Efficacy of Biling Weitong Granule combined with esomeprazole in the treatment of Hp related chronic gastritis and effects on T lymphocyte and inflammatory cytokine levels in peripheral blood
-
摘要: 目的 探讨荜铃胃痛颗粒联合艾司奥美拉唑四联疗法治疗幽门螺杆菌(Hp)相关性慢性胃炎的临床疗效以及其对患者外周血T淋巴细胞亚群和血清炎症相关细胞因子水平的影响。方法 选择廊坊市人民医院消化科2021年2月—2022年2月收治的100例Hp相关性慢性胃炎患者作为研究对象，按随机数字表法分成观察组与对照组各50例。观察组采用荜铃胃痛颗粒联合艾司奥美拉唑四联疗法治疗，对照组采用常规艾司奥美拉唑四联疗法治疗。连续治疗14 d后观察2组临床疗效和胃镜疗效，统计2组Hp根除率与不良反应情况。比较治疗前后2组中医证候积分、外周血T淋巴细胞亚群和血清炎性因子水平。结果 观察组临床及胃镜总有效率分别为94.00%(47/50)、90.00%(45/50)，与对照组[78.00%(39/50)、72.00%(36/50)]比较均显著升高(P< 0.05)。2组治疗后气滞血瘀证的各项症状积分均较治疗前显著降低(P< 0.05)，且均以观察组的下降更显著(P< 0.05)。观察组Hp根除率达94.00%(47/50)，较对照组[80.00%(40/50)]显著提高(P< 0.05)。与治疗前比较，2组患者治疗后外周血CD4+、CD4+/CD8+和血清干扰素γ(IFN-γ)水平均显著升高(P< 0.05)，外周血CD8+和血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6水平均显著降低(P< 0.05)；且均以观察组的改善更显著(P< 0.05)。观察组不良反应发生率与对照组比较差异无统计学意义[6.00%(3/50) vs.14.00%(7/50)](P>0.05)。结论 荜铃胃痛颗粒联合艾司奥美拉唑四联疗法治疗Hp相关性慢性胃炎的整体疗效显著，该联合方案能有效改善患者细胞免疫状态，下调血清IFN-γ、TNF-α、IL-6的表达水平，提高Hp根除率，且安全性好。Abstract: Objective To investigate the clinical efficacy of Biling Weitong Granule combined with esomeprazole in the treatment ofHelicobacter Pylori(Hp) related chronic gastritis and its effects on peripheral blood T lymphocyte and serum levels of inflammatory cytokines.Methods A total of 100 patients with Hp related chronic gastritis admitted to our hospital from February 2021 to February 2022 were randomly divided into observation group(50 cases) and control group(50 cases). The observation group was treated with Biling Weitong Granule combined with esomeprazole quadruple therapy, while the control group was treated with conventional esomeprazole quadruple therapy. After 14 days of continuous treatment, the clinical and gastroscopic efficacy, Hp eradication rate and adverse reactions were observed. Before and after treatment, TCM syndrome integral was performed in both groups, and the levels of T lymphocyte in peripheral blood of both groups were detected by flow cytometry, serum levels of IFN-γ, tumor necrosis factors α and interleukin 6 were measured by enzyme linked immunosorbent assay(ELISA).Results The total effective rates of clinical and gastroscopic of observation group were 94.00%(47/50) and 90.00%(45/50) respectively, which were significantly higher than those of control group (78.00%[39/50] and 72.00%[36/50]) (P< 0.05). After treatment, the symptom scores of Qi stagnation and blood stasis syndrome in both groups were significantly lower than those before treatment(P< 0.05), and the decrease was more significant in the observation group(P< 0.05). The eradication rate of Hp in the observation group was 94.00%(47/50), which was significantly higher than that in the control group(P< 0.05). After treatment, the levels of CD4+, CD4+/CD8+ and IFN-γ in peripheral blood were significantly increased(P< 0.05), and the level of CD8+, TNF-α and IL-6 in peripheral blood were significantly decreased(P< 0.05).Conclusion The combined therapy of Biling Weitong Granule and esomeprazole has a significant effect on Hp related chronic gastritis. The combined therapy can effectively correct the imbalance of T lymphocyte in peripheral blood and enhance the cellular immune function of patients, reduce the body's inflammatory reaction, improve the eradication rate of Hp, and of good security.
