黄芪建中汤加减对胃溃疡脾胃虚寒证患者临床疗效及机制研究

目的:探讨黄芪建中汤治疗胃溃疡脾胃虚寒型的可能作用机理。方法:将2013年1月至2016年1月收治的符合入组标准的虚寒型胃溃疡患者分为对照组和观察组各100例,对照组给予常规四联疗法(奥美拉唑+阿莫西林+克拉霉素+替硝唑),观察组在此基础上服用加味黄芪建中汤加减,2组均以8周为1个疗程,比较2组患者的总有效率、血清胃泌素(GAS)、胃动素(MTL)、血清白介素-6(IL-6)、白介素-8(IL-8)、白介素-4(IL-4)、白介素-17(IL-17)、肿瘤坏死因子(TNF-a)水平变化及复发率。结果:观察组总有效率98.0%高于对照组,治疗后观察组患者血清IL-6、IL-8、IL-17、TNF-a水平值均低于治疗前,且低于对照组治疗后,而观察组IL-4水平值明显高于治疗前及对照组治疗后;治疗后观察组GAS和MTL水平值均明显低于治疗前及对照组治疗后,观察组中医症状积分低于对照组治疗后。结论:黄芪建中汤加减联合常规四联疗法治疗虚寒型胃溃疡效果确切,并能够提高IL-4表达水平,降低IL-6、IL-8、IL-17及TNF-a水平。

Effects of Huangqi Jianzhong Decoction on Serum Gastrin,Motilin and Inflammatory Factors in Patients with Gastric Ulcer Syndrome for Cold Deficiency of Spleen and Stomach

Objective:To explore the possible mechanism of Huangqi Jianzhong decoction in treating cold deficiency of spleen and stomach for gastric ulcer.Methods:From January 2013 to January 2016,the patients with deficient and cold gastric ulcer who met the inclusion criteria were divided into the control group and the observation group,100 cases for each goup.The control group received conventional quadruple therapy(omeprazole+amoxicillin+clarithromycin+tinidazole),and the observation group received modified Huangqi Jianzhong decoction on this basis.Both groups were treated with a course of 8 weeks.The total effective rate,serum gastrin(GAS),motilin(MTL),serum interleukin-6(IL-6),interleukin-8(IL-8),interleukin-4(IL-4),interleukin-17(IL-17),and TNF-a levels of the two groups were compared.Results:The total effective rate of the observation group was 98.0%,higher than that of the control group.After treatment,serum IL-6,IL-8,IL-17 and TNF-αlevels in the observation group were lower than those before and after treatment in the control group,while IL-4 levels in the observation group were significantly higher than those before and after treatment in the control group.After treatment,GAS and MTL levels in the observation group were significantly lower than those before treatment and after treatment in the control group,and TCM symptom scores in the observation group were lower than those after treatment in the control group.Conclusion:Huangqi Jianzhong decoction combined with conventional quadruple therapy is effective in the treatment of gastric ulcer with deficiency and cold,and can increase the expression of IL-4 and reduce the levels of IL-6,IL-8,IL-17 and TNF-α.