白及萸连汤联合三联疗法治疗幽门螺杆菌阳性胃溃疡脾胃湿热证的疗效观察

doi:10.3877/cma.j.issn.2095-2015.2026.04.005

目的

探讨白及萸连汤联合三联疗法治疗幽门螺杆菌（Hp）阳性胃溃疡脾胃湿热证的疗效。

方法

本研究为前瞻性随机对照研究。选取2023年2月至2024年6月于东莞市人民医院住院的Hp阳性胃溃疡患者96例，以随机数字表法分入观察组（48例）与对照组（48例）。对照组予三联疗法；观察组在对照组治疗方案基础上加用白及萸连汤内服。两组连续用药4周。比较两组证候疗效、胃镜疗效评价、脾胃湿热证单项症状评分、Hp清除率、治疗后3 d大便潜血转阴率、炎症因子、胃蛋白酶原（PGⅠ）水平、组织三叶因子（TFF2）、血管内皮生长因子（VEGF）水平、不良反应发生情况。

结果

治疗4周后，观察组证候总有效率显著高于对照组（91.67% vs 72.92%，P<0.05）；观察组胃镜总有效率显著高于对照组（89.58% vs 70.83%，P<0.05）；两组脾胃湿热证评分显著减少，观察组减少更显著（P<0.05）；观察组Hp清除率显著高于对照组（95.83% vs 79.17%，P<0.05）；治疗3 d后，观察组病例大便潜血转阴26例（54.17%），对照组为17例（35.42%），观察组明显多于对照组（P<0.05）；治疗后两组病例血清肿瘤坏死因子α、白细胞介素（IL）-6、IL-10、PGⅠ水平明显降低，同时观察组降低更明显（P<0.05）；血清TFF2和VEGF水平明显增加，观察组增加更加显著（P<0.05）。观察组不良反应发生率为20.00%，对照组发生率为6.67%，差异无统计学意义（P>0.05）。

结论

白及萸连汤联合三联疗法治疗HP阳性胃溃疡脾胃湿热证的疗效显著，改善脾胃湿热证，能提高Hp清除率，促进大便潜血转阴，抑制炎症反应、调节胃肠激素水平，用药安全可靠。

关键词: 胃溃疡, 幽门螺杆菌, 白及萸连汤, 脾胃湿热证

Objective

To explore the efficacy of Baiji Yulian decoction combined with triple therapy in the treatment of helicobacter pylori (Hp)-infected gastric ulcer with syndrome of spleen and stomach damp-heat.

Methods

This study was a prospective randomized controlled trial. Ninety-six Hp-positive gastric ulcer patients admitted to Dongguan People's Hospital from February of 2023 to June of 2024 were selected and divided into observation group (48 cases) and control group (48 cases) by random number table method. The control group received triple therapy, and the observation group was given with Baiji Yulian decoction on the basis of control group. Both groups were treated continuously for 4 weeks. The curative effect of syndrome, gastroscopic effect, single symptom scores of spleen and stomach damp-heat, Hp clearance rate, stool occult blood conversion rate after 3 days of treatment, inflammatory factors, pepsinogenⅠ (PGⅠ), trefoil factor 2 (TFF2), vascular endothelial growth factor (VEGF), and occurrence of adverse reactions were compared between the two groups.

Results

After 4 weeks of treatment, the total curative effect of syndrome of observation group (91.67%) was significantly higher than that of control group (72.92%) (P<0.05). The gastroscopic effect of syndrome of observation group (89.58%) was significantly higher than that of control group (70.83%) (P<0.05). The spleen and stomach damp-heat syndrome score was significantly decreased in two groups, and the decrease was more significant in the observation group (P<0.05). The Hp clearance rate of observation group was 95.83%, which was significantly higher than that of control group (79.17%) (P<0.05). After 3 days of treatment, stool test results turned negative in 26 cases (54.17%) of the observation group and 17 cases (35.42%) of the control group, and the number of negative conversion cases was significantly higher in the observation group than in the control group (P<0.05). The serum levels of tumor necrosis factor-α, interleukin (IL)-6, IL-10 and PGⅠ in two groups were significantly decreased, and the decrease was more significant in observation group (P<0.05). The levels of serum TFF2 and VEGF significantly increased, and the increase was more pronounced in the observation group (P<0.05). The incidence of adverse reactions was 20.00% in the observation group and 6.67% in the control group, and there was no statistically significant difference between the two groups (P>0.05).

Conclusion

Baiji Yulian decoction combined with triple therapy is highly effective in treating Hp-infected gastric ulcer with syndrome of spleen and stomach damp-heat. It can improve the symptoms of spleen and stomach damp-heat syndrome, increase Hp clearance rate, promote the conversion of occult blood in the stool to negative, inhibit inflammatory response, regulate gastrointestinal hormone level, with safe and reliable drug use.

Key words: Gastric ulcer, Helicobacter pylori, Baiji Yulian decoction, Syndrome of spleen and stomach damp-heat

表1 两组Hp阳性胃溃疡脾胃湿热证患者证候疗效比较[例（%）]

组别	例数	临床痊愈	显效	好转	未愈	总有效率
观察组	48	22(45.83)	14(29.17)	8(16.67)	4(8.33)	44(91.67)
对照组	48	14(29.17)	13(27.08)	8(16.67)	13(27.08)	35(72.92)

表1 两组Hp阳性胃溃疡脾胃湿热证患者证候疗效比较[例（%）]

组别	例数	临床痊愈	显效	好转	未愈	总有效率
观察组	48	22(45.83)	14(29.17)	8(16.67)	4(8.33)	44(91.67)
对照组	48	14(29.17)	13(27.08)	8(16.67)	13(27.08)	35(72.92)

