摘要
目的分析胃镜下等离子消融术联合四联疗法在幽门螺杆菌(Hp)阳性疣状胃炎(VG)患者治疗中的应用价值。方法选取2020-02-06-2022-04-07虞城县人民医院Hp阳性VG患者78例,采用电脑随机法进行分组,每组各39例。常规组采用四联疗法治疗,埃索美拉唑口服,0.02g/次,2次/d;克拉霉素分散片口服,0.5g/次,2次/d;阿莫西林胶囊口服,0.5g/次,3次/d;枸橼酸铋钾颗粒冲服,0.22g/次,2次/d。手术组行胃镜下等离子消融术后再同对照组给予四联疗法治疗,均治疗4周。观察2组疗效、Hp清除率及不良反应发生情况,对比治疗前后各症状评分、炎性介质〔转化生长因子(TGF-β)、C反应蛋白(CRP)、降钙素原(PCT)〕、胃黏膜功能〔胃泌素(GAS)、生长抑素(SS)、胃蛋白酶原Ⅰ(PGⅠ)〕。计数资料采用n(%)表示,χ^(2)检测,计量资料以x-±s表示,采用t检验。结果手术组总有效率为97.44%(38/39)、Hp清除率为94.87%(37/39)明显高于常规组的79.49%(31/39)、76.92%(30/39),差异有统计学意义,χ^(2)值分别为4.552和5.186,均P<0.05;治疗后手术组上腹饱胀、胃部反酸、腹部胀痛评分分别为(1.08±0.41)分、(1.14±0.34)分和(0.95±0.31)分,明显低于常规组的(1.94±0.39)分、(2.08±0.38)分和(1.73±0.35)分,差异有统计学意义,F值分别为7.175、8.127和7.589,均P<0.001;治疗后,手术组TGF-β、CRP、PCT、PGⅠ水平分别为(13.38±3.55)mg/mL、(5.49±2.76)mg/L、(0.92±0.31)mg/mL、(33.48±4.66)μg/L,均低于常规组(16.72±4.27)mg/mL、(9.58±3.14)mg/L、(1.48±0.44)mg/mL、(41.75±5.03)μg/L,SS、GAS水平分别为(15.27±2.94)pg/mL、(22.43±3.55)pg/mL,均高于常规组的(13.89±2.53)pg/mL、(18.15±3.52)pg/mL,差异有统计学意义,F值分别为10.574、12.498、6.732、18.822、7.428和11.536,均P<0.001;手术组不良反应总发生率7.69%(3/39)与常规组5.13%(2/39)比较,差异无统计学意义,χ^(2)=0.000,P=1.000。结论胃镜下等离子消融术联合四联疗法能提高Hp阳性VG患者Hp清除率,减轻炎性反应,有助于改善胃黏膜功能,缓解患者症状,增强疗效,且安全性较高。
Objective To analyze the application value of endoscopic plasma ablation combined with quadruple therapy in the treatment of Helicobacter pylori(Hp)positive verrucous gastritis(VG).Methods A total of 78 Hppositive VG patients in Yucheng County People's Hospital from 2020-02-06to 2022-04-07were selected and divided into two groups by computer random method,with 39cases in each group.The conventional group was treated with quadruple therapy,esomeprazole orally,0.02g/time,2times/d;Oral clarithromycin dispersible tablet,0.5g/time,2times/d;Oral amoxicillin capsules,0.5g/time,3times/day;Bismuth potassium citrate granules,0.22g/time,2times/day.The operation group was given quadruple therapy after endoscopic plasma ablation,and the control group was given quadruple therapy for 4weeks.The efficacy,Hpclearance rate and adverse reactions of the two groups were observed,The symptom scores,inflammatory mediators[transforming growth factorβ(TGF-β),C-reactive protein(CRP),procalcitonin(PCT)],gastric mucosal function[gastrin(GAS),somatostatin(SS),pepsinogenⅠ(PGⅠ)]were compared before and after treatment.The count data were represented by n(%),χ^(2) test was conducted,and the measurement data were represented by(x-±s),and t test was used.Results The total effective rate and Hpclearance rate in the operation group were 97.44%(38/39)and 94.87%(37/39),which were significantly higher than 79.49%(31/39)and 76.92%(30/39)in the conventional group(χ^(2)=4.552,5.186,all P<0.05).After treatment,the scores of abdominal fullness,gastric acid reflux and abdominal pain in the operation group were(1.08±0.41)points,(1.14±0.34)points and(0.95±0.31)points,respectively.The scores were significantly lower than those in the conventional group[(1.94±0.39)points,(2.08±0.38)points,(1.73±0.35)points](F=7.175,8.127,7.589,all P<0.001).After treatment,the levels of TGF-β,CRP,PCT and PGI in the operation group were(13.38±3.55)mg/ml,(5.49±2.76)mg/l,(0.92±0.31)mg/ml,and(33.48±4.66)μg/l,respectively,which were lower than(16.72±4.27)mg/ml,(9.58±3.14)mg/l,(1.48±0.44)mg/ml,and(41.75±5.03)μg/l in the conventional group;The levels of SS and GAS were(15.27±2.94)pg/ml and(22.43±3.55)pg/ml,respectively.They were higher than those in the conventional group[(13.89±2.53)pg/ml,(18.15±3.52)pg/ml](F=10.574,12.498,6.732,18.822,7.428,11.536,all P<0.001).There was no significant difference in the total incidence of adverse reactions between the surgery group(7.69%,3/39)and the conventional group(5.13%,2/39)(χ^(2)=0.000,P=1.000).Conclusions Gastroscopic plasma ablation combined with quadruple therapy can improve the Hpclearance rate of Hppositive VG patients and reduce inflammatory reaction.It is helpful to improve the function of gastric mucosa,relieve the symptoms of patients,enhance the curative effect,and has high safety.
作者
林晓
杨惠
白阳秋
LIN Xiao;YANG Hui;BAI Yangqiu(Department of Gastroenterology,Yucheng County People's Hospital,Shangqiu,Henan476300,China;Department of Gastroenterology,Henan Provincial People's Hospital,Zhengzhou,Henan450000,China)
出处
《社区医学杂志》
CAS
2024年第7期243-247,252,共6页
Journal Of Community Medicine
关键词
疣状胃炎
幽门螺杆菌
等离子消融术
四联疗法
炎性反应
verrucous gastritis
Helicobacter pylori
plasma ablation
quadruple therapy
inflammatory reaction
