四逆散加味治疗慢性萎缩性胃炎的疗效观察及机制探讨
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[摘要] 目的 评价四逆散治疗慢性萎缩性胃炎肝郁脾虚型患者的有效性和作用机制。 方法 选择我院确诊为慢性萎缩性胃炎、中医辨证属肝郁脾虚型患者76例，并设健康对照组36例；将慢性萎缩性胃炎患者又随机分为两组，四逆散治疗组（40例）给予四逆散治疗，胃复春对照组（36例）给予胃复春治疗，两组均治疗3个月。观察三组临床疗效、胃镜下变化、病理改变、血清转化生长因子-α（TGF-α）水平及安全性指标。 结果 ①四逆散治疗组的临床、胃镜、病理疗效显著优于胃复春对照组（P ＜ 0.05）；②治疗前四逆散治疗组及胃复春对照组血清TGF-α水平均高于健康对照组，治疗后两组血清TGF-α水平较治疗前明显降低（P ＜ 0.05）。 结论 四逆散对慢性萎缩性胃炎肝郁脾虚型患者有良好的疗效，其作用机制可能与调节TGF-α的合成有关。
[关键词] 慢性萎缩性胃炎；四逆散；转化生长因子-α；临床观察
[中图分类号] R573.3 [文献标识码] A [文章编号] 1673-7210（2012）08（a）-0116-03
Therapeutic efficacy and mechanism of Sini San Decoction in the treatment of chronic atrophic gastritiss
ZHAO Cuili CAI Zhigang
Traditional Chinese Medicine Hospital of Futian District in Shenzhen City Affiliated to Hu'nan University of Chinese Medicine, Guangdong Province, Shenzhen 518034, China
[Abstract] Objective To evaluate the effectiveness and mechanism of Sini San Decoction in the treatment of patients with chronic atrophic gastritis in the syndrome of liver stagnation and spleen deficiency. Methods 76 cases of chronic atrophic gastritis with TCM diagnosis of liver stagnation and spleen deficiency and 36 cases of healthy people were enrolled in the study. Chronic atrophic gastritis patients were randomly divided into two groups. 40 cases in treatment group were given Sini San Decoction treatment and 36 cases in the Weifuchun control group were given Weifuchun treatment. 76 patients all were treated for 3 months and the clinical efficacy, endoscopic changes, pathological changes of serum, transforming growth factor-alpha (TGF-alpha) levels and safety indicators of the patients were observed. Results ①Clinical, endoscopic and pathological outcomes of the Sini San Decoction treatment group were significantly better than those of Weifuchun control group (P < 0.05); ②Serum TGF-α levels of both Weifuchun control group and Sini San Decoction treatment group were higher than that of healthy control group before treatment and were significantly decreased after treatment (P < 0.05). Conclusion Sini San Decoction shows a good efficacy in the treatment of patients with chronic atrophic gastritis in the syndrome of liver stagnation and spleen deficiency, and its mechanism of effect may be related to the synthesis of TGF-α.
[Key words] Chronic atrophic gastritis; Sini San Decoction; Transforming growth factor-α; Clinical observation
慢性萎缩性胃炎（chronic atrophic gastritis，CAG）是以局限性或广泛的胃黏膜固有腺体数量减少为特征，并伴有纤维组织增生、黏膜肌层增厚的消化系统疾病，为临床常见病。当伴有肠上皮化生（IM）及不典型增生（ATP）时则属于胃癌前病变[1]。然而西医对治疗慢性萎缩性胃炎尚无理想有效的方法，多以对症治疗为主，疗效不如人意。而祖国医学则兼具辨证论治和整体观念的特色，在中医学者的深入研究下， 中医药治疗CAG 取得了一定成绩。在笔者的临床实践中发现四逆散治疗该病效果显著，现将临床观察总结报道如下：