消痞和胃胶囊治疗胃癌前病变32例临床研究

Xiaopi Hewei Capsules Treatment on 32 Cases with Precancerous Lesions of Gastric Carcinoma

摘要:

目的: 观察消痞和胃胶囊治疗胃癌前病变(PLGC)(肝胃气滞证)的临床疗效及对血清内皮素(ET-1)、胃泌素(GAS)和生长抑素(SST)水平的影响. 方法: 64例PLGC患者采用随机按数字表法分为观察组和对照组各32例.两组均采用奥美拉唑镁肠溶片口服,20 mg/次,2次/d;口服枸橼酸铋钾片,2粒/次,2次/d;口服克拉霉素片,0.25 g/次,2次/d,疗程为2周.对照组同时加服胃复春片,4片/次,3次/d.观察组同时加服消痞和胃胶囊,6粒/次,3次/d.两组疗程均为6个月.进行肝胃气滞证评分;进行胃镜及病理检查,评价胃黏膜萎缩、肠化及异型增生程度;检测幽门螺杆菌(HP);检测治疗前后ET-1,GAS和SST水平. 结果: 经有序资料卡方检验,观察组胃镜和病理学疗效均优于对照组(P<0.05);经卡方检验,两组治疗后胃黏膜萎缩改善情况优于治疗前(P<0.01),观察组胃黏膜萎缩改善优于对照组(P<0.05);治疗后第3,6个月,观察组肝胃气滞证评分均低于对照组(P<0.01);治疗后观察组肠化或(和)异型增生评分低于对照组(P<0.01);治疗后1个月,对照组HP清除率为79.2%,观察组为84%,两组比较差异无统计学意义;治疗后6个月,对照组HP感染率40%,观察组为17.14%,观察组HP感染率低于对照组(P<0.05);治疗后观察组血清ET-1和GAS水平低于对照组,SST水平高于对照组(P<0.01). 结论: 消痞和胃胶囊能改善PLGC(肝胃气滞证)患者临床症状、降低了HP的复发,对PLGC向胃癌的进展有一定的阻断作用,其机制可能与升高血清SST水平,降低ET-1和GAS有关.

Abstract:

Objective: To observe the curative efficacy of Xiaopi Hewei capsules in treating precancerous lesions of gastric carcinoma (PLGC) which belonged to stagnation of liver-qi and stomach-qi, and to investigate its influence on endothelin (ET-1), gastrin (GAS) and somatostatin (SST). Method: Sixty-four patients with PLGC were randomly divided into control group (32 cases) and observation group (32 cases) by random number table. Patients in both groups received 20 mg omeprazole magnesium enteric-coated tablets,2 bismuth potassium citrate tablets and 0.25 g clarithromycin tablet twice daily for 2 weeks. Patients in control group added 4 weifu Chun tablets thrice daily, and patients in observation group added 6 Xiaopi Hewei capsules thrice daily for 6 months. Scores of stagnation of liver-qi and stomach-qi were evaluated. Gastroscope and pathology were carried out and scores of atrophy of gastric mucous, degree of intestinal metaplasia and dysplasia were graded. Helicobacter pylori (HP) was detected. The levels of ET-1, GAS and SST were detected before and after treatment. Result: By ordinal data chi-square test, the results of gastroscopy and pathological in observation group were superior to those in control group (P<0.05). Improvement of gastric mucosa atrophy in both groups was better than before according to chi-square test (P<0.01), while the observation group obtained better results (P<0.05). Liver-qi stagnation syndrome score in observation group was less than that in control group at the third and sixth months after treatment (P<0.01). Scores of intestinal metaplasia or (and) dysplasia in observation group were less than those in control group (P<0.01). Clearance of HP in control group was 79.2%, while the data in observation group was 84%. There was no significant difference between both groups. Infection rate of HP in control group was 40%, while the data in observation group was 17.14%. Infection rate in observation group was lower than that in control group after 6-month treatment (P<0.05). Levels of serum ET-1 and GAS in observation group were less than those in control group, SST level in observation group was higher than those in control group (P<0.01). Conclusion: Xiaopi Hewei capsules could improve clinical symptoms with PLGC patients (liver-qi stagnation syndrome), reduce the recurrence of HP. It has certain blocking effect on the progression from PLGC to gastric cancer. Its mechanism may be related to enhancing the serum level of SST and reducing the serum levels of ET-1 and GAS.