Objective: To evaluate the clinical effects of acupoint catgut embedding combined with quadruple therapy on Helicobacter pylori (Hp)-positive (+) chronic atrophic gastritis (CAG) of spleen and stomach deficiency syndrome and explore the underlying mechanism.
Methods: Hp (+) CAG patients with spleen and stomach deficiency syndrome were randomly divi-ded into a control group (n=68) and a treatment group (n=71). In addition to the routine quadruple therapy for two weeks, the patients in the control group received oral Weifuchun Tablets (4 tablets once, tid.), and those in the treatment group underwent acupoint catgut embedding at Pishu (BL20), Weishu (BL21), Zhongwan (CV12), and Zusanli (ST36), once a week. The two groups were treated for three months in total. The scores of traditional Chinese medicine (TCM) symptoms and signs, clinical efficacies, quality of life scale scores (PRO scores and HAMA scores), endoscopic and histopathologic scores, Hp eradication rates detected by 13C breath test, and the recurrence rates after six months of the two group were compared. The changes in serum gastrin 17 (G-17), pepsinogen Ⅰ (PGⅠ) and pepsinogen Ⅱ (PGⅡ) were detected by ELISA, and PGⅠ/PGⅡ was calculated.
Results: There was no significant difference in the eradication rate of Hp between the two groups after treatment (P>0.05), but the recurrence rate after six months in the treatment group was lower than that of the control group (P<0.05). After treatment, the scores of TCM symptoms and signs, endoscopic and histopathologic scores, PRO scores, and HAMA scores were decreased in both groups (P<0.01), while serum levels of G-17, PG Ⅰ, PG Ⅱ, and PG Ⅰ/PG Ⅱ were increased (P<0.05, P<0.01). The treatment group was superior to the control group in alleviating stomach discomfort by pressing or warmth, decreasing the total score of TCM symptoms and signs, relieving anorexia, mottled gastric mucosa, mucosal ulcer, chronic inflammation, and activity, improving anxiety, and regulating G-17 (P<0.05, P<0.01). The effective rates of the treatment group and the control group were 40.85% (29/71) and 23.53% (16/68)，the treatment group was higher than the control group (P<0.05).
Conclusion: Acupoint catgut embedding combined with quadruple therapy in the treatment of Hp (+) CAG of spleen and stomach deficiency syndrome is significant in clinical efficacy and low in recurrence rate, which is presumedly achieved by repairing gastric mucosa and sensitizing the secretion of G-17 and pepsinogen.
目的：评价穴位埋线联合四联疗法治疗幽门螺旋杆菌(Hp)(+)脾胃虚弱证慢性萎缩性胃炎(CAG)的临床疗效，探讨其治疗CAG的机制。方法：Hp(+)脾胃虚弱证CAG患者随机分为对照组68例、治疗组71例。两组均给予常规四联疗法2周，同时对照组给予胃复春片口服，4片/次，3次/d，治疗组给予脾俞、胃俞、中脘、足三里穴位埋线，每周1次，两组均治疗3个月。比较两组治疗前后中医症状积分并进行疗效评价，比较两组治疗前后胃镜黏膜评分及病理组织学评分、生存质量量表评分(PRO量表评分以及HAMA量表评分)，13C呼气试验检测Hp根除率及6个月后复发率，ELISA法测定血清胃泌素17(G-17)、胃蛋白酶原Ⅰ(PGⅠ)、胃蛋白酶原Ⅱ(PGⅡ)，计算PGⅠ/PGⅡ。结果：治疗后，两组Hp根除率比较差异无统计学意义(P＞0.05)，但6个月后治疗组复发率显著低于对照组(P<0.05)。与本组治疗前比较，两组治疗后中医症状积分、胃镜黏膜评分、病理组织学评分、PRO量表评分及HAMA量表评分均显著降低(P<0.01)，血清G-17、PGⅠ、PGⅡ含量及PGⅠ/PGⅡ均升高(P<0.01，P<0.05)。治疗组的胃部喜按或喜暖评分、食少纳呆评分、中医症状总积分、胃黏膜花斑评分、糜烂评分、慢性炎性反应评分、活动性评分及HAMA量表评分均低于对照组（P<0.01,P<0.05），而血清G-17含量高于对照组(P<0.01)。治疗组显效率为40.85%(29/71)，高于对照组的23.53%(16/68，P<0.05)。结论：穴位埋线联合四联疗法治疗Hp(+)脾胃虚弱证CAG，临床疗效显著，复发率低，可能是通过修复胃黏膜，增加G-17、PG的分泌实现的。.
Keywords: Acupoint catgut embedding; Chronic atrophic gastritis; Hp (+); Spleen and stomach deficiency syndrome.