连蒲饮对慢性胃炎患者幽门螺杆菌及其CagA、VacA蛋白的影响

发布时间：2018-03-19 10:53

本文选题：幽门螺杆菌　切入点：慢性胃炎　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察加减连蒲饮对幽门螺杆菌相关性胃炎脾胃湿热型患者症状改善情况、幽门螺杆菌根除率和血清CagA和VacA抗体水平的影响,并对其治疗机制进行初步探讨,从而为中医药治疗幽门螺杆菌相关性胃炎提供临床及理论依据。方法:收集30例慢性胃炎伴幽门螺杆菌感染的脾胃湿热证患者,予连蒲饮加减治疗2周,分别于治疗前和治疗停药一个月后行胃镜检查/13C呼气试验查幽门螺杆菌感染情况和检查血清CagA和VacA抗体水平,并分别于治疗前、服药2周后和停药一月后观察主要症状评分(痞满、胃胺疼痛)、次要症状评分(纳差、嗳气、反酸、舌脉等)。结果:确诊并纳入的脾胃湿热型幽门螺杆菌相关性慢性胃炎患者共29例,其中一例未复查血清。将Hp根治失败次数与血清抗体阳性率比较,无明显差异(P0.05)。将血清抗体双阳性、单阳性、无阳性组进行症状积分比较,无明显差异(P0.05)。在症候疗效方面,服药2周后总有效率为96.55%,停药1月后总有效率为86.21%,两者无明显差异(P0.05);各主要次要症状在治疗后也明显改善。治疗后Hp根除率仅17.24%。治疗后CagA抗体转阴率为22.2%,VacA抗体转阴率为36.4%,尿素酶转阴率为27.3%,三者的转阴情况前后均无明显差异(P0.05),但抗体滴度均下降,前后血清CagA、VacA抗体滴度均有明显差异(P0.05)。结论:Hp耐药性和症状严重程度与Hp毒力因子CagA、VacA无关;加减连蒲饮治疗脾胃湿热型Hp相关性胃炎,其对Hp的根治率较低,血清抗体转阴情况不明显,但能明显改善症状,且有较好的远期疗效,血清抗体滴度也明显下降,表明其作用机制可能与减轻、削弱Hp毒力有关。
[Abstract]:Objective: to observe the effects of Jiayuan Lianpu Yin on the improvement of symptoms, eradication rate of Helicobacter pylori and the levels of serum CagA and VacA antibodies in patients with Helicobacter pylori associated gastritis with damp-heat type of spleen and stomach, and to explore its therapeutic mechanism. Methods: 30 patients with chronic gastritis associated with Helicobacter pylori infection with damp-heat syndrome of spleen and stomach were collected and treated with Lianpu Yin for 2 weeks. Before treatment and one month after drug withdrawal, gastroscopy was performed to examine Helicobacter pylori infection and serum CagA and VacA antibody levels were examined by 13 C breath test. Two weeks after administration and January after withdrawal, the main symptom scores (bulging, stomach amine pain, minor symptoms (anorexia, belching, acid regurgitation) were observed. Results: 29 patients with Helicobacter pylori associated chronic gastritis with damp-heat type of spleen and stomach were diagnosed and included. There was no significant difference (P 0.05). There was no significant difference in symptom scores among the groups with double positive, single positive and no positive serum antibodies. The total effective rate was 96.55 after 2 weeks and 86.21 after the withdrawal of the drug on January. There was no significant difference between the two groups, and the major secondary symptoms were also significantly improved after treatment. The eradication rate of HP after treatment was only 17.244.After treatment, the negative rate of CagA antibody turned to negative. The negative rate was 36.4 and the urease negative rate was 27.3. There was no significant difference between the three groups before and after the negative conversion, but the antibody titers were all decreased. There were significant differences in the titer of serum CagAg Vaca antibody before and after treatment. Conclusion the drug resistance and symptom severity of 1 / HP have no relationship with the virulence factor CagAn Vaca, and the curative effect of Lianpu Yin on HP associated gastritis of damp-heat type of spleen and stomach is low. The serum antibody turned negative was not obvious, but it could obviously improve the symptoms, and had good long-term effect. The titer of serum antibody also decreased obviously, which indicated that the mechanism might be related to the reduction of the virulence of HP and the weakening of the virulence of HP.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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