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Article(id=1322926785817616909, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.10.039, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339924530, onlineDateStr=2026-10-30, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339924530, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339924530, creator=13701087609, updateTime=1793339924530, updator=13701087609, issue=Issue{id=1322926740955341011, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='10', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1760025600000', pubDateStr='2025-10-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339913834, creator='13701087609', updateTime=1793340753123, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930261259846420, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930261259846421, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926740955341011, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=212, endPage=216, ext={EN=ArticleExt(id=1322926786039915022, articleId=1322926785817616909, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Clinical Efficacy and Safety of Xiangsha Wenzhong Decoction（香砂温中汤）Combined with Acupoint Thread-Embedding in Intervention for Chronic Atrophic Gastritis with Helicobacter pylori Infection, columnId=1256183365644968140, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Platform of Provincial Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the clinical efficacy and safety of Xiangsha Wenzhong Decoction（香砂温中汤）combined with acupoint thread-embedding in the intervention for chronic atrophic gastritis（CAG）with Helicobacter pylori（HP）infection.

Methods

A total of 160 patients with CAG and Hp infection who were admitted to the hospital from January 2022 to June 2023 were enrolled in this study.They were randomly divided into group A，group B，group Cand group D using the random number table method.Group A was treated with acupoint thread-embedding.Group B was treated with Xiangsha Wenzhong Decoction.Group Cwas treated with acupoint thread-embedding combined with Xiangsha Wenzhong Decoction.Group D was treated with teprenone.The 4 groups were compared in terms of clinical efficacy，TCM syndrome scores，gastric mucosal histopathological score，endothelial function［epidermal growth factor（EGF）and vascular endothelial growth factor（VEGF）］，inflammatory factors［interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α）］，cellular immune function，expression of cyclooxygenase-2（COX-2）and p53 in gastric mucosa，and the incidence of adverse reactions.

Results

The total effective rate of group C（95.00%，38/40）was higher than that of group A，group B and group D［70.00%（28/40），75.00%（30/40）and 62.50%（25/40）］（P<0.05）.The total effective rates in group A，group Band group D were close（P>0.05）.After 6 months of treatment，TCM syndrome scores and gastric mucosal histopathological score of group Cwere lower than those of group A，group B and group D（P<0.05），but there was no significant difference among group A，group B and group D（P>0.05）.After 6 months of treatment，the levels of VEGF，CD3+and CD4+in group Cwere higher than those in group A，group B and group D.The levels of EGF，IL-6，TNF-αand CD8+were lower than those in group A，group B and group D（P<0.05）.However，there was no significant difference among group A，group B or group D（P>0.05）.After 6 months of treatment，the expressions of COX-2 and p53 in group C were lower than those in group A，group B and group D（P<0.05），but there was no significant difference among group A，group B and group D（P>0.05）.There was no significant difference in the incidence of adverse reactions among the four groups（P>0.05）.

Conclusion

Xiangsha Wenzhong Decoction combined with acupoint thread-embedding is significantly effective in the treatment of patients with CAG and Hp infection.It can improve the patients’symptoms and endothelial function，reduce the levels of inflammatory factors，enhance the immune function and down-regulate the expressions of COX-2 and p53，with high safety.

, authors=Ran ZHANG, Kun YANG, Zhenjun ZENG, Junying LIU, Jie LIU, authorsList=Ran ZHANG, Kun YANG, Zhenjun ZENG, Junying LIU, Jie LIU, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926789584101919, articleId=1322926785817616909, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=香砂温中汤联合穴位埋线干预伴幽门螺杆菌感染慢性萎缩性胃炎的临床疗效与安全性观察, columnId=1256183369033965799, journalTitle=中华中医药学刊, columnName=省级项目平台, runingTitle=null, highlight=null, articleAbstract=
目的

观察香砂温中汤联合穴位埋线干预伴幽门螺杆菌（helicobacter pylori，HP）感染慢性萎缩性胃炎（chronic atrophic gastritis，CAG）的临床疗效与安全性。

方法

选取2022年1月—2023年6月医院收治的160例伴HP感染CAG患者，随机数字表法分为A组、B组、C组和D组各40例，A组给予穴位埋线治疗，B组给予香砂温中汤治疗，C组给予穴位埋线联合香砂温中汤治疗，D组给予替普瑞酮治疗，比较4组临床疗效、中医证候积分、胃黏膜组织病理评分、内皮功能［表皮生长因子（epidermal growth factor，EGF）、血管生长因子（vascular endothelial growth factor，VEGF）］、炎性因子［白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）］、细胞免疫功能、胃黏膜组织中环氧化酶-2（cyclooxygenase-2，COX-2）和p53表达及不良反应发生率。

结果

C组总有效率为95.00%（38/40），高于A组、B组和D组的70.00%（28/40）、75.00%（30/40）和62.50%（25/40）（P<0.05），A组、B组和D组总有效率比较差异无统计学意义（P>0.05）。治疗6个月后，C组中医证候积分和胃黏膜组织病理评分低于A组、B组和D组（P<0.05），但A组、B组和D组比较差异无统计学意义（P>0.05）。治疗6个月后，C组VEGF水平和CD3+、CD4+高于A组、B组和D组，EGF、IL-6、TNF-α水平和CD8+低于A组、B组和D组（P<0.05），但A组、B组和D组比较差异无统计学意义（P>0.05）。治疗6个月后，C组COX-2、p53表达低于A组、B组和D组（P<0.05），但A组、B组和D组比较差异无统计学意义（P>0.05）。4组不良反应发生率比较差异无统计学意义（P>0.05）。

结论

香砂温中汤联合穴位埋线治疗伴HP感染的CAG患者临床疗效显著，可改善患者症状和内皮功能，降低炎性因子，提高免疫功能，下调COX-2、p53表达，且安全性较高。

, authors=张然, 杨坤, 曾震军, 刘君颖, 刘杰, authorsList=张然, 杨坤, 曾震军, 刘君颖, 刘杰, authorCompany=null, correspAuthors=null, authorNote=

