2018 年第 4 期 第 13 卷

自拟舒胃和肝散治疗慢性萎缩性胃炎癌前病变的效果及安全性观察

Efficacy and safety of self-made Shuwei Hegan powders in treatment of precancerous lesion of chronic atrophic gastritis

作者：郭忠聪文静

英文作者：

单位：410003长沙，湖南中医药大学第一附属医院肿瘤科

英文单位：

关键词：胃炎，萎缩性；癌前病变；胃动素；胃泌素

英文关键词：

• 摘要：

• 目的    探讨自拟舒胃和肝散应用于慢性萎缩性胃炎（CAG）癌前病变患者的临床疗效及安全性。方法    选取2016年1月至2017年6月湖南中医药大学第一附属医院收治的CAG癌前病变患者78例,应用随机数字表法分为对照组与观察组，各39例。对照组给予叶酸片5 mg/次、3次/d口服，胃复春片4片/次、3次/d口服；观察组在对照组的用药基础上给予自拟舒胃和肝散治疗，研为细粉每日50 g以沸水冲后待自然沉淀取上清液，代茶饮，每日最少冲2次；2组均治疗6个月。观察2组患者的临床疗效、治疗前后胃动素和胃泌素的变化、组织病理学改变和胃镜检查结果、中医证候及不良反应情况。结果    ①对照组临床治愈13例（33.3%），显效6例（15.4%），有效5例（12.8%），无效15例（38.5%）；观察组临床治愈19例（48.7%），显效9例（23.1%），有效6例（15.4%），无效5例（12.8%）,观察组临床疗效优于对照组(P=0.030)。②治疗后2组患者血清胃动素、胃泌素均高于治疗前，且观察组高于对照组，差异均有统计学意义（均P<0.001）。③治疗后2组患者炎性病变、萎缩、肠上皮化生、异型增生病理积分均低于治疗前，且观察组低于对照组，差异均有统计学意义（均P<0.001）。④治疗6个月2组患者行胃镜检查，观察组溃疡、糜烂、胆汁反流以及出血斑发生率均低于对照组［10.3%(4/39)比30.8%（12/39），12.8%（5/39）比33.3%（13/39），5.1%（2/39）比23.1%（9/39），7.7%（3/39）比25.6%（10/39）］，差异均有统计学意义（均P<0.05）。⑤治疗后2组患者胃脘痛、痞满、嘈杂、乏力、纳差中医证候积分均低于治疗前，且观察组低于对照组，差异均有统计学意义（均P<0.001）。⑥2组患者在治疗期间均未见严重不良反应。结论    自拟舒胃和肝散可有效改善CAG癌前病变患者胃泌素、胃动素分泌水平，促进黏膜组织愈合，且用药安全无严重不良反应。

• Objective    To observe the efficacy and safety of self-made Shuwei Hegan powders in treatment of precancerous lesion of chronic atrophic gastritis（CAG）. Methods    Totally 78 patients with CAG precancerous lesion at the First Affiliated Hospital of Hunan University of Chinese Medicine from January 2016 to June 2017 were randomly divided into control group and observation group, with 39 cases in each group. The control group took folic acid tablets and Weifuchun tablets; the observation group was treated by Shuwei Hegan powders. After 6 months of treatment, clinical efficacy, motilin and gastrin, histopathological and gastroscopic results, traditional Chinese medicine（TCM） syndrome features and adverse reactions were analyzed. Results   In control group, the cure rate was 33.3%（13/39）; the obvious effective rate was 15.4%（6/39）; the effective rate was 12.8%（5/39）; the ineffective rate was 38.5%（15/39）. In observation group, the cure rate was 48.7%（19/39）; the obvious effective rate was 23.1%（9/39）; the effective rate was 15.4%（6/39）; the ineffective rate was 12.8%（5/39）. Clinical efficacy in observation group was significantly better than that in control group(P=0.030). After treatment, serum levels of motilin and gastrin were significantly higher than those before treatment in both groups; serum levels of motilin and gastrin in observation group were significantly higher than those in control group（P<0.001）. Pathological scores of inflammatory lesion, atrophy, intestinal metaplasia and dysplasia after treatment were significantly lower than those before treatment in both groups; pathological scores of inflammatory lesion, atrophy, intestinal metaplasia and dysplasia after treatment in observation group were significantly lower than those in control group（P<0.001）. Incidences of ulcer, erosion, bile regurgitation and blood spots under gastroscope after treatment in observation group were significantly lower than those in control group［10.3%(4/39) vs 30.8%（12/39）， 12.8%（5/39） vs 33.3%（13/39）， 5.1%（2/39） vs 23.1%（9/39）， 7.7%（3/39） vs 25.6%（10/39）］（P<0.05）. TCM syndrome scores of gastric abscess, distention and fullness, noisy, weakness, digestive dysfunction after treatment were significantly lower than those before treatment in both groups; TCM syndrome scores of gastric abscess, distention and fullness, noisy, weakness, digestive dysfunction after treatment in observation group were significantly lower than those in control group（P<0.001）. No severe adverse reaction was observed in both groups. Conclusion    Shuwei Hegan powders treating CAG precancerous lesion can effectively and safely improve serum gastrin, motilin secretion and promote mucosal healing.