中药治疗慢性胃炎伴糜烂黏膜修复机制的临床探讨

摘要

目的:通过蒲元和胃胶囊治疗幽门螺杆菌(Helicobacter Pylori,Hp)阴性慢性胃炎伴胃窦糜烂前后表皮生长因子(Epidermal Growth Factor,EGF)、微血管密度(Microvessel Density,MVD)的变化,初步探讨中药修复胃黏膜作用机制.方法:选择经胃镜及病理诊断明确的患者90例,按照随机、对照、双盲、双模拟原则随机分组,PYHW组(PYHW+安慰剂)30例,替普瑞酮组(PYHW+替普瑞酮胶囊)30例,雷贝拉唑组(PYHW+雷贝拉唑肠溶胶囊)30例.记录每组患者病情的改变情况,并通过定标活检获取治疗前后各组患者胃窦糜烂处及糜烂旁的黏膜标本,采用免疫组化技术分别测定所取标本的EGF、MVD的表达情况.结果:PYHW组、替普瑞酮组、雷贝拉唑组糜烂处胃黏膜治疗前后EGF的阳性表达率分别为20.00%vs 56.70%,16.7%vs 46.7%,13.3%vs 43.3%,差异有统计学意义(P<0.05);PYHW组、替普瑞酮组、雷贝拉唑组糜烂旁处胃黏膜治疗前后EGF的阳性表达率分别为10.00%vs 26.70%,13.30%vs 16.70%,16.70%vs 23.30%,差异无统计学意义(P>0.05).PYHW组、替普瑞酮组及雷贝拉唑组治疗后均对糜烂处胃黏膜MVD比治疗前上调作用明显,治疗前后差异有统计学意义(P<0.05).对糜烂旁胃黏膜MVD有不同程度的上调作用,治疗前、后差异无统计学意义(P>0.05).结论:中药修复胃黏膜糜烂的作用机制与EGF及MVD相关,并能明显改善慢性胃炎伴胃窦糜烂患者的临床症状、糜烂.%Objective:To explore the mechanism of traditional Chinese medicine ( TCM) on the repair of gastric mucosa through the changes of epidermal growth factor ( EGF) ,microvessel density ( MVD) of chronic gastritis with antral erosion without Helico-bacter pylori ( Hp) infection before and after the treatment of Puyuanhewei capsule ( PYHW) .Methods:The 90 experimental sub-jects diagnosed by gastroscope and pathology were divided into PYHW group (PYHW+placebo) 30 cases, Teprenone group (PY-HW+Teprenone) 30 cases and Rabeprazole group (PYHW+Rabeprazole) 30 cases as the randomised, double-blind, placebo-controlled, double-dummy trials.These subjects in PYHW group were treated with PYHW and placebo like Rabeprazole or Te-prenone.The patient′s condition of every group were recorded constantly .Specimens were obtained in the erosion and erosion-ad-jacent normal mucosa by scaling biopsy before and after treatment in the three groups .Using immunohistochemical technology , the positive expression of EGF and MVD were detected .Results:The positive expression rate of EGF of erosion of gastric mucosa was 20.00%vs 56.70%, 46.7%vs 16.7%, 43.3%vs 13.3% before and after treatment in PYHW group , teprenone group , and rabeprazole group respectively , with statistical significance ( P<0.05 ) .The positive expression rate of EGF of erosion-adjacent gastric mucosa was 10.00%vs 26.70%, 13.30%vs 16.70%, 16.70%vs 23.3%before and after treatment in PYHW group , teprenone group , rabeprazole group respectively with no statistical significance .( P>0.05 ) .MVD of erosion of gastric mucosa were increased obviously after treatment in PYHW group , teprenone group , rabeprazole group than before , and the difference had statistical significance (P<0.05).MVD of erosion adjacent gastric mucosa were upregulated at different degrees after treatment , showing no significant difference (P>0.05).Conclusion:The mechanism of Traditional Chinese Medicine in the repair of gastric mucosal erosion is related to EGF and MVD , and it can improve the clinical symptoms and erosion of patients with chronic gastritis with antral erosion .