张然（1983-），男，河南南乐人，副主任医师，硕士，研究方向：中医药防治胃肠病。

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张然（1983-），男，河南南乐人，副主任医师，硕士，研究方向：中医药防治胃肠病。

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张然（1983-），男，河南南乐人，副主任医师，硕士，研究方向：中医药防治胃肠病。

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volume=17, issue=4, pageStart=143, pageEnd=146, url=null, language=null, rfNumber=［20］, rfOrder=19, authorNames=娄莹莹, 李佃贵, 霍永利, journalName=中国医药导报, refType=null, unstructuredReference=娄莹莹，李佃贵，霍永利，等. 化浊解毒和胃方对慢性萎缩性胃炎患者VEGF、EGF及Th1/Th2平衡的影响［J］. 中国医药导报，2020，17（4）：143-146., articleTitle=化浊解毒和胃方对慢性萎缩性胃炎患者VEGF、EGF及Th1/Th2平衡的影响, refAbstract=null), Reference(id=1322926798404723309, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, doi=null, pmid=null, pmcid=null, year=null, volume=16, issue=4, pageStart=226, pageEnd=233, url=null, language=null, rfNumber=［21］, rfOrder=20, authorNames=ZHAO C N, XIAO L L, ZHANG Y, journalName=Gastroenterol Res, refType=null, unstructuredReference=ZHAO C N，XIAO L L，ZHANG Y. 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Gastroenterol Res，16（4）：226-233., articleTitle=Effects of Helicobacter pylori infection on the prognosis of chronic atrophic gastritis by inducing the macrophage polarization, refAbstract=null), Reference(id=1322926798492803694, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, doi=null, pmid=null, pmcid=null, year=2021, volume=45, issue=5, pageStart=717, pageEnd=718, url=null, language=null, rfNumber=［22］, rfOrder=21, authorNames=付超, 韩春玲, journalName=贵州医药, refType=null, unstructuredReference=付超，韩春玲. 四逆散合柴胡疏肝散配合穴位敷贴治疗肝胃不和型慢性萎缩性胃炎的效果与对胃动力及炎性因子水平的影响［J］. 贵州医药，2021，45（5）：717-718., articleTitle=四逆散合柴胡疏肝散配合穴位敷贴治疗肝胃不和型慢性萎缩性胃炎的效果与对胃动力及炎性因子水平的影响, refAbstract=null), Reference(id=1322926798606049903, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, doi=null, pmid=null, pmcid=null, year=2022, volume=37, issue=6, pageStart=3480, pageEnd=3483, url=null, language=null, rfNumber=［23］, rfOrder=22, authorNames=黄杨, 程文静, 李鹏, journalName=中华中医药杂志, refType=null, unstructuredReference=黄杨，程文静，李鹏，等. 艾灸胃经穴对慢性萎缩性胃炎大鼠胃黏膜miR-146a，NF-κBp65及COX-2表达的影响［J］. 中华中医药杂志，2022，37（6）：3480-3483., articleTitle=艾灸胃经穴对慢性萎缩性胃炎大鼠胃黏膜miR-146a，NF-κBp65及COX-2表达的影响, refAbstract=null), Reference(id=1322926798694130288, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, doi=null, pmid=null, pmcid=null, year=2020, volume=29, issue=7, pageStart=773, pageEnd=777, url=null, language=null, rfNumber=［24］, rfOrder=23, authorNames=黎慧娟, 陈露, 唐畅宇, journalName=胃肠病学和肝病学杂志, refType=null, unstructuredReference=黎慧娟，陈露，唐畅宇. TLR4/NF-κB/COX-2致炎信号通路对幽门螺杆菌相关性慢性萎缩性胃炎发生、发展的影响及机制研究［J］. 胃肠病学和肝病学杂志，2020，29（7）：773-777., articleTitle=TLR4/NF-κB/COX-2致炎信号通路对幽门螺杆菌相关性慢性萎缩性胃炎发生、发展的影响及机制研究, refAbstract=null), Reference(id=1322926798765433457, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, doi=null, pmid=null, pmcid=null, year=2021, volume=36, issue=1, pageStart=182, pageEnd=186, url=null, language=null, rfNumber=［25］, rfOrder=24, authorNames=刘宇, 杜小龙, 王钢, journalName=中医学报, refType=null, unstructuredReference=刘宇，杜小龙，王钢，等. 参芪消痞汤对慢性萎缩性胃炎癌前期病变患者肿瘤标志物及血清p53蛋白，MDA，GSH-Px的影响［J］. 中医学报，2021，36（1）：182-186., articleTitle=参芪消痞汤对慢性萎缩性胃炎癌前期病变患者肿瘤标志物及血清p53蛋白，MDA，GSH-Px的影响, refAbstract=null)], funds=[Fund(id=1322926795007337046, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, awardId=222102310727, language=CN, fundingSource=河南省科技攻关项目(222102310727), fundOrder=null, country=null), Fund(id=1322926795074445911, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, awardId=2022JDZX095, language=CN, fundingSource=河南省中医药科学研究专项(2022JDZX095), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322926789877703200, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, xref=null, ext=[AuthorCompanyExt(id=1322926789890286113, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, companyId=1322926789877703200, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The First Affiliated Hospital of Henan University of Chinese Medicine，Zhengzhou 450099，Henan，China), AuthorCompanyExt(id=1322926789898674722, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, companyId=1322926789877703200, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=河南中医药大学第一附属医院，河南 郑州 450099)])], figs=[ArticleFig(id=1322926793870680648, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数性别/[例（%）]年龄/
（岁，）		病程/
（年，）		胃镜下黏膜萎缩分级/[例（%）]
男女轻度中度重度
A组4022（55.00）18（45.00）50.71±6.895.77±1.2315（37.50）20（50.00）5（12.50）
B组4025（62.50）15（37.50）51.22±7.086.03±1.2912（30.00）22（55.00）6（15.00）
C组4021（52.50）19（47.50）50.49±6.726.18±1.3410（25.00）23（57.50）7（17.50）
D组4023（57.50）17（42.50）51.33±7.165.93±1.2512（30.00）19（47.50）9（22.50）
χ2/F值0.8920.1280.7142.813
P值0.8270.9430.5450.832
), ArticleFig(id=1322926793962955337, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=CN, label=表1, caption=