表2 两组Hp阳性胃溃疡脾胃湿热证患者胃镜疗效比较[例（%）]

组别	例数	临床治愈	显效	有效	未愈	总有效
观察组	48	21(43.75)	16(33.33)	6(12.50)	5(10.42)	43(89.58)
对照组	48	14(29.17)	13(27.08)	7(14.58)	14(29.17)	34(70.83)

表2 两组Hp阳性胃溃疡脾胃湿热证患者胃镜疗效比较[例（%）]

组别	例数	临床治愈	显效	有效	未愈	总有效
观察组	48	21(43.75)	16(33.33)	6(12.50)	5(10.42)	43(89.58)
对照组	48	14(29.17)	13(27.08)	7(14.58)	14(29.17)	34(70.83)

表3 两组Hp阳性胃溃疡患者脾胃湿热证评分比较（

±s）

组别	例数	时间	胃脘灼热疼痛	身重困倦	口干口黏	恶心呕吐	食少纳呆	总评分
观察组	48	治疗前	5.34±0.62	5.41±0.65	5.30±0.60	5.22±0.57	5.19±0.56	26.46±3.19
	48	治疗后	1.58±0.25^ab	1.61±0.26^ab	1.57±0.24^ab	1.51±0.23^ab	1.49±0.22^ab	7.76±0.86^ab
对照组	48	治疗前	5.39±0.64	5.46±0.67	5.27±0.58	5.27±0.28	5.15±0.55	26.54±3.21
	48	治疗后	1.91±0.28^a	1.98±0.30^a	1.88±0.27^a	1.85±0.26^a	1.81±0.25^a	9.56±1.93^a
t值			6.091	6.457	5.945	6.786	6.657	5.902
P值			0.000	0.000	0.000	0.000	0.000	0.000

表3 两组Hp阳性胃溃疡患者脾胃湿热证评分比较（

±s）

组别	例数	时间	胃脘灼热疼痛	身重困倦	口干口黏	恶心呕吐	食少纳呆	总评分
观察组	48	治疗前	5.34±0.62	5.41±0.65	5.30±0.60	5.22±0.57	5.19±0.56	26.46±3.19
	48	治疗后	1.58±0.25^ab	1.61±0.26^ab	1.57±0.24^ab	1.51±0.23^ab	1.49±0.22^ab	7.76±0.86^ab
对照组	48	治疗前	5.39±0.64	5.46±0.67	5.27±0.58	5.27±0.28	5.15±0.55	26.54±3.21
	48	治疗后	1.91±0.28^a	1.98±0.30^a	1.88±0.27^a	1.85±0.26^a	1.81±0.25^a	9.56±1.93^a
t值			6.091	6.457	5.945	6.786	6.657	5.902
P值			0.000	0.000	0.000	0.000	0.000	0.000

表4 两组Hp阳性胃溃疡脾胃湿热证患者血清炎症因子水平比较（pg/mL，

±s）

组别	例数	时间	肿瘤坏死因子-α	白细胞介素-6	白细胞介素-10	胃蛋白酶原Ⅰ
观察组	48	治疗前	804.33±82.40	904.31±93.46	130.31±15.03	303.94±33.14
	48	治疗后	144.85±16.36^a	149.40±17.03^a	94.36±10.04^a	215.04±23.01^a
对照组	48	治疗前	803.12±8194	903.04±92.51	129.89±14.93	304.01±33.17
	48	治疗后	203.46±22.93^a	204.09±23.40^a	111.48±12.41^a	230.41±25.93^a
t值			14.416	13.092	7.430	3.072
P值			0.000	0.000	0.000	0.001

表4 两组Hp阳性胃溃疡脾胃湿热证患者血清炎症因子水平比较（pg/mL，

±s）

组别	例数	时间	肿瘤坏死因子-α	白细胞介素-6	白细胞介素-10	胃蛋白酶原Ⅰ
观察组	48	治疗前	804.33±82.40	904.31±93.46	130.31±15.03	303.94±33.14
	48	治疗后	144.85±16.36^a	149.40±17.03^a	94.36±10.04^a	215.04±23.01^a
对照组	48	治疗前	803.12±8194	903.04±92.51	129.89±14.93	304.01±33.17
	48	治疗后	203.46±22.93^a	204.09±23.40^a	111.48±12.41^a	230.41±25.93^a
t值			14.416	13.092	7.430	3.072
P值			0.000	0.000	0.000	0.001

表5 两组Hp阳性胃溃疡脾胃湿热证患者血清TFF2和VEGF水平比较（

±s）

组别	例数	时间	TFF2(pg/mL)	VEGF(ng/L)
观察组	48	治疗前	71.41±8.03	369.41±38.46
	48	治疗后	120.91±13.94^a	460.01±47.04^a
对照组	48	治疗前	71.22±7.99	368.90±36.40
	48	治疗后	108.33±13.04^a	414.81±45.03^a
t值			4.566	4.809
P值			0.000	0.000

表5 两组Hp阳性胃溃疡脾胃湿热证患者血清TFF2和VEGF水平比较（

±s）

组别	例数	时间	TFF2(pg/mL)	VEGF(ng/L)
观察组	48	治疗前	71.41±8.03	369.41±38.46
	48	治疗后	120.91±13.94^a	460.01±47.04^a
对照组	48	治疗前	71.22±7.99	368.90±36.40
	48	治疗后	108.33±13.04^a	414.81±45.03^a
t值			4.566	4.809
P值			0.000	0.000

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Effect of Baiji Yulian decoction combined with triple therapy on Hp-infected gastric ulcer with syndrome of spleen and stomach damp-heat

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Effect of Baiji Yulian decoction combined with triple therapy on Hp-infected gastric ulcer with syndrome of spleen and stomach damp-heat