-
-
表 1 2组基线资料比较
组别 例数 性别/例 年龄/岁 病程/年 男 女 观察组 50 23 27 45.31±6.17 6.47±1.98 对照组 50 25 25 44.68±6.43 6.25±1.83 χ2/t 0.160 0.500 0.577 P 0.689 0.618 0.565 
下载: 导出CSV
表 2 2组临床疗效比较
例 组别 例数 痊愈 显效 有效 无效 总有效率/% 观察组 50 18 17 12 3 94.00 对照组 50 10 11 18 11 78.00 χ2 5.316 P 0.021
下载: 导出CSV
表 3 2组胃镜疗效比较
例 组别 例数 痊愈 显效 有效 无效 总有效率/% 观察组 50 18 14 13 5 90.00 对照组 50 10 9 17 14 72.00 χ2 5.263 P 0.022
下载: 导出CSV
表 4 2组中医证候积分比较
分，X±S 组别 例数 胃脘痛 胃脘胀满 胸闷喜太息 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 50 4.11±0.37 1.25±0.341) 3.96±0.32 1.33±0.281) 1.85±0.24 0.96±0.161) 对照组 50 3.98±0.42 2.17±0.261) 3.87±0.36 2.24±0.301) 1.77±0.29 1.44±0.201) t 1.642 15.199 1.321 15.680 1.503 13.252 P 0.104 < 0.001 0.189 < 0.001 0.136 < 0.001 组别 例数 嗳气频繁 舌质暗 脉弦涩 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 50 2.01±0.26 1.17±0.161) 4.56±0.42 1.12±0.281) 4.33±0.37 1.21±0.271) 对照组 50 1.94±0.22 1.55±0.181) 4.47±0.38 2.15±0.331) 4.24±0.43 1.64±0.321) t 1.453 11.157 1.124 16.829 1.122 7.262 P 0.149 < 0.001 0.264 < 0.001 0.265 < 0.001 与组内治疗前比较，1)P < 0.05。
下载: 导出CSV
表 6 2组外周血T淋巴细胞亚群水平比较
X±S 组别 例数 CD4+/% CD8+/% CD4+/CD8+ 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 50 38.57±3.46 48.12±4.221) 24.65±2.17 19.34±1.641) 1.54±0.23 2.49±0.281) 对照组 50 38.24±3.18 42.58±3.951) 24.38±2.03 22.15±1.861) 1.58±0.22 1.92±0.251) t 0.497 6.777 0.642 8.013 0.889 10.738 P 0.621 < 0.001 0.522 < 0.001 0.376 < 0.001 与组内治疗前比较，1)P < 0.05。
下载: 导出CSV
表 7 2组血清炎性因子水平比较
pg/mL，X±S 组别 例数 IFN-γ TNF-α IL-6 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 50 22.87±3.21 35.12±4.471) 36.12±4.21 17.22±3.851) 45.22±2.84 15.87±1.341) 对照组 50 23.12±3.09 29.04±4.251) 35.86±3.97 24.34±3.401) 45.08±2.76 29.92±2.261) t 0.397 6.970 0.318 9.802 0.250 37.813 P 0.692 < 0.001 0.751 < 0.001 0.803 < 0.001 与组内治疗前比较，1)P < 0.05。
下载: 导出CSV
表 8 2组不良反应比较
例 组别 例数 恶心呕吐 便秘 腹泻 皮疹 食欲不振 总发生率/% 观察组 50 1 0 1 0 1 6.00 对照组 50 2 1 2 1 1 14.00 χ2 1.778 P 0.182
下载: 导出CSV
-
[1] Anjana ML, Kavitha Y. Evaluation of chronic gastritis with Helicobacter pylori using updated Sydney system[J]. Int J Res Med Sci, 2021, 9(9): 2728-2732. doi: 10.18203/2320-6012.ijrms20213415
[2] Alrashidi HE, El-Ageery SM, Fawzy IM, et al. The role of T helper 17 cells in Helicobacter pylori associated chronic gastritis[J]. J Med Microbiol, 2021, 30(3): 119-126.
