世界中医药

目的：观察柴胡疏肝散加减治疗肝胃不和型慢性浅表性胃炎(CSG)患者的临床疗效，探讨疗效机制及其治疗CSG的临床价值。方法：选取2017年3月至2018年2月衡水市人民医院收治的肝胃不和型CSG患者112例作为研究对象，随机分为对照组和观察组，每组56例。2组患者均按照CSG常规方案治疗，观察组患者再以柴胡疏肝散为基础方，辨证加减治疗。2周为1个疗程，2组患者均连续治疗2个疗程。比较2组患者治疗后主要症状疗效、胃镜下胃黏膜改善疗效、幽门螺杆菌（Hp）清除率。比较2组患者治疗前后血清白细胞介素-2、6（IL-2、IL-6）、肿瘤坏死因子-α（TNF-α）、趋化因子-1（MCP-1）、C反应蛋白（CRP）及SF-36生命质量评分变化。比较2组患者治疗期间药物不良反应发生率。结果：1）治疗2个疗程后，2组患者主要临床症状餐后饱胀不适、早饱感、上腹部疼痛或不适、烧灼感积分均较治疗前明显下降，且观察组低于对照组，差异有统计学意义（P<0.05）；治疗后观察组患者上述症状临床有效率明显高于对照组，差异有统计学意义（P<0.05）。2）2组患者治疗后血清IL-2、IL-6、TNF-α、MCP-1及CRP较治疗前显著降低，且观察组低于对照组，差异有统计学意义（P<0.05）。3）观察组患者治疗后Hp清除率明显高于对照组，差异有统计学意义（P<0.05）；4）治疗后，观察组患者胃镜下胃黏膜改善有效率明显高于对照组，差异有统计学意义（P<0.05）；5）2组患者治疗过程中未出现严重不良反应，一般不良反应比较,差异无统计学意义（P>0.05）。结论：柴胡疏肝散加减辨治可有效改善肝胃不和型CSG患者可提升Hp清除率、降低患者炎性反应及免疫相关炎性反应递质水平，改善CSG患者临床症状及生命质量，且安全。

English Summary:

To observe clinical efficacy of modified Chaihu Shugan Powder in chronic superficial gastritis(CSG)with liver-stomach disharmony，and to explore therapeutic mechanism and its clinical value in treating CSG.Methods:A total of 112 patients with liver-stomach disharmony type CSG who were treated in Hengshui People's Hospital from March 2017 to February 2018 were selected as subjects and randomly divided into control group and observation group，with 56 cases in each group.The 2 groups of patients were treated according to conventional CSG scheme，then Chaihu Shugan powder was taken as the basic formula in the observation group to perform syndrome differentiation，modification and treatment.Two weeks was 1 course of treatment，and the 2 groups of patients were treated for 2 consecutive courses of treatment.Efficacy in main symptoms，efficacy in gastroscopic gastric mucosal improvement and clearance rate of Helicobacter pylori(HP)were compared between the 2 groups after the treatment.Changes of serum interleukin-2 and interleukin-6(IL-2 and IL-6)，tumor necrosis factor-α(TNF-α)，chemokine-1(MCP-1)，CRP and SF-36 quality of life scores before and after the treatment were compared between the 2 groups.Rates of adverse drug reactions/toxic and side effects during the treatment were compared between the 2 groups.Results:1)After 2 courses of the treatment，the scores of main clinical symptoms such as postprandial distension and discomfort，early satiety，upper abdominal pain or discomfort，and burning sensation in the 2 groups were significantly decreased compared with those before the treatment，and those in the observation group were lower than those in the control group(P<0.05).After the treatment，total effective rates of the above symptoms in the observation group were significantly higher than those in the control group(P<0.05).2)The serum levels of IL-2，IL-6，TNF-α，MCP-1 and CRP in the 2 groups were significantly lower than those in the control group after the treatment，and those in the observation group were lower than those in the control group.3)After the treatment，the HP clearance rate in the observation group was significantly higher than that in the control group(P<0.05).4)After the treatment，the total effective rate of gastroscopic gastric mucosal improvement in the observation group was significantly higher than that in the control group(P<0.05).5)There were no serious adverse reactions/toxic and side effects during the treatment in the 2 groups.There was no significant difference in general adverse reactions/toxic and side effects(P>0.05).Conclusion:Syndrome differentiation，modification and treatment of Chaihu Shugan Powder can effectively improve the clearance rate of HP，decrease the inflammatory state of patients and the levels of immune-related inflammatory factors in CSG with liver-stomach disharmony，so as to improve the clinical symptoms and quality of life for patients with CSG.It is safe and has high clinical value.

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