顾小生 方邦江

摘 要 目的：观察加味逍遥散治疗慢性萎缩性胃炎的临床疗效。方法：124例慢性萎缩性胃炎伴幽门螺杆菌（H. pylori）感染且辨证为肝胃不和型的患者随机分为对照组和观察组各62例。对照组口服奥美拉唑肠溶胶囊、阿莫西林胶囊（过敏者改服克拉霉素片）及胶体果胶铋，观察组加服加味逍遥散并随证加减。2组均连续治疗4周，8周后复查胃镜及病理学检查。治疗前后，观察患者主要症状及胃镜征象及病理学改变。结果：观察组总有效率为91.93%，对照组总有效率为82.25% （P<0.05）。治疗后，观察组症状积分及胃镜征象、病理学积分改善方面明显优于对照组，2组对比有显著性差异（P<0.05）。结论：加味逍遥散联合西药治疗慢性萎缩性胃炎疗效确切。

关键词 加味逍遥散 慢性萎缩性胃炎 H. pylori 胃镜病理组织学

中图分类号：R289.5； R259 文献标志码：A 文章编号：1006-1533（2019）01-0030-03

Treatment of 124 cases of chronic atrophic gastritis with Jiawei Xiaoyao San

GU Xiaosheng1*， FANG Bangjiang2**（1. Sanya Hospital of Traditional Chinese Medicine， Hainan Sanya 572000， China； 2. Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine， Shanghai 200030， China）

ABSTRACT Objective： To observe the clinical effect of Jiawei Xiaoyao San in the treatment of chronic atrophic gastritis. Methods： One hundred and twenty-four cases of chronic atrophic gastritis with H. pylori infection and syndrome differentiation of liver and stomach disharmony were randomly divided into a control group and an observation group with 62 cases each. The control group was treated with omeprazole enteric-coated capsules， amoxicillin capsules （allergic patients changed to clarithromycin tablets） and colloidal bismuth pectin while the observation group was additionally treated with modified Xiaoyao Powder and added or subtracted with the card， which were lasted for 4 weeks. Gastroscopy and pathological examination were reviewed after 8 week treatment. The main symptoms， gastroscopic signs and pathological changes were observed before and after treatment. Results： The total effective rate was 91.93% in the observation group and 82.25% in the control group （P<0.05）. The symptom scores， gastroscopic signs and pathological scores were significantly better in the observation group than the control group after treatment （P<0.05）. Conclusion： Jiawei Xiaoyao Powder combined with western medicines is effective in the treatment of chronic atrophic gastritis.

KEy WORDS Jiawei Xiaoyao San； chronic atrophic gastritis； H. pylori； gastroscopy histopathology

慢性萎缩性胃炎（CAG）是以胃黏膜腺体萎缩伴不同程度的肠上皮化生和异型增生为特征的慢性胃炎[1]。西医药治疗以缓解临床症状为主，尚无理想的逆转胃黏膜萎缩的方法[1]。中医药已广泛应用于慢性萎缩性胃炎的治疗并表现出一定的特色优势[2]。本试验旨在观察加味逍遥散联合西药治疗慢性萎缩性胃炎的临床疗效。

1 资料与方法

1.1 诊断、纳入及排除标准

西医诊断标准参照《中国慢性胃炎共识意见》[1]，中医辨证标准参照《慢性萎缩性胃炎中医诊疗共识意见》[2]及《中药新药治疗慢性萎缩性胃炎临床研究指导原则》[3]。纳入标准：①符合慢性萎缩性胃炎的西医诊断标准，经过胃镜及病理组织学检查确定诊断，且经13C呼气试验确定为幽门螺杆菌（H. pylori）感染者；②符合中医辨证为肝胃不和型；③年龄18～65周岁。④患者知情同意本次试验并簽字且配合诊断及治疗。……