Study on the curative effect of Wei'an Chuyou decoction on Helicobacter pylori associated gastritis
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摘要: 目的 探讨胃安除幽汤对幽门螺杆菌(Helicobacter pylori，HP)相关性胃炎的疗效及肝细胞生长因子(hepatocyte growth factor，HGF)/肝细胞生长因子受体(c-Mesenchymal to epithelial transition factor，c-Met)信号通路的影响。方法 选取2020年6月—2023年12月收治的210例HP相关性胃炎患者，随机分为试验组和对照组，每组各105例。对照组患者行常规四联疗法，试验组在对照组基础上加用胃安除幽汤治疗。对比两组患者在HP根除率、中医症状评分、临床疗效、免疫功能、炎症指标、HGF/c-Met信号通路以及不良反应等方面的差异。随访至2024年3月，分析HP复发的相关影响因素。结果 治疗后，试验组患者的HP根除率为98.10%，明显高于对照组的82.86%，差异有统计学意义(χ2=14.147，P < 0.05)；试验组的所有症状评分均显著低于对照组，差异有统计学意义(P < 0.001)；试验组的总有效率为94.29%，对照组为85.71%，差异有统计学意义(χ2=4.286，P < 0.05)；试验组患者的免疫功能(CD4+T细胞百分比、CD4+/CD8+)和炎症因子(IL-1β、TGF-β1、TNF-α)指标均显著优于对照组(P < 0.001)，HGF和c-Met信号通路指标均显著低于对照组(P < 0.001)。两组不良反应发生率比较差异无统计学意义(χ2=2.835，P＞0.05)。HP复发率为21.93%，logistic回归分析结果表明，治疗方案、家庭人口、HGF/c-Met是HP复发的显著影响因素(P < 0.05)。结论 胃安除幽汤联合传统四联疗法应用于HP相关性胃炎患者可有效提高HP根除率、减少中医证候积分、增强临床疗效、恢复免疫功能、消除炎症反应，且不增加不良反应发生率，与减轻HGF/c-Met信号通路的表达相关。
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关键词:
- 胃安除幽汤 /
- 幽门螺杆菌 /
- 胃炎 /
- HGF/c-Met信号通路
Abstract: Objective To explore the efficacy of Wei'an Chuyou decoction on Helicobacter pylori(HP) -related gastritis and its effect on hepatocyte growth factor(HGF)/c-Mesenchymal to epithelial transition factor(c-Met) signaling pathway.Methods A total of 210 patients diagnosed with HP-related gastritis, treated between June 2020 and December 2023, were enrolled and randomly assigned to either an experimental group or a control group, with 105 patients in each group. The control group received standard quadruple therapy, while the experimental group was treated with Wei'an Chuyou decoction in addition to the standard therapy. Outcomes compared between the two groups included HP eradication rates, traditional Chinese medicine(TCM)syndrome scores, clinical efficacy, immune-inflammatory markers, HGF/c-Met signaling pathway activity, and adverse reactions. Follow-up was conducted until March 2024 to evaluate the factors associated with HP recurrence.Results Following treatment, the HP eradication rate in the experimental group was 98.10%, significantly higher than 82.86% in the control group, with a statistically significant difference(χ2=14.147, P < 0.05). Symptom scores in the experimental group were significantly lower than those in the control group(P < 0.001). The overall effective rate was 94.29% in the experimental group compared to 85.71% in the control group, showing a statistically significant difference(χ2=4.286, P < 0.05). Immune function indicators(CD4+ T cell percentage, CD4+/CD8+ ratio) and inflammatory