4组伴幽门螺杆菌感染慢性萎缩性胃炎患者一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数性别/[例（%）]年龄/
（岁，）		病程/
（年，）		胃镜下黏膜萎缩分级/[例（%）]
男女轻度中度重度
A组4022（55.00）18（45.00）50.71±6.895.77±1.2315（37.50）20（50.00）5（12.50）
B组4025（62.50）15（37.50）51.22±7.086.03±1.2912（30.00）22（55.00）6（15.00）
C组4021（52.50）19（47.50）50.49±6.726.18±1.3410（25.00）23（57.50）7（17.50）
D组4023（57.50）17（42.50）51.33±7.165.93±1.2512（30.00）19（47.50）9（22.50）
χ2/F值0.8920.1280.7142.813
P值0.8270.9430.5450.832
), ArticleFig(id=1322926794030064202, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数痊愈显效有效无效总有效
A组4010（25.00）10（25.00）8（20.00）12（30.00）28（70.00）#
B组4012（30.00）11（27.50）7（17.50）10（25.00）30（75.00）#
C组4017（42.50）13（32.50）8（20.00）2（5.00）38（95.00）
D组408（20.00）11（27.50）6（15.00）15（37.50）25（62.50）#
), ArticleFig(id=1322926794122338891, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=CN, label=表2, caption=

4组伴幽门螺杆菌感染慢性萎缩性胃炎患者临床疗效比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数痊愈显效有效无效总有效
A组4010（25.00）10（25.00）8（20.00）12（30.00）28（70.00）#
B组4012（30.00）11（27.50）7（17.50）10（25.00）30（75.00）#
C组4017（42.50）13（32.50）8（20.00）2（5.00）38（95.00）
D组408（20.00）11（27.50）6（15.00）15（37.50）25（62.50）#
), ArticleFig(id=1322926794189447756, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间主证次证
胃脘胀满胃脘灼热四肢倦怠面色萎黄气短懒言大便稀溏
A组40治疗前4.69±1.074.49±1.024.43±0.992.56±0.442.55±0.472.41±0.37
治疗后2.81±0.65*#2.70±0.62*#2.44±0.40*#1.34±0.26*#1.27±0.20*#1.16±0.20*#
B组40治疗前4.86±1.154.57±1.054.33±0.922.69±0.552.60±0.482.48±0.41
治疗后2.69±0.55*#2.51±0.50*#2.31±0.33*#1.30±0.21*#1.23±0.17*#1.13±0.18*#
C组40治疗前4.77±1.134.63±1.094.39±0.962.66±0.522.50±0.432.43±0.39
治疗后1.90±0.32*1.88±0.30*1.71±0.22*0.84±0.13*0.79±0.10*0.62±0.08*
D组40治疗前4.95±1.184.70±1.124.59±1.012.59±0.482.58±0.462.50±0.44
治疗后2.97±0.72*#2.75±0.69*#2.50±0.59*#1.40±0.30*#1.33±0.28*#1.22±0.25*#
), ArticleFig(id=1322926794260750925, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=CN, label=表3, caption=

4组伴幽门螺杆菌感染慢性萎缩性胃炎患者中医证候积分比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间主证次证
胃脘胀满胃脘灼热四肢倦怠面色萎黄气短懒言大便稀溏
A组40治疗前4.69±1.074.49±1.024.43±0.992.56±0.442.55±0.472.41±0.37
治疗后2.81±0.65*#2.70±0.62*#2.44±0.40*#1.34±0.26*#1.27±0.20*#1.16±0.20*#
B组40治疗前4.86±1.154.57±1.054.33±0.922.69±0.552.60±0.482.48±0.41
治疗后2.69±0.55*#2.51±0.50*#2.31±0.33*#1.30±0.21*#1.23±0.17*#1.13±0.18*#
C组40治疗前4.77±1.134.63±1.094.39±0.962.66±0.522.50±0.432.43±0.39
治疗后1.90±0.32*1.88±0.30*1.71±0.22*0.84±0.13*0.79±0.10*0.62±0.08*
D组40治疗前4.95±1.184.70±1.124.59±1.012.59±0.482.58±0.462.50±0.44
治疗后2.97±0.72*#2.75±0.69*#2.50±0.59*#1.40±0.30*#1.33±0.28*#1.22±0.25*#
), ArticleFig(id=1322926794332054094, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间黏膜炎症活动度腺体萎缩肠上皮化生异型增生
A组40治疗前2.31±0.252.20±0.232.12±0.181.76±0.171.65±0.12
治疗后1.70±0.18*#1.42±0.17*#1.10±0.11*#0.88±0.11*#0.85±0.10*#
B组40治疗前2.35±0.282.19±0.242.06±0.141.80±0.201.68±0.13
治疗后1.65±0.14*#1.39±0.15*#1.07±0.10*#0.85±0.10*#0.83±0.07*#
C组40治疗前2.37±0.302.21±0.242.10±0.171.75±0.161.70±0.14
治疗后0.92±0.11*0.80±0.07*0.73±0.05*0.58±0.02*0.60±0.04*
D组40治疗前2.40±0.332.23±0.262.08±0.151.79±0.181.72±0.15
治疗后1.72±0.20*#1.45±0.19*#1.12±0.12*#0.91±0.13*#0.87±0.12*#
), ArticleFig(id=1322926794411745871, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=CN, label=表4, caption=

