Effects of Jiawei Shugan Hewei drink combined with quadruple therapy on Helicobacter pylori eradication rate and PGR in patients with Helicobacter pylori associated gastritis
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摘要: 目的 研究加味舒肝和胃饮联合四联疗法对幽门螺杆菌相关性胃炎(Helicobacter pylori associated gastritis，HPAG)患者HP根除率及胃蛋白酶原比值(pepsinogen ratio，PGR)的影响。方法 选取2022年10月—2023年10月在常熟市中医院就诊的80例HPAG患者为研究对象，随机分为四联组和联合组，每组各40例。四联组患者采用四联疗法治疗，联合组采用加味舒肝和胃饮联合四联疗法治疗，两组患者均连续治疗14 d。观察患者治疗后的临床疗效、HP根除率、胃蛋白酶原Ⅰ(pepsinogen Ⅰ，PGⅠ)、胃蛋白酶原Ⅱ(pepsinogen Ⅱ，PGⅡ)、PGR、汉密尔顿焦虑量表(Hamilton anxiety scale，HAMA)和汉密尔顿抑郁量表(Hamilton depression scale，HAMD)、炎症指标和不良反应发生情况。结果 治疗后，联合组治疗总有效率为92.50%，显著高于四联组的72.50%，差异有统计学意义(P < 0.05)。联合组的HP根除率为95.00%，显著高于四联组的72.50%，差异有统计学意义(P < 0.05)。治疗后，两组患者的IL-1、IL-6、C反应蛋白(C-reactive protein，CRP)、HAMA和HAMD均显著降低(P < 0.05)，且联合组显著低于四联组(P < 0.001)。与治疗前比较，两组患者的PGⅠ、PGR水平明显提高，PGⅡ水平降低，且联合组的变化水平均显著优于四联组(P < 0.05)。两组患者不良反应发生情况比较差异无统计学意义(P>0.05)。结论 加味舒肝和胃饮联合四联疗法治疗HPAG，可以改善患者的临床症状，提高临床疗效和HP根除率，减轻炎症反应，促进胃功能恢复，改善焦虑、抑郁情绪。Abstract: Objective To investigate the effects of Jiawei Shugan Hewei drink combined with quadruple therapy on the Helicobacter pylori(HP) eradication rate and pepsinogen ratio(PGR) in patients with HP associated gastritis(HPAG).Methods Eighty patients with HPAG admitted to Changshu Traditional Chinese Medicine Hospital between October 2022 and October 2023, were randomly assigned to either the quadruple therapy group or the combination group(n=40 per group). The quadruple therapy group received standard quadruple therapy, while the combination group received Jiawei Shugan Hewei drink in addition to quadruple therapy. Both groups received treatment for 14 consecutive days.We evaluated clinical efficacy, HP eradication rate, pepsinogenⅠ(PGⅠ), pepsinogenⅡ(PGⅡ), PGR, Hamilton anxiety scale(HAMA) scores, Hamilton depression scale (HAMD) scores, inflammatory markers, and adverse reactions after treatment.Results The total effective rate in the combination group (92.50%) was significantly higher than in the quadruple therapy group(72.50%)(P < 0.05). The HP eradication rate in the combination group(95.00%) was significantly higher than in the quadruple therapy group(72.50%) (P < 0.05). Levels of interleukin-6(IL-6), IL-1, and C-reactive protein(CRP), as well as HAMA and HAMD scores, were significantly reduced in both groups after treatment. The combination group showed significantly lower levels compared to the quadruple therapy group(P < 0.05). Both groups showed an increase in PGⅠ and PGR, and a decrease in PGⅡ, after treatment, with the combination group exhibiting significantly better changes compared to the quadruple therapy group(P < 0.05). There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion Jiawei Shugan Hewei drink combined with quadruple therapy for HPAG, can improve clinical symptoms, increase clinical efficacy and HP eradication rates, alleviate inflammatory responses, promote gastric function recovery, and improve symptoms of anxiety and depression.
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Key words:
- Jiawei Shugan Hewei drink /
- quadruple therapy /
- Helicobacter pylori /
- gastritis /
- pepsinogen ratio
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表 1 两组患者的临床资料比较
例(%)，X±S 组别 例数 性别 年龄/岁 病程/年 BMI 男 女 四联组 40 21(52.50) 19(47.50) 45.15±6.10 5.10±1.21 22.78±3.60 联合组 40 18(45.00) 22(55.00) 46.30±6.45 4.95±1.15 23.10±4.12 χ2/t 0.450 0.819 0.568 0.370 P 0.502 0.415 0.571 0.712 
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表 2 两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 四联组 40 5(12.50) 15(37.50) 9(22.50) 11(27.50) 29(72.50) 联合组 40 8(20.00) 17(42.50) 12(30.00) 3(7.50) 37(92.50) χ2 5.541 P 0.019
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表 3 两组患者治疗前后的HP根除情况比较
例 组别 例数 阴性 阳性 根除率/% 四联组 40 29 11 72.50 联合组 40 38 2 95.00 χ2 7.440 P 0.006
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表 4 两组患者治疗前后的血清PGⅠ、PGⅡ、PGR水平比较
X±S 组别 例数 PGⅠ/(μg/L) PGⅡ/(μg/L) PGR 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 四联组 40 70.65±10.10 85.10±10.351) 15.30±2.65 12.10±2.451) 4.75±0.60 7.12±0.841) 联合组 40 71.30±10.65 95.20±12.121) 15.26±2.30 10.45±1.621) 4.70±0.58 8.70±0.981) t 0.280 4.008 0.072 3.553 0.379 7.742 P 0.780 < 0.001 0.943 0.001 0.706 < 0.001 与治疗前比较，1)P < 0.05。
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表 5 两组患者治疗前后的焦虑、抑郁评分比较
分，X±S 组别 例数 HAMA HAMD 治疗前 治疗后 治疗前 治疗后 四联组 40 15.20±3.45 12.64±3.101) 16.10±3.20 14.35±3.561) 联合组 40 15.05±3.10 9.60±1.451) 15.96±2.89 9.12±2.601) t 0.205 5.618 0.205 7.503 P 0.838 < 0.001 0.838 < 0.001 与治疗前比较，1)P < 0.05。
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表 6 两组患者治疗前后的炎症因子水平比较
X±S 组别 例数 IL-1/(ng/L) IL-6/(ng/L) CRP/(mg/L) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 四联组 40 79.84±10.65 50.25±8.121) 25.60±4.15 18.12±3.121) 10.12±2.45 7.05±1.851) 联合组 40 80.15±11.08 35.02±6.301) 25.45±3.60 12.30±2.541) 9.97±1.56 4.12±1.461) t 0.128 9.372 0.173 9.149 0.327 7.863 P 0.899 < 0.001 0.863 < 0.001 0.745 < 0.001 与治疗前比较，1)P < 0.05。
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表 7 两组患者的不良反应发生情况比较
例(%) 组别 例数 恶心 呕吐 头晕 皮疹 腹泻 总发生率/% 四联组 40 3(7.50) 2(5.00) 3(7.50) 1(2.50) 1(2.50) 25.00 联合组 40 2(5.00) 1(2.50) 1(2.50) 0 0 10.00 χ2 3.117 P 0.077
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