肝汤合消痞宽胃汤治疗肝胃不和型慢性胃炎的临床疗效 [J]. 国际医药卫生导报, 2024, 30(16): 2766-2771.

Zhou Caicai, Su Yinxu.

Clinical efficacy of Chai-Zhi Ping-Gan decoction combined with Xiao-Pi Kuan-Wei decoction in the treatment of liver-stomach disharmony type chronic gastritis [J]. International Medicine and Health Guidance News, 2024, 30(16): 2766-2771.

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