4组伴幽门螺杆菌感染慢性萎缩性胃炎患者胃黏膜组织病理评分比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间黏膜炎症活动度腺体萎缩肠上皮化生异型增生
A组40治疗前2.31±0.252.20±0.232.12±0.181.76±0.171.65±0.12
治疗后1.70±0.18*#1.42±0.17*#1.10±0.11*#0.88±0.11*#0.85±0.10*#
B组40治疗前2.35±0.282.19±0.242.06±0.141.80±0.201.68±0.13
治疗后1.65±0.14*#1.39±0.15*#1.07±0.10*#0.85±0.10*#0.83±0.07*#
C组40治疗前2.37±0.302.21±0.242.10±0.171.75±0.161.70±0.14
治疗后0.92±0.11*0.80±0.07*0.73±0.05*0.58±0.02*0.60±0.04*
D组40治疗前2.40±0.332.23±0.262.08±0.151.79±0.181.72±0.15
治疗后1.72±0.20*#1.45±0.19*#1.12±0.12*#0.91±0.13*#0.87±0.12*#
), ArticleFig(id=1322926794474660432, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间EGF/（pg/L）VEGF/（pg/L）IL-6/（pg/mL）TNF-α/（pg/mL）
A组40治疗前146.71±17.5557.01±9.1845.22±9.2113.80±3.32
治疗后253.44±21.82*#117.77±12.24*#26.71±6.39*#7.30±1.63*#
B组40治疗前147.53±17.0354.96±7.7246.05±10.1213.96±3.35
治疗后260.37±22.07*#120.38±13.22*#23.69±5.17*#7.22±1.45*#
C组40治疗前148.45±17.4056.70±8.6445.70±9.4414.66±3.39
治疗后285.26±25.87*130.48±15.62*17.22±4.36*5.05±0.79*
D组40治疗前146.37±16.5955.23±7.7944.82±9.0115.20±3.46
治疗后253.90±20.48*#115.65±10.04*#26.16±7.18*#7.76±1.70*#
), ArticleFig(id=1322926794587906641, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=CN, label=表5, caption=

4组伴幽门螺杆菌感染慢性萎缩性胃炎患者内皮功能和炎性因子水平比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间EGF/（pg/L）VEGF/（pg/L）IL-6/（pg/mL）TNF-α/（pg/mL）
A组40治疗前146.71±17.5557.01±9.1845.22±9.2113.80±3.32
治疗后253.44±21.82*#117.77±12.24*#26.71±6.39*#7.30±1.63*#
B组40治疗前147.53±17.0354.96±7.7246.05±10.1213.96±3.35
治疗后260.37±22.07*#120.38±13.22*#23.69±5.17*#7.22±1.45*#
C组40治疗前148.45±17.4056.70±8.6445.70±9.4414.66±3.39
治疗后285.26±25.87*130.48±15.62*17.22±4.36*5.05±0.79*
D组40治疗前146.37±16.5955.23±7.7944.82±9.0115.20±3.46
治疗后253.90±20.48*#115.65±10.04*#26.16±7.18*#7.76±1.70*#
), ArticleFig(id=1322926794667598418, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间CD3+/（%）CD4+/（%）CD8+/（%）
A组40治疗前53.29±8.1727.12±4.0122.26±2.50
治疗后57.76±10.06*#36.40±4.89*#21.03±1.90*#
B组40治疗前52.73±8.35*26.13±3.8022.39±2.54*
治疗后59.77±11.02*#37.02±5.11*#20.65±1.80*#
C组40治疗前53.71±8.4426.54±3.9022.78±2.63
治疗后65.22±12.70*40.31±7.66*18.04±1.42*
D组40治疗前52.80±8.3927.03±3.9822.60±2.59
治疗后55.37±9.90*#35.22±4.67*#21.44±2.03*#
), ArticleFig(id=1322926794734707283, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=CN, label=表6, caption=

4组伴幽门螺杆菌感染慢性萎缩性胃炎患者细胞免疫功能比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间CD3+/（%）CD4+/（%）CD8+/（%）
A组40治疗前53.29±8.1727.12±4.0122.26±2.50
治疗后57.76±10.06*#36.40±4.89*#21.03±1.90*#
B组40治疗前52.73±8.35*26.13±3.8022.39±2.54*
治疗后59.77±11.02*#37.02±5.11*#20.65±1.80*#
C组40治疗前53.71±8.4426.54±3.9022.78±2.63
治疗后65.22±12.70*40.31±7.66*18.04±1.42*
D组40治疗前52.80±8.3927.03±3.9822.60±2.59
治疗后55.37±9.90*#35.22±4.67*#21.44±2.03*#
), ArticleFig(id=1322926794818593364, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间COX-2p53
A组40治疗前3.59±0.202.00±0.20
治疗后1.25±0.18*#1.18±0.16*#
B组40治疗前3.62±0.222.05±0.24
治疗后1.22±0.16*#1.15±0.13*#
C组40治疗前3.70±0.282.03±0.22
治疗后1.09±0.12*1.01±0.09*
D组40治疗前3.66±0.252.07±0.25
治疗后1.30±0.20*#1.22±0.18*#
), ArticleFig(id=1322926794894090837, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926785817616909, language=CN, label=表7, caption=

4组伴幽门螺杆菌感染慢性萎缩性胃炎患者COX-2、p53蛋白表达（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间COX-2p53
A组40治疗前3.59±0.202.00±0.20
治疗后1.25±0.18*#1.18±0.16*#
B组40治疗前3.62±0.222.05±0.24
治疗后1.22±0.16*#1.15±0.13*#
C组40治疗前3.70±0.282.03±0.22
治疗后1.09±0.12*1.01±0.09*
D组40治疗前3.66±0.252.07±0.25
治疗后1.30±0.20*#1.22±0.18*#
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香砂温中汤联合穴位埋线干预伴幽门螺杆菌感染慢性萎缩性胃炎的临床疗效与安全性观察
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张然 , 杨坤 , 曾震军 , 刘君颖 , 刘杰
中华中医药学刊 | 省级项目平台 2025,43(10): 212-216
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中华中医药学刊 |省级项目平台 2025 , 43 (10) : 212 -216
香砂温中汤联合穴位埋线干预伴幽门螺杆菌感染慢性萎缩性胃炎的临床疗效与安全性观察
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张然（1983-），男，河南南乐人，副主任医师，硕士，研究方向：中医药防治胃肠病。