markers(IL-1β, TGF-β1, TNF-α) were significantly improved in the experimental group(P < 0.001), while HGF and c-Met pathway activity was significantly lower(P < 0.001) compared to the control group. There was no statistically significant difference in the incidence of adverse reactions between the groups(χ2=2.835, P > 0.05). The HP recurrence rate was 21.93%. Logistic regression analysis revealed that treatment regimen, family size, HGF, and c-Met were significant factors influencing HP recurrence(P < 0.05).Conclusion The use of Wei'an Chuyou decoction in combination with standard quadruple therapy for patients with HP-related gastritis significantly improves HP eradication rates, reduces TCM syndrome scores, enhances clinical efficacy, restores immune function, and alleviates the inflammatory response, without increasing the incidence of adverse reactions. These effects are associated with the downregulation of the HGF/c-Met signaling pathway.-
Key words:
- Wei'an Chuyou decoction /
- Helicobacter pylori /
- gastritis /
- HGF/c-Met signaling pathway
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表 1 试验组和对照组患者的临床资料比较
例(%)，X±S 临床资料 试验组(105例) 对照组(105例) χ2/t P 性别 1.913 0.167 男 61(58.10) 51(48.57) 女 44(41.90) 54(51.43) 年龄/岁 43.35±9.99 44.01±8.70 0.511 0.610 BMI 24.65±3.06 25.02±4.12 0.739 0.461 病程/年 6.34±0.76 6.42±0.87 0.710 0.479 文化水平 2.651 0.266 初中 34(32.38) 24(22.86) 中专或高中 45(42.86) 48(45.71) 大专及以上 26(24.76) 33(31.43) 胃炎类型 2.258 0.323 浅表性胃炎 37(35.24) 28(26.67) 萎缩性胃炎 40(38.10) 41(39.05) 糜烂性胃炎 28(26.66) 36(34.28) 内镜分级 0.338 0.845 Ⅰ级 41(39.05) 38(36.19) Ⅱ级 37(35.24) 41(39.05) Ⅲ级 27(25.71) 26(24.76) 
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表 2 试验组和对照组患者的症状评分比较
分，X±S 症状 试验组(105例) 对照组(105例) t P 饱胀 治疗前 2.17±0.47 2.10±0.39 1.174 0.242 治疗后 0.42±0.111) 0.72±0.141) 17.266 < 0.001 胃脘胀痛 治疗前 1.92±0.58 1.84±0.44 1.126 0.262 治疗后 0.49±0.151) 1.02±0.321) 15.367 < 0.001 烧灼感 治疗前 2.43±0.56 2.51±0.65 0.955 0.340 治疗后 1.05±0.331) 1.58±0.461) 9.593 < 0.001 嗳气泛酸 治疗前 2.54±0.28 2.61±0.34 1.629 0.105 治疗后 0.98±0.111) 1.45±0.231) 18.890 < 0.001 大便不畅 治疗前 2.31±0.51 2.27±0.43 0.614 0.540 治疗后 0.56±0.111) 0.98±0.141) 24.172 < 0.001 与治疗前比较，1)P < 0.05。
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表 3 试验组和对照组患者的临床疗效比较
例(%) 组别 例数 痊愈 显效 有效 无效 总有效率/% 试验组 105 45(42.86) 29(27.62) 25(23.81) 6(5.71) 94.29 对照组 105 31(29.52) 20(19.05) 39(37.14) 15(14.29) 85.71 χ2 4.286 P 0.038
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表 4 试验组和对照组患者的免疫功能、炎症因子水平比较
