化浊解毒方治疗慢性萎缩性胃炎伴幽门螺杆菌感染患者的临床研究

目的?观察化浊解毒方治疗浊毒内蕴证慢性萎缩性胃炎（CAG）伴幽门螺杆菌感染（Hp）患者的Hp根除率及临床疗效，探讨其可能的作用机制。方法?将120例CAG伴Hp感染患者随机分为治疗组和对照组各60例。治疗组予化浊解毒方口服，每日1剂；对照组先予标准四联杀菌疗法服用2周，继予安慰剂口服，每日1剂。治疗3个月后比较2组治疗前后的中医证候积分、胃镜黏膜征象积分、病理学组织改变积分、胃泌素-17（G-17）、血清胃蛋白酶原Ⅰ、Ⅱ（PGⅠ、PGⅡ）、PGⅠ/PGⅡ比值（PGR）、细胞毒素相关蛋白(CagA)、空泡细胞毒素(VacA)及尿素酶B（UreB）水平变化；治疗前、治疗6周、治疗3个月记录Hp根除率，并随访6个月，观察Hp的复发情况。结果?治疗后，2组中医证候积分均较治疗前降低（P<0.05~0.01），优于对照组（P<0.05~0.01）。治疗组的胃镜黏膜征象积分、病理学组织改变积分均较治疗前降低（P<0.05~0.01），优于对照组（P<0.01）。治疗组PGⅠ、PGR水平较治疗前升高，PGⅡ、G-17水平较治疗前降低（P<0.05~0.01），优于对照组（P<0.05~0.01）。2组CagA、VacA及UreB的阳性率均较治疗前明显降低（P<0.01），优于对照组（P<0.05~0.01）。治疗组Hp根除率优于对照组（P<0.05~0.01）。随访6个月，治疗组复发率低于对照组（P<0.01）。结论?化浊解毒方治疗浊毒内蕴证CAG伴Hp感染，抑杀Hp效果好，复发率低，且可有效缓解临床症状、改善病理组织学病变、促进黏膜修复，其治疗CAG的作用机制可能与影响CagA、VacA、UreB、PGⅠ、PGⅡ、PGR及G-17的水平相关。 

Effects of Huazhuo Jiedu Formula on Chronic Atrophic Gastritis Patients with Helicobacter Pylori<\i> Infection

OBJECTIVE?To observe the Helicobacter pylori(Hp) eradication rate and clinical effect of Huazhuo Jiedu Formula in the treatment of chronic atrophic gastritis (CAG) with Hp infection， and to explore its possible mechanism. METHODS?120 patients of CAG with Hp infection were randomly divided into two groups: the treatment group and the control group. The treatment group was given one dose of Huazhuo Jiedu formula per day， while the control group was given standard quadruple bactericidal therapy for 2 weeks， followed by placebo， one dose per day. After 3 months' treatment， TCM syndrome score， gastroscope mucosal symptom score， pathological tissue change score， gastrin-17 (G-17)， serum pepsinogen Ⅰ， Ⅱ (PGⅠ， PGⅡ)， PGⅠ/PG Ⅱ ratio (PGR)， cytotoxin associated protein (CagA)， vacuole cytotoxin (VacA) and urease B (UreB) of the two groups were compared before and after treatment. The eradication rate of HP was recorded before treatment， 6 weeks and 3 months after treatment， and after the follow-up for 6 months to observe the recurrence of Hp. RESULTS?After three months' treatment， TCM syndrome scores in the two groups were significantly lower than those before treatment with significant difference (P<0.05， P<0.01)， compared with the control group (P<0.05， P<0.01). Compared with the control group， the gastroscope mucosal symptom score and pathological tissue change score in the treatment group were lower than those before treatment (P<0.05， P<0.01)， compared with the control group (P<0.05， P<0.01). The levels of PGⅠ and PGR in the treatment group were higher than those before treatment， and the levels of PG Ⅱ and G-17 were lower than those before treatment (P<0.05， P<0.01)， compared with the control group (P<0.05， P<0.01). The positive rates of CagA， VacA and UreB in the two groups were significantly lower than those before treatment (P<0.01)， compared with the control group (P<0.05， P<0.01). The eradication rate of Hp of patients in the treatment group was better than that in the control group (P<0.05). The 6 months follow-up recurrence rate of the treatment group was lower than that of the control group (P<0.01). CONCLUSION?Huazhuo Jiedu formula， having good effect on Hp inhibition and low recurrence rate， is effective in the treatment of CAG with Hp infection. It can effectively alleviate clinical symptoms， improve pathological changes and promote mucosal repair. Its mechanism may be related to the levels of CagA， VacA， UreB， PGⅠ， PGⅡ， PGR and G-17.