目的 探讨仁青常觉联合泮托拉唑四联方案治疗幽门螺杆菌（Hp）阳性慢性萎缩性胃炎的临床疗效。方法 选取2022年5月—2025年4月平顶山市第一人民医院消化内科收治的82例Hp阳性慢性萎缩性胃炎患者，按照随机数字法分为对照组41例和治疗组41例。对照组患者给予泮托拉唑标准四联疗法，泮托拉唑钠肠溶片40 mg/次，早晚餐前30 min口服，每日2次；阿莫西林胶囊1 g/次，早晚餐前30 min口服，每日2次；克拉霉素片0.5 g/次，枸橼酸铋钾片0.22 g/次，早晚餐后30 min口服，每日2次。在对照组的基础上，治疗组口服仁青常觉，1 g/次，每隔3天服用1次。两组用药2周。观察两组的临床疗效，比较两组治疗前后中医症状积分、胃黏膜病理积分、血清炎性因子和胃肠激素水平。结果 治疗后，治疗组患者总有效率高于对照组（P＜0.05）。治疗后，两组胃痛痞满积分、胃热嘈杂积分、口干口苦积分、嗳气反酸积分均显著降低（P＜0.05）；治疗后，与对照组对比，治疗组胃痛痞满积分、胃热嘈杂积分、口干口苦积分、嗳气反酸积分均更低（P＜0.05）。治疗后，两组胃泌素17（G-17）、胃蛋白酶原Ⅰ（PGⅠ）水平显著升高，而胃蛋白酶原Ⅱ（PGⅡ）水平降低（P＜0.05）；治疗后，与对照组对比，治疗组患者G-17、PGⅠ水平均更高，PGⅡ水平更低（P＜0.05）。治疗后，两组患者胃黏膜萎缩评分、不典型增生评分、胃黏膜炎症评分、肠上皮化生评分显著降低（P＜0.05）；治疗后，与对照组对比，治疗组胃黏膜萎缩评分、不典型增生评分、胃黏膜炎症评分、肠上皮化生评分均更低（P＜0.05）。治疗后，两组单核细胞趋化因子-1（MCP-1）、白细胞介素-1β（IL-1β）水平显著降低，而胃促生长素（Ghrelin）、表皮生长因子（EGF）水平升高（P＜0.05）；治疗后，与对照组对比，治疗组MCP-1、IL-1β水平更低，且Ghrelin、EGF水平均更高（P＜0.05）。结论 仁青常觉联合四联疗法治疗Hp阳性慢性萎缩性胃炎效果良好，可较好地改善患者临床症状，降低胃黏膜严重程度，调节血清炎性因子和胃肠激素水平。

Objective To explore the clinical effect of Renqing Changjue combined with quadruple therapy in treatment of Hp-positive chronic atrophic gastritis. Methods A total of 82 patients with Hp-positive chronic atrophic gastritis admitted to the Department of Gastroenterology of Pingdingshan First People’s Hospital from May 2022 to April 2025 were selected and divided into control group of 41 cases and treatment group of 41 cases according to random number method. Patients in control group were given pantoprazole standard quadruple therapy, Pantoprazole Sodium Enteric-coated Tablets 40 mg/time, orally 30 min before breakfast and dinner, twice daily. Amoxicillin Capsules 1 g/time, taken orally 30 min before breakfast and dinner, twice daily. Clarithromycin Tablets 0.5 g/time, Bismuth Potassium Citrate Tablets 0.22 g/time, take orally 30 min after breakfast and dinner, twice daily. Based on control group, the treatment group took Renqing Changjue orally, 1 g/time, once every 3 d. Both groups were treated with medication for two weeks. The clinical efficacy of two groups was observed, and TCM symptom scores, gastric mucosa pathological scores, serum inflammatory factors and gastrointestinal hormone in two groups were compared before and after treatment. Results After treatment, the total effective rate of patients in treatment group was higher than that in control group (P < 0.05). After treatment, the scores of stomach pain and fullness, stomach heat and noise, dry and bitter mouth, and belching and acid reflux in both groups were significantly reduced (P < 0.05). After treatment, compared with control group, the scores of stomach pain and fullness, stomach heat and noise, dry and bitter mouth, and belching and acid reflux in treatment group were all lower (P < 0.05). After treatment, the levels of G-17 and PG I in both groups significantly increased, but the level of PG II decreased (P < 0.05). After treatment, compared with control group, the levels of G-17 and PGⅠ in treatment group were higher, but the level of PGⅡ was lower (P < 0.05). After treatment, the scores of gastric mucosal atrophy, atypical hyperplasia, gastric mucosal inflammation and intestinal metaplasia in both groups were significantly decreased (P < 0.05). After treatment, compared with the control group, the scores of gastric mucosal atrophy, atypical hyperplasia, gastric mucosal inflammation and intestinal metaplasia in the treatment group were all lower (P < 0.05). After treatment, the levels of MCP-1 and IL-1β in both groups decreased significantly, but the levels of Ghrelin and EGF increased (P < 0.05). After treatment, compared with control group, the levels of MCP-1 and IL-1β in treatment group were lower, but the levels of Ghrelin and EGF were higher (P < 0.05). Conclusion Renqing Changjue combined with quadruple therapy has a good effect in treatment of Hp-positive chronic atrophic gastritis, and can effectively improve the clinical symptoms of patients, reduce the severity of gastric mucosa, and regulate the levels of serum inflammatory factors and gastrointestinal hormones.

R975

河南省医学科技攻关计划联合共建项目（LHGJ20230848）