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张然（1983-），男，河南南乐人，副主任医师，硕士，研究方向：中医药防治胃肠病。

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张然, 杨坤, 曾震军, 刘君颖, 刘杰
作者信息
  • 河南中医药大学第一附属医院，河南 郑州 450099
作者简介:

张然（1983-），男，河南南乐人，副主任医师，硕士，研究方向：中医药防治胃肠病。

Clinical Efficacy and Safety of Xiangsha Wenzhong Decoction（香砂温中汤）Combined with Acupoint Thread-Embedding in Intervention for Chronic Atrophic Gastritis with Helicobacter pylori Infection
Ran ZHANG, Kun YANG, Zhenjun ZENG, Junying LIU, Jie LIU
Affiliations
  • The First Affiliated Hospital of Henan University of Chinese Medicine，Zhengzhou 450099，Henan，China
出版时间: 2025-10-10 doi: 10.13193/j.issn.1673-7717.2025.10.039
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摘要
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目的

观察香砂温中汤联合穴位埋线干预伴幽门螺杆菌（helicobacter pylori，HP）感染慢性萎缩性胃炎（chronic atrophic gastritis，CAG）的临床疗效与安全性。

方法

选取2022年1月—2023年6月医院收治的160例伴HP感染CAG患者，随机数字表法分为A组、B组、C组和D组各40例，A组给予穴位埋线治疗，B组给予香砂温中汤治疗，C组给予穴位埋线联合香砂温中汤治疗，D组给予替普瑞酮治疗，比较4组临床疗效、中医证候积分、胃黏膜组织病理评分、内皮功能［表皮生长因子（epidermal growth factor，EGF）、血管生长因子（vascular endothelial growth factor，VEGF）］、炎性因子［白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）］、细胞免疫功能、胃黏膜组织中环氧化酶-2（cyclooxygenase-2，COX-2）和p53表达及不良反应发生率。

结果

C组总有效率为95.00%（38/40），高于A组、B组和D组的70.00%（28/40）、75.00%（30/40）和62.50%（25/40）（P<0.05），A组、B组和D组总有效率比较差异无统计学意义（P>0.05）。治疗6个月后，C组中医证候积分和胃黏膜组织病理评分低于A组、B组和D组（P<0.05），但A组、B组和D组比较差异无统计学意义（P>0.05）。治疗6个月后，C组VEGF水平和CD3+、CD4+高于A组、B组和D组，EGF、IL-6、TNF-α水平和CD8+低于A组、B组和D组（P<0.05），但A组、B组和D组比较差异无统计学意义（P>0.05）。治疗6个月后，C组COX-2、p53表达低于A组、B组和D组（P<0.05），但A组、B组和D组比较差异无统计学意义（P>0.05）。4组不良反应发生率比较差异无统计学意义（P>0.05）。

结论

香砂温中汤联合穴位埋线治疗伴HP感染的CAG患者临床疗效显著，可改善患者症状和内皮功能，降低炎性因子，提高免疫功能，下调COX-2、p53表达，且安全性较高。

慢性萎缩性胃炎  /  幽门螺杆菌感染  /  香砂温中汤  /  穴位埋线  /  临床疗效  /  安全性
Objective

To observe the clinical efficacy and safety of Xiangsha Wenzhong Decoction（香砂温中汤）combined with acupoint thread-embedding in the intervention for chronic atrophic gastritis（CAG）with Helicobacter pylori（HP）infection.

Methods

A total of 160 patients with CAG and Hp infection who were admitted to the hospital from January 2022 to June 2023 were enrolled in this study.They were randomly divided into group A，group B，group Cand group D using the random number table method.Group A was treated with acupoint thread-embedding.Group B was treated with Xiangsha Wenzhong Decoction.Group Cwas treated with acupoint thread-embedding combined with Xiangsha Wenzhong Decoction.Group D was treated with teprenone.The 4 groups were compared in terms of clinical efficacy，TCM syndrome scores，gastric mucosal histopathological score，endothelial function［epidermal growth factor（EGF）and vascular endothelial growth factor（VEGF）］，inflammatory factors［interleukin-6（IL-6）and tumor necrosis factor-α（TNF-α）］，cellular immune function，expression of cyclooxygenase-2（COX-2）and p53 in gastric mucosa，and the incidence of adverse reactions.

Results

The total effective rate of group C（95.00%，38/40）was higher than that of group A，group B and group D［70.00%（28/40），75.00%（30/40）and 62.50%（25/40）］（P<0.05）.The total effective rates in group A，group Band group D were close（P>0.05）.After 6 months of treatment，TCM syndrome scores and gastric mucosal histopathological score of group Cwere lower than those of group A，group B and group D（P<0.05），but there was no significant difference among group A，group B and group D（P>0.05）.After 6 months of treatment，the levels of VEGF，CD3+and CD4+in group Cwere higher than those in group A，group B and group D.The levels of EGF，IL-6，TNF-αand CD8+were lower than those in group A，group B and group D（P<0.05）.However，there was no significant difference among group A，group B or group D（P>0.05）.After 6 months of treatment，the expressions of COX-2 and p53 in group C were lower than those in group A，group B and group D（P<0.05），but there was no significant difference among group A，group B and group D（P>0.05）.There was no significant difference in the incidence of adverse reactions among the four groups（P>0.05）.

