目的 探讨猴头健胃灵片联合四联疗法治疗幽门螺旋杆菌（Hp）阳性慢性胃炎的临床疗效。方法 选取2021年6月—2024年2月复旦大学附属浦东医院和上海市浦东新区洋泾社区卫生服务中心收治的160例Hp阳性慢性胃炎患者，按随机数字表法将所有患者分为对照组和治疗组，每组各80例。对照组进行四联方案治疗，（1）早晚餐前0.5 h口服雷贝拉唑钠肠溶胶囊，20 mg/次，2次/d；（2）早晚餐前0.5 h口服胶体果胶铋胶囊，200 mg/次，2次/d；（3）早晚餐后口服阿莫西林胶囊，1.0 g/次，2次/d；（4）早晚餐后口服克拉霉素片，0.5 g/次，2次/d。（1）用药4周，（2）、（3）、（4）用药2周。治疗组在对照组治疗基础上饭后口服猴头健胃灵片，4 片/次，3次/d，用药4周。两组连续治疗4周。观察两组临床疗效、症状消失时间和Hp根除率。比较两组治疗前后症状自评量表（SCL-90）评分、36项健康调查简表（SF-36）评分、血清胃功能三项[胃泌素-17（G-17）、胃蛋白酶原（PG）Ⅰ、PGⅡ]和炎症指标[白细胞介素（IL）-1β、IL-8、C反应蛋白（CRP）]水平的变化。结果 治疗后，治疗组总有效率是97.50%，显著高于对照组的88.75%（P＜0.05）。治疗组上腹痛、嗳气、反酸、腹胀、恶心消失时间短于对照组（P＜0.05）；治疗组Hp根除率是72.50%，显著高于对照组的57.50%（P＜0.05）。治疗后，两组SCL-90评分都显著降低，而SF-36评分显著增加（P＜0.05）；治疗后，治疗组SCL-90、SF-36评分改善优于对照组（P＜0.05）。治疗后，两组血清G-17水平显著上升，血清PGⅠ、PGⅡ、CRP、IL-1β、IL-8水平都低于治疗前（P＜0.05）；治疗后，治疗组血清胃功能三项和CRP、IL-1β、IL-8水平改善优于对照组（P＜0.05）。结论 猴头健胃灵片联合四联疗法治疗Hp阳性慢性胃炎患者能有效加速消化道症状消除，提高Hp根除率，促进炎症反应及胃黏膜损害减轻，患者心理健康水平和生活质量得到较大程度改善，值得临床推广应用。

Objective To investigate the therapeutic effect of Houtou Jianweiling Tablets combined with quadruple therapy in treatment of Helicobacter pylori (Hp) positive chronic gastritis. Methods A total of 160 patients with HP positive chronic gastritis admitted to Pudong Hospital of Fudan University and Shanghai Pudong New Area Yangjing Community Health Service Center from June 2021 to February 2024 were selected and divided into control group and treatment group according to random number table method, with 80 patients in each group. Patients in control group were given quadruple therapy, (1) they were po administered with Rabeprazole Sodium Enteric Capsules 0.5 h before breakfast and dinner, 20 mg/time, twice daily. (2) They were po administered with Colloidal Bismuth Pectin Capsules 0.5 h before breakfast and dinner, 200 mg/time, twice daily. (3) They were po administered with Amoxicillin Capsules after breakfast and dinner, 1.0 g/time, twice daily. (4) They were po administered with Clarithromycin Tablets after breakfast and dinner, 0.5 g/time, twice daily. (1) were administered for 4 weeks, (2), (3), (4) were administered for 2 weeks. Patients in treatment group were po administered with Houtou Jianweiling Tablets after meals on the basis of control group, 4 tablets/times, 3 times daily, for 4 weeks. Patients in two groups were treated for 4 weeks. The clinical efficacy, symptom disappearance time and Hp eradication rate of two groups were observed. The levels of Symptom Rating Scale (SCL-90), 36-item health survey Summary Form (SF-36), serum gastric function (G-17, PG Ⅰ, PGⅡ) and inflammatory indicators (IL-1β, IL-8, CRP) before and after treatment were compared between two groups. Results After treatment, the total effective rate of treatment group was 97.50%, which was significantly higher than that of control group (88.75%, P < 0.05). The disappearance time of upper abdominal pain, belching, acid reflux, abdominal distension, and nausea in treatment group was shorter than that in control group (P < 0.05). The eradication rate of Hp in treatment group was 72.50%, which was significantly higher than 57.50% in control group (P < 0.05). After treatment, SCL-90 score was significantly decreased in both groups, but SF-36 score was significantly increased (P < 0.05). After treatment, the improvement of SCL-90 and SF-36 scores in treatment group was better than that in control group (P < 0.05). After treatment, serum G-17 level was significantly increased, but serum PG-Ⅰ, PG-ⅠⅠ, CRP, IL-1β and IL-8 levels were lower than before treatment (P < 0.05). After treatment, the improvement of serum gastric function and levels of CRP, IL-1β and IL-8 in treatment group was better than that in control group (P < 0.05). Conclusion Houtou Jianweiling Tablets combined with quadruple therapy in treatment of helicobacter pylori (Hp) positive chronic gastritis can effectively accelerate the elimination of digestive tract symptoms, and can improve the eradication rate of Hp, promote inflammatory response and reduce gastric mucosal damage, and improve the mental health level and life quality to a great extent, which is worthy of clinical application.

R975

上海浦东新区卫生健康委员会卫生科技项目（PW2023A-48）