Retrospective analysis of clinical effect of Wudan Weifu Granules on chronic atrophic gastritis
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摘要: 目的 回顾性总结分析五丹胃福颗粒对慢性萎缩性胃炎的临床疗效，为进一步推广应用提供临床实践依据和研究导向。方法 回顾性分析2016年1月—2018年12月天津中医药大学第二附属医院消化科门诊中100例慢性萎缩性胃炎患者的临床数据资料，根据接受的治疗不同将患者分为暴露组(五丹胃福颗粒干预)和非暴露组(采用常规西药治疗), 各50例，分析两组患者中医证候积分、胃镜下表现、病理情况、临床疗效及安全性。结果 ① 暴露组临床总有效率、胃镜下疗效及病理疗效均高于非暴露组，差异有统计学意义(P < 0.05)。②中医证候积分：治疗后两组患者中医证候积分均较治疗前改善，差异有统计学意义(P < 0.05)；在胃脘痞满、痛有定处、面色暗滞、恶心、反酸烧心及总积分方面暴露组均优于非暴露组，差异有统计学意义(P < 0.05)。③胃镜下表现：暴露组患者治疗后胃镜积分较治疗前显著改善，且明显优于非暴露组，差异有统计学意义(P < 0.05)。④病理情况：治疗后暴露组和非暴露组较治疗前炎症、萎缩、肠化病理积分显著改善，差异有统计学意义(P < 0.05)；异型增生积分改善程度与治疗前比较，差异无统计学意义(P>0.05)；在炎症、萎缩积分方面，暴露组较非暴露组显著改善(P < 0.05)，肠化、异型增生积分治疗后两组比较，均差异无统计学意义(P>0.05)。⑤临床疗效：治疗结束后8周随访，暴露组复发率低于和非暴露组，差异有统计学意义(P < 0.05)；⑥安全性评价：研究过程中严格监测所纳入患者生命体征，两组均未出现不良反应。结论 五丹胃福颗粒能显著提高慢性萎缩性胃炎患者临床总有效率、胃镜下疗效及病理疗效，降低复发率，改善胃镜下表现及病理情况，临床应用安全。Abstract: Objective To retrospectively analyze the clinical effect of Wudan Weifu Granules on chronic atrophic gastritis, so as to provide clinical practice basis and research guidance for further application.Methods Clinical data of 100 patients with chronic atrophic gastritis in the Department of Gastroenterology, the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2016 to December 2018 were retrospectively analyzed. According to different treatments received, the patients were divided into exposed group(Wudan Weifu Granule intervention) and non-exposed group(conventional medicine treatment) with 50 cases each. Traditional Chinese Medicine(TCM)syndrome score, gastroscopic manifestations, pathological conditions, long-term efficacy and safety of the two groups of patients were analyzed.Results ① The total clinical effective rate, gastroscopic efficacy and pathological efficacy of exposed group were higher than those of non-exposed group(P < 0.05). ②TCM syndrome score: After treatment, TCM syndrome score of both groups was improved compared with that before treatment(P < 0.05), and the exposed group was superior to the non-exposed group in terms of epigastric fullness of epigastric fullness, pain at a fixed point, dull complexion, nausea, acid reflux heartburn and total score(P < 0.05). ③Gastroscopic performance: the gastroscopic score of exposed group after treatment was significantly improved compared with that before treatment, and was significantly better than that of non-exposed group(P < 0.05). ④Pathology: After treatment, the pathological scores of inflammation, atrophy and intestinal metaplasia were significantly improved in the exposed and non-exposed groups compared with those before treatment(P < 0.05), while the improvement degree of dysplasia scores in the exposed and non-exposed groups was not statistically significant compared with that before treatment(P>0.05). In terms of inflammation and atrophy scores, the exposed group was significantly improved compared with the non-exposed group(P < 0.05), and there was no statistical significance in intestinal metaplasia and dysplasia scores between the two groups after treatment(P>0.05). ⑤Follow-up clinical efficacy: After 8 weeks of follow-up, the recurrence rate of exposed group was lower than that of non-exposed group(P < 0.05). ⑥Safety evaluation: Vital signs of the included patients were strictly monitored during the study, and no adverse reactions occurred in the two groups.Conclusion Wudan Weifu Granules can significantly improve the total clinical effective rate, gastroscopic efficacy and pathological efficacy of patients with chronic atrophic gastritis, reduce the recurrence rate, improve the gastroscopic manifestations and pathological conditions, and the clinical application is safe.