X±S 试验组(105例) 对照组(105例) t P CD4+/% 治疗前 37.37±4.81 38.12±4.98 1.110 0.268 治疗后 49.25±5.32 43.39±5.12 8.132 < 0.001 t 16.972 7.561 P < 0.001 < 0.001 CD4+/CD8+ 治疗前 1.10±0.20 1.13±0.24 0.984 0.326 治疗后 1.46±0.24 1.31±0.21 4.820 < 0.001 t 11.808 5.784 P < 0.001 < 0.001 IL-1β/(ng/L) 治疗前 42.39±4.21 42.15±4.04 0.421 0.674 治疗后 20.38±3.12 27.98±3.67 16.167 < 0.001 t 43.04 26.603 P < 0.001 < 0.001 TGF-β1/(pg/mL) 治疗前 28.77±8.44 29.30±8.21 0.461 0.645 治疗后 16.72±5.12 21.44±6.50 5.845 < 0.001 t 12.508 7.691 P < 0.001 < 0.001 TNF-α/(ng/L) 治疗前 52.87±11.20 53.11±10.09 0.163 0.871 治疗后 30.23±3.65 41.99±4.32 12.039 < 0.001 t 19.694 10.381 P < 0.001 < 0.001
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表 5 试验组和对照组患者HGF/c-Met信号通路比较
IOD，X±S 试验组(105例) 对照组(105例) t P HGF 治疗前 45 034.38±501.34 44 955.11±555.81 1.085 0.279 治疗后 15 446.77±405.16 32 091.18±509.81 261.911 < 0.001 t 470.354 174.774 P < 0.001 < 0.001 c-Met 治疗前 63 442.81±581.99 63 591.84±605.47 1.818 0.070 治疗后 14 698.91±405.33 31 542.33±302.18 341.382 < 0.001 t 704.253 485.319 P < 0.001 < 0.001
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表 6 试验组和对照组患者治疗期间不良反应比较
例(%) 组别 例数 恶心 呕吐 便秘 腹泻 口干 发生率/% 试验组 105 3(2.86) 4(3.81) 1(0.95) 3(2.86) 2(1.90) 12.38 对照组 105 1(0.95) 2(1.90) 1(0.95) 1(0.95) 1(0.95) 5.71 χ2 2.835 P 0.092
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表 7 HP复发的单因素分析
X±S，例(%) 相关因素 复发组(41例) 未复发组(146例) t/χ2 P 年龄/岁 43.76±3.78 43.89±4.16 0.180 0.857 BMI 24.81±3.39 25.10±4.44 0.450 0.654 家庭人口 4.56±0.30 3.11±0.26 30.480 < 0.001 性别 0.578 0.447 男 22(53.66) 88(60.27) 女 19(46.34) 58(39.73) 吸烟史 14(34.15) 31(21.23) 2.921 0.087 饮酒史 10(24.39) 28(19.18) 0.537 0.464 病程/年 6.37±0.70 6.40±0.81 0.216 0.830 文化水平 4.922 0.085 初中 14(34.15) 41(28.08) 中专或高中 10(24.39) 63(43.15) 大专及以上 17(41.46) 42(28.77) 胃炎类型 4.442 0.109 浅表性胃炎 15(36.59) 48(32.88) 萎缩性胃炎 12(29.27) 67(45.89) 糜烂性胃炎 14(34.14) 31(21.23) 内镜分级 1.114 0.573 Ⅰ级 17(41.46) 49(33.56) Ⅱ级 14(34.15) 62(42.47) Ⅲ级 10(24.39) 35(23.97) 治疗方案 19.991 < 0.001 四联疗法 10(24.39) 93(63.70) 四联疗法+胃安除幽汤 31(75.61) 53(36.30) 治疗后指标 CD4+/% 46.28±4.88 46.67±5.91 0.387 0.699 CD4+/CD8+ 1.39±0.12 1.43±0.18 1.671 0.098 IL-1β/(ng/L) 24.19±3.20 24.50±3.39 0.524 0.601 TGF-β1/(pg/mL) 19.38±5.29 19.87±6.02 0.472 0.637 TNF-α/(ng/L) 36.15±4.00 36.81±5.19 0.753 0.452 HGF/IOD 28 192.19±605.32 17 034.88±718.90 90.709 < 0.001 c-Met/IOD 29 155.45±504.76 16 111.72±506.98 145.703 < 0.001
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表 8 HP复发的logistic回归分析结果
变量 β S.E. Wald P OR 95%CI 治疗方案 -0.631 0.182 12.020 0.001 0.532 0.372~0.760 家庭人口 0.604 0.199 9.212 0.002 1.829 1.239~2.702 HGF 0.515 0.109 22.323 < 0.001 1.674 1.352~2.072 c-Met 1.032 0.427 5.841 0.016 2.807 1.215~6.481 常数项 -0.572 0.119 23.105 < 0.001
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