[3] Chang YW, Park YM, Oh CH, et al. Effects of probiotics or broccoli supplementation on Helicobacter pylori eradication with standard clarithromycin-based triple therapy[J]. Korean J Intern Med, 2020, 35(3): 574-581. doi: 10.3904/kjim.2019.139
[4] 张诗宇, 王垂杰, 路小龙. 慢性胃炎中医辨治思路[J]. 江苏中医药, 2020, 52(12): 43-45. https://www.cnki.com.cn/Article/CJFDTOTAL-JSZY202012018.htm
[5] 于丽, 巩阳. 荜铃胃痛颗粒联合四联疗法治疗Hp阳性胃溃疡的临床疗效观察[J]. 中国中西医结合消化杂志, 2021, 29(3): 175-177, 182. doi: 10.3969/j.issn.1671-038X.2021.03.04 http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=3aefed9f-140a-4a52-bdd9-1f5b933fd3bc
[6] 中华医学会消化病学分会. 中国慢性胃炎共识意见(2017年, 上海)[J]. 胃肠病学, 2017, 22(11): 670-687. doi: 10.3969/j.issn.1008-7125.2017.11.007
[7] 中国中西医结合学会消化系统疾病专业委员会. 慢性胃炎中西医结合诊疗共识意见(2011年天津)[J]. 中国中西医结合杂志, 2012, 32(6): 738-743. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ201206009.htm
[8] 国家中医药管理局. 国家中医药管理局办公室关于印发中风病(脑梗死)等92个病种中医临床路径和中医诊疗方案(2017年版)的通知[EB/OL]. (2017-03-22)[2021-02-01]. http://yzs.satcm.gov.cn/gongzuodongtai/2018-03-24/2651.html.
[9] 中华中医药学会脾胃病分会. 脾胃病症状量化标准专家共识意见(2017)[J]. 中华中医药杂志, 2017, 32(8): 3590-3596. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201708072.htm
[10] 郑筱萸. 中药新药临床研究指导原则(试行)[M]. 北京: 中国医药科技出版社, 2002: 383-384.
[11] Elias RE, Gisuthan B, Sreeganesh AS. Histopathological Changes in Helicobacter pylori Associated Gastritis and Scope of Special Stain and Immunohistochemistry as Diagnostic Aids[J]. J Evid Based Med Healthc, 2020, 7(50): 3027-3032. doi: 10.18410/jebmh/2020/618
[12] 姚国鹏, 李启祥, 段雪辉, 等. 荆花胃康胶丸联用四联疗法补救治疗幽门螺杆菌感染的随机对照研究[J]. 现代消化及介入诊疗, 2020, 25(7): 922-925. doi: 10.3969/j.issn.1672-2159.2020.07.020
[13] 刘敏. 荜铃胃痛颗粒的基础研究及临床应用[J]. 中国中西医结合消化杂志, 2018, 26(7): 553-556. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=86d0e344-b97b-44c6-b9b8-4deabaf2f8b5
[14] 崔丹阳, 巩阳. 对比观察荜铃胃痛颗粒与气滞胃痛颗粒对肝胃不和型非萎缩性胃炎的临床疗效和起效时间[J]. 中华消化杂志, 2019, 39(6): 412-414. doi: 10.3760/cma.j.issn.0254-1432.2019.06.015
[15] 姚鹏, 田晶晶, 康洪昌, 等. 荜铃胃痛颗粒联合标准四联疗法治疗慢性萎缩性胃炎伴轻中度肠上皮化生患者的效果研究[J]. 中国中西医结合外科杂志, 2021, 27(6): 855-859. doi: 10.3969/j.issn.1007-6948.2021.06.010
[16] 杜爱平, 张利伟, 翟亚娟. 叶酸联合萎胃颗粒对Hp阳性慢性萎缩性胃炎患者血清炎性指标和外周血T细胞亚群的影响[J]. 免疫学杂志, 2019, 35(2): 151-156. https://www.cnki.com.cn/Article/CJFDTOTAL-MYXZ201902012.htm
[17] 房涛, 王歌文, 赵佳华. 益胃汤加减联合三联疗法对HP感染所致慢性胃炎患者血清炎性因子、HP清除率的影响[J]. 陕西中医, 2019, 40(11): 1598-1601. doi: 10.3969/j.issn.1000-7369.2019.11.030
-