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表 1 两组患者计量资料比较
M(Q1, Q3) 组别 例数 年龄/岁 病程/d 暴露组 50 60.00(51.00，63.50) 8.00(6.00，9.00) 非暴露组 50 60.50(55.00，65.00) 8.00(7.00，10.00) Z -1.648 -0.531 P 0.099 0.595 
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表 3 两组患者病理分组比较
例 组别 严重程度 级别 炎症 萎缩 肠化 异型增生 暴露组 轻度 16 16 18 11 中度 31 31 29 4 重度 3 3 3 0 非暴露组 轻度 20 24 22 12 中度 28 24 26 1 重度 2 2 2 0
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表 4 两组患者中医证候积分比较
分，M(Q1, Q3) 症状 暴露组 非暴露组 例数 治疗前 治疗后 有效率/% 例数 治疗前 治疗后 有效率/% 胃脘痞满 41 4.00(2.00，4.00) 2.00(1.00，4.00)1)2) 82.93 41 4.00(4.00，4.00) 2.00(2.00，4.00)1) 53.66 痛有定处 34 4.00(2.00，4.00) 2.00(2.00，2.50)1)2) 85.29 33 4.00(2.00，4.00) 2.00(2.00，4.00)1) 57.58 疼痛拒按 34 3.00(3.00，5.00) 1.00(1.00，3.00) 85.29 34 3.00(2.50，5.00) 3.00(1.00，3.00)1) 52.94 黑便 29 3.00(1.00，4.00) 1.00(0.00，3.00) 93.10 30 3.00(2.50，5.00) 3.00(1.00，3.00)1) 70.00 面色暗滞 41 3.00(1.00，3.00) 1.00(1.00，2.00)1)2) 87.80 43 3.00(3.00，5.00) 1.00(1.00，3.00)1) 53.49 恶心 42 3.00(1.00，3.00) 1.00(1.00，3.00)1)2) 85.71 41 3.00(2.00，3.00) 1.00(1.00，3.00)1) 56.10 反酸烧心 36 3.00(1.00，4.50) 1.00(0.00，3.00)1)2) 83.3 37 3.00(3.00，5.00) 1.00(1.00，3.00)1) 48.65 与本组治疗前比较，1)P < 0.05；与非暴露组比较，2)P < 0.05
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表 5 两组用药前后胃镜积分比较
分，M(Q1, Q3) 组别 例数 用药前 用药后 暴露组 50 1.00(1.00，2.00) 1.00(0.75，1.00)1)2) 非暴露组 50 1.00(1.00，2.00) 1.00(1.00，1.00)1) 与本组治疗前比较，1)P < 0.05；与非暴露组比较，2)P < 0.05。
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表 6 两组用药前后病理积分对比
分，M(Q1, Q3) 病理表现 暴露组 非暴露组 例数 治疗前 治疗后 例数 治疗前 治疗后 炎症 50 4.00(2.00，4.00) 2.00(2.00，4.00)1) 50 4.00(2.00，4.00) 2.00(2.00，4.00)1) 萎缩 50 6.00(3.00，9.00) 3.00(0.00，3.00)1) 50 6.00(3.00，9.00) 3.00(3.00，6.00)1) 肠化 50 4.00(2.00，4.00) 2.00(2.00，4.00)2) 50 4.00(2.00，4.00) 2.00(2.00，2.00)2) 异型增生 20 1.00(1.00，2.00) 1.00(1.00，1.00)2) 23 1.00(1.00，2.00) 1.00(1.00，2.00)2) 与本组用药前比较，1)P < 0.05，2)P < 0.05。
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表 7 两组总临床疗效比较
例 组别 例数 疗效 有效率
/%痊愈 显效 有效 无效 暴露组 50 4 10 33 2 96.001) 非暴露组 50 1 6 26 17 66.00 与非暴露组比较，1)P < 0.05。
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表 8 两组胃镜疗效对比
例(%) 组别 例数 疗效 有效率/% 痊愈 显效 有效 无效 暴露组 50 12(24.00) 1(2.00) 15(30.00) 22(44.00) 56.001) 非暴露组 50 3(6.00) 1(2.00) 14(28.00) 32(64.00) 36.00 与非暴露组比较，1)P < 0.05。
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表 9 两组病理疗效比较
例 组别 痊愈 显效 有效 无效 总有效率/% 暴露组 炎症 6 12 19 13 74.001) 萎缩 13 13 12 12 76.001) 肠化 9 11 19 11 78.001) 异型增生 0 0 6 14 30.00 非暴露组 炎症 3 8 15 24 52.00 萎缩 8 9 10 23 54.00 肠化 4 10 15 21 58.00 异型增生 0 0 6 17 26.09 与非暴露组比较，1)P < 0.05。
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表 10 治疗后8周随访对比
例 组别 例数 复发 未复发 复发率/% 暴露组 48 7 41 14.581) 非暴露组 33 13 20 39.39 与非暴露组比较，1)P < 0.05。
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