运脾清热除湿方治疗幽门螺杆菌相关性胃炎消化不良的临床观察及可能机制

陈万群 黄玉兰 杨小军

〔摘要〕 目的 观察运脾清热除湿方治疗幽门螺杆菌（Helicobactor pylori， Hp）相关性胃炎消化不良的疗效及可能机制。方法 将符合纳入标准的90例门诊患者按照随机数字表法分为3组各30例，中药组单纯口服运脾清热除湿方，中药合并Hp根除组在口服运脾清热除湿方基础上加Hp根除四联疗法，单纯Hp根除组采用Hp根除四聯疗法，3组疗程均为2周。观察3组治疗前后中医证候评分及Hp根除率，并通过胃镜下病理活检后免疫组化比较治疗前后白介素-12（IL-12）、干扰素-γ（IFN-γ）的表达。结果 中药合并Hp根除组Hp根除率为96.7%，高于中药组的43.3%（P<0.05），与单纯Hp根除组的90.0%之间差异无统计学意义（P>0.05）。第2月及第6月随访中，中药合并Hp根除组中医证候改善均优于中药组及单纯Hp根除组（P<0.05），中医证候疗效总有效率为90.0%，优于其余两组（P<0.05）。3组IL-12、IFN-γ表达较治疗前明显降低（P<0.05），中药合并Hp根除组二者下降较中药组及单纯Hp根除组更显著（P<0.05）。结论 运脾清热除湿方可有效缓解Hp相关性胃炎消化不良症状，联合Hp根除治疗远期疗效更佳，其机制可能为通过抑制IL-12、IFN-γ的表达起作用。

〔关键词〕 幽门螺杆菌相关性胃炎;消化不良;运脾清热除湿方;白介素-12;干扰素-γ

〔中图分类号〕R256.3;R573.3       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2019.05.017

〔Abstract〕 Objective To investigate the clinical efficacy of spleen-activating， heat-clearing， and dampness-removing prescription （SHDP） in the treatment of dyspepsia and Helicobacter pylori （Hp）-associated gastritis and its possible mechanism. Methods A total of 90 outpatients who met the inclusion criteria were equally and randomly divided into three groups using a random number table： traditional Chinese medicine （TCM） group， TCM combined with Hp eradication （TCM+Hp） group， and Hp eradication group （Hp group）. The TCM group was orally given SHDP alone， the TCM+Hp group received quadruple therapy for Hp eradication in addition to the oral administration of SHDP， and the Hp group received quadruple therapy for Hp eradication alone. The course of treatment was two weeks for all the three groups. The following indices were compared between the three groups： TCM syndrome score before and after treatment， Hp eradication rate after treatment， and the expression of interluekin-12 （IL-12） and interferon-γ （IFN-γ） before and after treatment， which was measured by immunohistochemistry after gastroscopic biopsy. Results The TCM+Hp group had a significantly higher Hp eradication rate than the TCM group （96.7% vs 43.3%， P<0.05）. However， there was no significant difference in Hp eradication rate between the TCM+Hp group and the Hp group （96.7% vs 90.0%， P>0.05）. The TCM+Hp group had significantly more improvements in TCM syndromes and a significantly higher overall response rate for TCM syndromes （90.0%） compared with the other two groups at 2-month and 6-month follow-up （all P<0.05）. After treatment， all the three groups showed significantly reduced expression of IL-12 and IFN-γ （P<0.05）， and the TCM+Hp group had significantly greater reductions in the expression of IL-12 and IFN-γ compared with the other two groups （P<0.05）. Conclusion SHDP can effectively alleviate dyspepsia in Hp-associated gastritis. SHDP combined with Hp eradication therapy has better long-time efficacy， possibly by inhibiting the expression of IL-12 and IFN-γ.

〔Keywords〕 Helicobacter pylori-associated gastritis; dyspepsia; spleen-activating， heat-clearing， and dampness-removing prescription; interluekin-12; interferon-γ

目前，国际上统称的消化不良作为一个复杂症状而并非临床诊断，其定义随着研究的深入已有所变化，现主要指中上腹症状（诸如上腹痛、上腹不适），而将烧心、反流排除出此定义。最近研究发现社区中超过20%的个体均体验过消化不良症状，严重降低了社区人群的生活质量[1]。同时，2014年京都会议总结得出幽门螺杆菌（Helicobactor pylori， Hp）感染对消化不良症状具有重要影响，建议Hp感染者即便无消化不良症状亦应根除Hp，提出将Hp相关性胃炎作为一种独立的疾病[2]。但是，并非所有患者经根除Hp后消化不良症状均可得到改善，研究发现仅有60%的患者对此完全应答[3]。由于消化不良疗效评估时间需要至少6个月以上，部分患者可能因消化不良症状而反复就诊，势必造成医疗资源的浪费。……