目的 探讨复方田七胃痛片联合以埃索美拉唑镁肠溶片为基础的四联疗法治疗难治性消化性溃疡的临床疗效.方法 选择2013 年3 月-2015 年3 月辽宁省人民医院消化内科收治的消化性溃疡患者149 例,随机分为对照组(75 例)和治疗组(74 例).对照组口服埃索美拉唑镁肠溶片20 mg/次,2 次/d;果胶铋胶囊3 粒/次,3 次/d;克拉霉素片0.5 g/次,2 次/d;阿莫西林胶囊1 g/次,2 次/d.治疗组在对照组的基础上口服复方田七胃痛片4 片/次,3 次/d.8 周后评价疗效.比较临床疗效、镜下疗效、幽门螺杆菌的消除情况以及胃窦黏膜一氧化氮(NO)和内皮素(ET)水平.结果 治疗组临床疗效的有效率、显效率分别为97.30%、86.49%,对照组的有效率、显效率分别为85.33%、66.67%,两组比较的差异具有统计学意义(P< 0.05).治疗组的镜下疗效有效率为98.65%,高于对照组(90.67%),两组比较差异具有统计学意义(P< 0.05).治疗组的根除率(91.89%)高于对照组(76.00%),两组比较差异具有统计学意义(P< 0.05).治疗后两组NO 水平升高,ET 水平下降,与治疗前比较差异均具有统计学意义(P< 0.01);与对照组比较,治疗组NO 水平上升,ET 水平下降,两组差异具有统计学意义(P< 0.01).结论 复方田七胃痛片联合以埃索美拉唑镁肠溶片为基础的四联疗法具有较好的临床疗效,加快溃疡愈合,消除幽门螺杆菌,其机制可能与提高胃窦黏膜NO 水平、降低ET 水平有关.

Objective To investigate the clinical curative effect of Compound Tianqi Weitong Tablets combined with quadruple therapy based on Esomeprazole Magnesium Enteric-coated Tablets in treatment of refractory peptic ulcer. Methods Patients (149 cases) with refractory peptic ulcer from Department of Gastroenterology in The People's Hospital of Liaoning Province from March 2013 to March 2014 were randomly divided into control and treatment groups, with 75 and 74 cases, respectively. The patients in the control group were given quadruple therapy based on po administration with Esomeprazole Magnesium Enteric-coated Tablets, 20 mg/time, twice daily; Bismuth Pectin Capsules, 3 capsules/time, three times daily; Clarithromycin Tablets 0.5 g/time, twice daily; Amoxicillin Capsules 1 g/time, twice daily. The patients in the treatment group were po administered with Tianqi Weitong Tablets on the basis of the control group, 4 tablets /time, three times daily. Patients in both groups were treated for 8 weeks. The clinical efficacies, efficacies under microscope, and elimination of Helicobacter pylori between two groups were observed after treatment. At the same time, the levels of NO and ET in gastric antrum mucosa of two groups were compared. Results The effective rate and obvious effective rate of clinical efficacies in the treatment group were 97.30% and 86.49%, respectively, and those in the control group were 85.33% and 66.67%, with significant difference between two groups (P < 0.05). The effective rate of efficacy under microscope in the treatment group was 98.65%, above 90.67% of the control group, and there were differences between two groups (P < 0.05). The eradication rate in the treatment group (91.89%) was above that of the control group (90.67%), and the difference was statistically significant (P < 0.05). After treatment, levels of NO in two groups were significantly increased, but those of ET were significantly reduced, and the difference was statistically significant in the same group (P < 0.01). Compared with the control group,levels of NO in the treatment group increased, but those of ET decreased, and there was significant difference between two groups (P < 0.01). Conclusion Compound Tianqi Weitong Tablets combined with quadruple therapy based on Esomeprazole Magnesium Enteric-coated Tablets has the good clinical effect in treatment of refractory peptic ulcer, can accelerate refractory peptic ulcer healing, eliminate H. pylori, and its mechanism may related to improvement of NO levels and reduction of ET levels in gastric antrum mucosa.