Conclusion

Xiangsha Wenzhong Decoction combined with acupoint thread-embedding is significantly effective in the treatment of patients with CAG and Hp infection.It can improve the patients’symptoms and endothelial function，reduce the levels of inflammatory factors，enhance the immune function and down-regulate the expressions of COX-2 and p53，with high safety.

chronic atrophic gastritis  /  Helicobacter pylori infection  /  Xiangsha Wenzhong Decoction（香砂温中汤）  /  acupoint thread-embedding  /  clinical efficacy  /  safety
张然, 杨坤, 曾震军, 刘君颖, 刘杰. 香砂温中汤联合穴位埋线干预伴幽门螺杆菌感染慢性萎缩性胃炎的临床疗效与安全性观察. 中华中医药学刊, 2025 , 43 (10) : 212 -216 . DOI: 10.13193/j.issn.1673-7717.2025.10.039
Ran ZHANG, Kun YANG, Zhenjun ZENG, Junying LIU, Jie LIU. Clinical Efficacy and Safety of Xiangsha Wenzhong Decoction（香砂温中汤）Combined with Acupoint Thread-Embedding in Intervention for Chronic Atrophic Gastritis with Helicobacter pylori Infection[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (10) : 212 -216 . DOI: 10.13193/j.issn.1673-7717.2025.10.039
正文
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慢性萎缩性胃炎（chronic atrophic gastritis，CAG）是指胃慢性炎症已累及胃黏膜的深处的腺体并引起萎缩，是临床常见消化系统疾病[1]。其以胃黏膜病变为主要病理特征，常表现为上腹部疼痛、胀满、嗳气、厌食等非特异性症状，被认为是癌前病变[2]。多数CAG患者伴有幽门螺杆菌（helicobacter pylori，HP）感染，若不及时治疗，会导致胃溃疡、胃出血，甚至引起癌变，严重威胁患者生命[3]。替普瑞酮是治疗CAG的常用药，可根除HP，改善局部胃黏膜组织的再生能力和局部微循环功能，加快胃黏膜修复[4]。近年来，中医药辨治CAG中累积了丰富的理论及临床经验。中医学认为，伴HP感染CAG属“痞满”“胃脘痛”等范畴，病机为脾胃素虚、饮食不节、情志不畅、外邪侵袭、过度劳倦及病迁延耗损正气，脾胃虚弱，胃失和降，气机阻滞。故治疗以健脾益气、疏肝理气、和胃止痛为主[5]。香砂温中汤为我科经验用药，具有益气健脾、温中和胃功效。而穴位埋线是近年来临床上一门新兴学科，通过药线及针具经穴位刺激经络，促进气血、阴阳平衡，调理脏腑功能，且对机体损伤较小[6]。但临床关于其相关报道较少，故本研究将香砂温中汤联合穴位埋线用于HP感染CAG患者中，旨在为临床提供参考，现报道如下。
1　资料与方法
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1.1　一般资料
选取2022年1月—2023年6月收治的160例伴HP感染CAG患者。纳入标准：（1）西医符合《中国慢性胃炎共识意见》[7]；中医符合《中药新药临床研究指导原则》[8]中脾虚肝郁胃滞证，主证：胃脘胀满，胃脘灼热，四肢倦怠；次证：面色萎黄，气短懒言，大便稀溏；舌质淡，苔薄白或白腻，脉沉弦细。（2）经13 C尿素呼气试验证实HP阳性。（3）年龄18～75岁。（4）知情同意。排除标准：（1）胃黏膜严重不典型增生或疑似癌变者；（2）合并心脑血管、肝、肾及造血系统严重原发性疾病；（3）肠胃手术史者；（4）急慢性感染者；（5）对本药过敏者；（6）严重精神疾病者；（7）妊娠、哺乳期妇女。随机数字表法分为A、B、C和D组各40例，4组一般资料比较差异无统计学意义（P>0.05），有可比性。见表1。本研究经医学伦理委员会批准。
1.2　治疗方法
A组给予穴位埋线治疗：①将1.5寸毫针从7号注射针头后方的针孔穿入，针体全部穿入可以在注射针头前端看见毫针针尖，然后固定住注射针头并将毫针针体略微后退，并用手固定好注射针头和毫针，再用镊子将长大概约1.0 cm的4-0羊肠线装入7号注射针头内，保持线体全部装入针管内，不能有线头外漏，线头与针尖内缘齐平。②准备完毕后，先用2.5%碘酒对穴位及其周围皮肤消毒，并用75%酒精脱碘（此时注射针头内作为针芯的1.5寸不锈钢毫针稍退后）。③在脾俞穴位下方约0.5 cm处进针，针尖向上斜刺，刺至所需深度略微提插针头，有紧致感后边退针管，边进针灸针，感觉针下无阻力的时候方将针管和针灸针一并退出，使羊肠线位于穴位皮下组织或肌层内，线头不外露，按压针孔20 s；中脘斜刺、足三里直刺，操作方法同脾俞穴，1次/2周。B组给予香砂温中汤，药用：茯苓12 g，生白术10 g，陈皮10 g，半夏10 g，香附10 g，厚朴10 g，炒白芍10 g，乌药10 g，枳壳10 g，砂仁9 g，桂枝5 g，木香6 g，甘草3 g。煎服方法：水泡30 min，大火煮沸后用小火煎熬30 min，煎出200 mL药汁，二煎以大火煮沸后用小火煎熬20 min，煎出200 mL药汁，两次混匀，均分成2份，200 mL/次，早晚饭后2 h温服。C组给予穴位埋线联合香砂温中汤治疗：方法同上述一致。D组给予替普瑞酮（北京同仁堂，规格50 mg×100粒）50 mg，3次/d。均持续治疗6个月。
