Clinical Observation on the Treatment of Chronic Atrophic Gastritis with Syndrome of Spleen Deficiency and Stasis Obstruction by Shenqi Taohong Decoction and Its Mechanism
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摘要: 目的 研究参芪桃红汤治疗脾虚瘀阻证慢性萎缩性胃炎(CAG)的临床疗效。方法 选取昆山市中医医院脾胃肝胆科2018年1月至2019年6月CAG辨证符合脾虚瘀阻证门诊患者80例，按随机数字表法随机分为治疗组和对照组，每组各40例，治疗组口服参芪桃红汤，对照组口服胃复春片。2组均连续治疗12周，观察治疗前后中医证候积分、胃黏膜萎缩程度和范围，胃黏膜中三叶因子2(TFF2)和核因子-κB(NF-κB)表达水平的变化。结果 治疗后，2组中医证候积分、胃黏膜萎缩程度和范围分期、病理积分均有显著改善(P < 0.01)，治疗组优于对照组(P < 0.05，P < 0.01)；2组胃黏膜中TFF2的表达增加、NF-κB的表达降低(P < 0.01)，治疗组优于对照组(P < 0.05)。结论 参芪桃红汤能有效改善脾虚瘀阻证CAG主要中医证候、胃镜病理表现，其机制可能与提高胃黏膜中TFF2表达、降低NF-κB表达，从而促进损伤胃黏膜修复，改善胃黏膜的萎缩、肠化生有关。Abstract: OBJECTIVE To study the clinical efficacy of Shenqi Taohong decoction in treating chronic atrophic gastritis with syndrome of spleen deficiency and stasis obstruction.METHODS From January 2018 to June 2019, a total of 80 patients with chronic atrophic gastritis identified as spleen deficiency and stasis obstruction syndrome were selected from the Department of Spleen, Stomach, Liver and Gallbladder, Traditional Chinese Medicine Hospital of Kunshan, and randomly divided into treatment group and control group according to random number table (40 cases in each group). The treatment group received Shenqi Taohong decoction orally, while the control group received Wei Fuchun Tablets orally. Both groups were treated continuously for 12 weeks. The Traditional Chinese medicine (TCM)syndrome score, the degree of gastric mucosal atrophy, and the expression levels of Trefoil factor2 (TFF2) and Nuclear factor-κB (NF-κB) in gastric mucosa were observed before and after treatment.RESULTS After treatment, the TCM syndrome score, the degree of gastric mucosal atrophy spreading staging and pathological integral in the 2 groups were significantly improved (P < 0.01), but the treatment group was better than the control group (P < 0.05, P < 0.01). In addition, the expression levels of TFF2 in the gastric mucosa were increased and the expression levels of NF-κB were decreased in the 2 groups (P < 0.01), but the treatment group was better than the control group (P < 0.05).CONCLUSION Shenqi Taohong decoction can effectively improve the main TCM syndromes, gastroscopic results, and pathological manifestations of chronic atrophic gastritis in the syndrome of spleen deficiency and stasis obstruction, and its mechanism may be related to increasing TFF2 expression levels and decreasing NF-κB expression levels in gastric mucosa to promote repair of damaged gastric mucosa and reduce atrophy and intestinal metaplasia of gastric mucosa.
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表 2 2组患者治疗前后中医证候积分比较(x±s，n=40)
组别 时间 总积分 胃脘痞满 胃脘疼痛 纳差 嗳气泛酸 神疲乏力 治疗组 治疗前 14.20±4.17 4.53±1.70 3.85±1.81 2.93±1.85 1.95±1.88 0.95±1.48 治疗后 6.40±3.35**## 2.23±1.41** 1.95±1.43** 1.25±1.56** 0.83±1.60**# 0.15±0.65**# 对照组 治疗前 14.18±3.55 3.83±2.06 3.73±1.84 3.03±1.64 2.35±1.88 1.25±1.79 治疗后 9.35±2.78** 2.48±1.67** 2.55±1.63** 1.93±1.75** 1.70±1.79** 0.70±1.45** 注：组内比较，**P < 0.01；组间比较，#P < 0.05，##P < 0.01。 
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表 3 2组患者临床疗效比较(n=40)
组别 临床痊愈 显效 有效 无效 总有效率/% 治疗组 8 19 8 5 87.50# 对照组 6 11 10 13 67.50 注：2组比较，χ2=4.59，#P < 0.05。
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表 4 2组治疗前后OLGA分期情况比较
组别 时间 0级 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 治疗组 治疗前 0 32 6 2 0 治疗后 27 3 8 2 0 对照组 治疗前 0 33 6 1 0 治疗后 18 6 14 2 0
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表 5 2组治疗后OLGA分期变化情况比较(n=40)
组别 改善 稳定 进展 改善率/% 治疗组 27 9 4 67.50# 对照组 18 11 11 45.00 注：2组比较，χ2=4.11，#P < 0.05。
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表 6 2组治疗前后胃黏膜病理积分比较(x±s，n=40)
组别 时间 总积分 慢性炎性反应 活动性 萎缩 肠化生 治疗组 治疗前 12.15±3.33 3.45±1.18 3.55±1.52 2.15±1.44 3.00±2.10 治疗后 3.95±2.77**## 1.00±1.18** 1.20±1.40** 0.85±1.17**# 0.90±2.26** 对照组 治疗前 12.35±3.06 3.30±1.14 3.85±1.57 2.05±1.30 3.15±1.89 治疗后 5.55±2.55** 1.30±1.22** 1.50±1.16** 1.40±1.28** 1.35±2.22** 注：组内比较，**P < 0.01;组间比较，#P < 0.05，##P < 0.01。
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表 7 2组治疗前后伴低级别上皮内瘤变人数比较(n=40)
组别 治疗前 治疗后 消除率/% 治疗组 24 10 58.33# 对照组 23 13 43.48 注：2组比较，χ2=1.04，#P＞0.05。
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表 8 2组治疗前后胃黏膜TFF2和NF-κB表达水平比较(x±s，pg·mL-1, n=40)
组别 时间 TFF2 NF-κB 治疗组 治疗前 126.78±11.22 82.08±7.33 治疗后 213.40±18.64**# 48.28±11.77**# 对照组 治疗前 129.73±8.90 85.20±12.15 治疗后 204.13±17.59** 53.78±9.41** 注：组内比较，**P＜0.01；组间比较，#P＜0.05。
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