柴芩益胃汤治疗肝胃不和型慢性浅表性胃炎临床疗效及机制探讨

目的:观察柴芩益胃汤治疗肝胃不和型慢性浅表性胃炎(CSG)临床疗效,探讨其治疗机制。方法:选择河北省中医院脾胃科2015年1月至2017年1月收治的肝胃不和型CSG患者130例,按照数字随机表法分为2组,每组65例,治疗组给予中药制剂柴芩益胃汤口服,水煎服,每日1剂;对照组不服用中药,给予铝碳酸镁片、雷贝拉唑肠溶胶囊、枸橼酸莫沙必利片等西药治疗,两组均连续治疗4周。比较两组治疗前后主要中医证候评分、外周血T淋巴细胞亚群、胃黏膜环氧化酶-2(COX-2)表达,并比较两组胃镜观察有效率、病理学有效率和临床总有效率。结果:治疗前两组主要中医证候评分、外周血T淋巴细胞亚群、胃黏膜COX-2表达差异无统计学意义,与治疗前比较,治疗后两组主要中医证候评分降低,血CD3~+,CD4~+水平,CD4~+/CD8~+升高,胃黏膜COX-2表达情况降低(P0.01),治疗后治疗组主要中医证候胃脘疼痛、脘腹胀满、胸闷、嗳气积分低于对照组,外周血CD3~+,CD4~+水平,CD4~+/CD8~+高于对照组,胃黏膜COX-2表达低于对照组(P0.01),胃镜观察有效率、病理学有效率和临床总有效率均高于对照组(P0.05)。结论:柴芩益胃汤可有效缓解症状,治疗肝胃不和型CSG疗效确切,其机制可能与调节机体免疫系统,抑制胃黏膜的炎症反应有关。

Clinical Efficacy and Mechanism of Chaiqin Yiwei Decoction on Chronic Superficial Gastritis with Liver-stomach Disharmony

Objective:To observe the clinical efficacy of Chaiqin Yiwei decoction on chronic superficial gastritis (CSG) with liver-stomach disharmony and to discusses its mechanism of treatment. Method:The 130 CSG patients with liver-stomach disharmony treated in Department of Spleen and Stomach of the Hebei Province Hospital of Traditional Chinese Medicine(TCM) from January, 2015 to January, 2017 were divided into 2 groups according to the random number table, with 65 cases in each group. Patients in treatment group were given with Chaiqin Yiwei decotion by oral administration, 1 dose/day. The patients in control group were given with conventional western medicine such as hydrotalcite tablets, rabeprazole sodium enteric-coated capsules and mosapride citrate tablets, and all patients were treated for 4 weeks in both groups. The main TCM syndrome scores, peripheral blood T lymphocyte subsets, gastric mucosa cyclooxygenase-2 (COX-2) expression and gastroscope observation before and after treatment were compared in two groups, and the effective rate of gastroscope observation, effective rate of pathology and total clinical effective rate were compared between these two groups. Result:There was not statistically significant difference in the main TCM syndrome score, peripheral blood T lymphocyte subsets and gastric mucosa COX-2 expression before treatment. As compared with before treatment, the main TCM syndrome score was decreased, CD3⁺, CD4⁺ and CD4⁺/CD8⁺ ratio were increased, and gastric mucosa COX-2 expression was reduced in both groups after treatment (P<0.01). As compared with the control group, the scores in stomach duct pain, abdominal fullness and distention, chest distress and eructation were lower, peripheral blood CD3⁺, CD4⁺, CD4⁺/CD8⁺ were higher, and gastric mucosa COX-2 expression was lower in treatment group (P<0.01). The effective rates of gastroscope observation, pathology and total clinical effective rate in treatment group were all higher than those of control group (P<0.05). Conclusion:Chaiqin Yiwei decoction can relieve patients'' symptoms, with clear efficacy for CSG with liver-stomach disharmony, and its mechanism may be related to regulating the body''s immune system and inhibiting inflammation of gastric mucosa.