1.3　观察指标
1.3.1　疗效标准
参照《中药新药临床研究指导原则》，根据积分法判定：临床痊愈：证候积分≥90%；显效：证候积分≥70%，<90%；证候积分≥30%，<70%；无效：证候积分<30%。总有效率＝（痊愈+显效+有效）/总例数×100%。
1.3.2　中医证候积分
根据《中药新药临床研究指导原则》，主证按无、轻度、中度、重度对应0、2、4、6分，次证按无、轻度、中度、重度对应0、1、2、3分。
1.3.3　胃黏膜组织病理评分
参照《慢性萎缩性胃炎中西医结合诊疗共识意见》[9]制定的病理组织学分级量化标准，取胃体大弯和小弯、胃窦大弯和小弯、胃角处胃黏膜进行病理活检。分为无、轻度、中度、重度，其中萎缩、肠上皮化生和异型增生按病变程度赋予0、3、9分，慢性炎症和活动性赋予0、1、2、3分。
1.3.4　内皮功能和炎性因子
晨取外周静脉5 mL，待液凝固后离心5 min，采用ELISA测定血清表皮生长因子（epidermal growth factor，EGF）、血管生长因子（vascular endothelial growth factor，VEGF）、白介素-6（Interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）水平。
1.3.5　细胞免疫功能
采用流式细胞仪测定CD3+、CD4+、CD8+。
1.3.6　胃黏膜组织中环氧化酶-2（cyclooxygenase-2，COX-2）和p53表达
采用免疫组织化学法检测胃黏膜组织中COX-2、p53表达。
1.3.7　不良反应
记录不良反应发生情况。
1.4　统计学处理
采用SPSS 24.0软件处理数据，计量资料以（）表示，用单因素方差分析和LSD-t检验，计量资料以（%）表示，行χ2检验，当P<0.05时有统计学意义。
2　结果
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2.1　临床疗效
C组总有效率高于A、B和D组（P<0.05），A、B和D组比较差异无统计学意义（P>0.05）。见表2。
2.2　中医证候积分
治疗前4组中医证候积分比较差异无统计学意义（P>0.05），治疗后4组中医证候积分均降低（P<0.05），且C组低于A、B和D组（P<0.05），但A、B和D组比较差异无统计学意义（P>0.05）。见表3。
2.3　胃黏膜组织病理评分
治疗前4组胃黏膜组织病理评分比较差异无统计学意义（P>0.05），治疗后4组胃黏膜组织病理评分均降低（P<0.05），且C组低于A、B和D组（P<0.05），但A、B和D组比较差异无统计学意义（P>0.05）。见表4。
2.4　内皮功能和炎性因子水平
治疗前4组EGF、VEGF、IL-6、TNF-α水平比较差异无统计学意义（P>0.05），治疗后4组VEGF升高，EGF、IL-6、TNF-α降低（P<0.05），且C组VEGF高于A组、B组和D组，EGF、IL-6、TNF-α低于A、B和D组（P<0.05），但A、B和D组比较差异无统计学意义（P>0.05）。见表5。
2.5　细胞免疫功能
治疗前4组CD3+、CD4+、CD8+比较差异无统计学意义（P>0.05），治疗后4组CD3+、CD4+均升高，CD8+降低（P<0.05），且C组CD3+、CD4+高于A组、B组和D组，CD8+低于A、B和D组（P<0.05），但A、B和D组比较差异无统计学意义（P>0.05）。见表6。
2.6　COX-2、p53蛋白表达
治疗前4组COX-2、p53蛋白表达比较无差异（P>0.05），治疗后4组COX-2、p53蛋白表达均降低（P<0.05），且C组COX-2、p53蛋白表达低于A、B和D组（P<0.05），但A、B和D组比较差异无统计学意义（P>0.05）。见表7。
2.7　不良反应
A组出现发热1例，不良反应率为2.50%；B组出现腹泻、腹痛各1例，不良反应率为5.00%；C组出现腹泻1例，腹痛2例，不良反应率为7.50%；D组出现腹痛、恶心、腹泻各1例，不良反应率为7.50%。4组不良反应发生率比较差异无统计学意义（P>0.05）。
3　讨论
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现代医学对CAG缺乏特效疗法，对伴HP感染CAG多采取根除HP、保护胃黏膜、抑酸等治疗，但对是否能逆转胃黏膜萎缩存在争议[10]。中医学将CAG归属为“胃脘痛”“痞满”等范畴，认为本病的病因不外乎饮食不节、情志失调、劳倦久病等。饮食不节、过食生冷，恣食辛甘厚味，可使脾胃纳化升降失常，气血凝滞而发病，情志失调，肝气郁滞，肝郁化火，影响到胃而发病，劳倦内伤及各种疾病日久殃及后天之本，导致本病的发生[11]。而病久必虚，脾胃虚弱，则饮食水谷不能消化吸收，气血生成乏源，致使气血不足，全身脏腑功能低下，脾虚更甚，脾胃虚弱是CAG形成的基础[12]。本病病位在胃，且与肝、脾密切相关，病机关键是脾胃虚弱、肝郁胃滞。《临证指南医案·木乘土》曰：“肝为起病之源，胃为传病之所”。若肝气郁结，肝疏泄功能失常，中焦气机结聚而不得发越，当升者不能升，当降者不能降，当变化者不能变化，造成胃失和降，出现胃脘胀满，纳差食少、嗳气吞酸等证，因此脾虚肝郁胃滞是其病机关键，治则应以益气健脾、疏肝行气、和胃为主[13-14]。
