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,0.02 g/次,2次/d;克拉霉素分散片口服,0.5 g/次,2次/d;阿莫西林胶囊口服,0.5 g/次,3次/d;枸橼酸铋钾颗粒冲服,0.22 g/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(PG Ⅰ)].计数资料采用n(％)表示,x2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,x2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、PG Ⅰ 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,x2=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.
Abstract
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 Hp positive VG patients in Yucheng County People's Hospital from 2020-02-06 to 2022-04-07 were selected and divided into two groups by computer random method,with 39 cases in each group.The conventional group was treated with quadruple therapy,es-omeprazole orally,0.02 g/time,2 times/d;Oral clarithromycin dispersible tablet,0.5 g/time,2 times/d;Oral amoxi-cillin capsules,0.5 g/time,3 times/day;Bismuth potassium citrate granules,0.22 g/time,2 times/day.The operation group was given quadruple therapy after endoscopic plasma ablation,and the control group was given quadruple therapy for 4 weeks.The efficacy,Hp clearance rate and adverse reactions of the two groups were observed,The symptom scores,inflammatory mediators[transforming growth factor β(TGF-β),C-reactive protein(CRP),procalcitonin(PCT)],gastric mucosal function[gastrin(GAS),somatostatin(SS),pepsinogen Ⅰ(PG Ⅰ)]were compared before and after treatment.The count data were represented by n(％),x2test was conducted,and the measurement data were represented by((x)±s),and t test was used.Results The total effective rate and Hp clearance 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(x2=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)(x2=0.000,P=1.000).Conclusions Gastroscopic plasma ablation com-bined with quadruple therapy can improve the Hp clearance rate of Hp positive VG patients and reduce inflammatory re-action.It is helpful to improve the function of gastric mucosa,relieve the symptoms of patients,enhance the curative effect,and has high safety.
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