香砂温中汤是李振华教授治疗慢性胃病的经验方，方中茯苓健脾利水、益气补脾；白术益气健脾、燥湿利水；陈皮理气健脾、燥湿化痰；半夏疏肝理气、降逆止呕；香附疏肝解郁、理气宽中、活血化瘀；厚朴疏肝理气、健脾养胃；白芍柔肝止痛、平抑肝阳、舒肝解郁、活血祛瘀；乌药活血祛瘀、行气止痛、疏肝解郁；枳壳理气宽中、行滞消胀、行气化瘀；砂仁疏肝理气、行气和胃、舒肝解郁；桂枝和胃化湿、调和营卫；木香疏理肝气、健脾和胃；甘草调和诸药，诸药合用共奏健脾益气、疏肝解郁、理气和胃功效[15]。现代药理学表明，茯苓可调节机体免疫、抗氧化、抗炎，并促进胃肠蠕动、增加胃液分泌、减轻胃部不适；白术有增强机体免疫力、调节胃肠运动、保护胃黏膜作用，并可抑制胃酸分泌，降低胃液酸度及提高胃部pH值等作用；陈皮可减少胃黏膜的炎症反应，并可提高免疫力；半夏可降低胃蛋白酶的活性，促进胃黏膜修复、抗溃疡，并具有抗炎抗菌、调节免疫功能作用；香附止痛、抑菌、改善胃黏膜病变部位血液循环、修复胃部黏膜；厚朴有抗胃酸、抗溃疡和抗炎作用，可以缓解胃肠道疼痛，并具有较强的抗菌和抗病毒和调节免疫系统的作用；白芍可减少胃酸对胃黏膜的刺激，制胃炎的病原微生物和炎症反应，保护和修复胃黏膜；乌药可保护胃黏膜和促进组织修复；枳壳可调节胃肠运动、抗溃疡作用；砂仁抗炎、镇痛、修复肠胃黏膜；桂枝能抑制肠胃中多种细菌，缓解胃肠痉挛；木香可调节胃肠滞气，兴奋和抑制胃肠道，拮抗急性胃黏膜损伤，并具有较强的抗菌作用[16-17]。中医学认为，针灸在达到行气活血，舒筋通络的同时，也着重调节机体动态平衡，即以局部治疗为主，辅助全身阴阳平衡地调节[18]。穴位埋线是针灸的组成部分，通过特制的针具，将羊肠线或者其他可吸收的线，植入到人体特定的穴位上，通过针具和药线在穴位内发生的刺激反应，可疏通经络、平衡阴阳、调整脏腑[19]。本研究显示，C组总有效率为95.00%，高于A组、B组和D组的70.00%、75.00%和62.50%，且C组中医证候积分和胃黏膜组织病理评分低于A组、B组和D组，但A组、B组和D组比较差异无统计学意义，表明香砂温中汤联合穴位埋线治疗伴HP感染的CAG患者疗效显著，可缓解患者症状，改善胃黏膜病理，分析其机制可能与降低炎性因子、提高免疫功能、下调COX-2、p53表达有关。血管生成机制是胃癌形成的重要环节，故在CAG中抑制血管生成有利于抑制病理改变。EGF、VEGF均属于促血管生成因子，其中EGF参与胃上皮细胞增殖和迁移，促进黏膜愈合，当其过度升高时，可引起细胞过度分化增生，不利于预后。VEGF通过激活磷脂酶，增加微血管通透性，是促进血管新生及维持血管内皮完整性的血管生成最强的促进因子[20]。本研究发现，治疗6个月后C组VEGF水平高于A组、B组和D组，EGF低于A组、B组和D组，但A组、B组和D组比较差异无统计学意义，表明香砂温中汤联合穴位埋线治疗可提示胃黏膜保护效果和损伤修复效果，分析原因：香砂温中汤中的中药成分可能通过促进胃肠道黏膜的修复和再生，降低炎症反应，进而降低EGF水平，并通过改善血液循环，促进血管新生，提高VEGF水平，而穴位埋线通过刺激相关穴位，调节脾胃功能，改善胃肠道的血液循环和代谢，进而对EGF和VEGF水平产生影响。
研究发现，炎性因子浸润是导致胃黏膜腺体萎缩、肠生化的危险因素[21]。IL-6、TNF-α是临床监测炎症进展的指标，当CAG发生时，IL-6、TNF-α异常升高，并与病情呈正相关。本研究发现，治疗6个月后C组IL-6、TNF-α水平低于A组、B组和D组，但A组、B组和D组比较差异无统计学意义，与付超等[22]研究一致，说明香砂温中汤联合穴位埋线可降低炎性因子，这是由于香砂温中汤通过其药理作用调节机体的炎性反应，而穴位埋线则通过刺激穴位产生生理效应，两者共同作用，可能更有效地降低IL-6、TNF-α水平，从而改善机体炎症状态。胃黏膜上皮细胞过度凋亡被认为是CAG的发病机制之一，当胃黏膜上皮细胞凋亡过度时，可能导致胃黏膜修复能力下降，进而加重炎症损伤，甚至可能诱发胃癌的发生[23]。COX-2在胃黏膜炎症及肿瘤发生过程中起着关键作用，可通过加快局部细胞增殖，下调细胞凋亡水平，促进新生血管形成及提高肿瘤侵袭转移能力等机制，参与了胃黏膜损伤和修复的平衡调节[24]。在CAG的发病过程中，COX-2的过度表达可能会加剧胃黏膜的炎症损伤，促进病情的发展。p53是抑癌基因，能够通过调节下游基因的表达，抑制细胞的异常增殖，促进细胞凋亡，从而维持细胞的正常生长和分化。研究显示，p53蛋白在胃癌前病变及胃癌中均呈阳性表达，这可能与CAG的恶性转化有关[25]。因此，p53表达可作为评估CAG分化程度和预后的重要指标。本研究显示，治疗6个月后C组COX-2、p53表达低于A组、B组和D组，但A组、B组和D组比较差异无统计学意义，提示香砂温中汤联合穴位埋线可下调COX-2、p53表达，香砂温中汤联合穴位埋线通过综合调节机体的炎症反应、细胞周期和凋亡以及微环境等方面，下调了COX-2和p53的表达，从而在治疗慢性萎缩性胃炎等胃部疾病方面发挥了积极作用。此外，研究发现，4组不良反应无差异，提示4种治疗方式安全性均高。
综上，香砂温中汤联合穴位埋线治疗可改善伴HP感染的CAG患者症状和内皮功能，降低炎性因子，提高免疫功能，下调COX-2、p53表达，疗效显著、安全性高。
基金
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  • 河南省科技攻关项目(222102310727)
  • 河南省中医药科学研究专项(2022JDZX095)
文献
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参考文献 引证文献
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2025年第43卷第10期
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doi: 10.13193/j.issn.1673-7717.2025.10.039
  • 首发时间：2026-10-30
  • 出版时间：2025-10-10
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河南省科技攻关项目(222102310727)
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    河南中医药大学第一附属医院，河南 郑州 450099
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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