【目的】 客观评价小建中汤合大柴胡汤治疗慢性萎缩性胃炎的临床疗效，为该方的临床应用提供科学依据。【方法】 选 取 2020 年 1 月～2023 年 12 月在广州中医药大学顺德医院消化内科门诊就诊的 80 例平人型（根据长桑君脉法脉息术，患者 1 min内脉搏与呼吸次数的比值为 4～5）慢性萎缩性胃炎脾虚瘀热证患者，根据治疗方式的不同，将患者分为治疗组和对照 组，每组各40例。对照组给予常规西药治疗，治疗组给予小建中汤合大柴胡汤治疗，7 d 为 1 个疗程，共治疗6个月。观察 2组患者治疗前后的中医证候积分、胃镜评分、病理积分及胃功能指标的变化情况，并评价 2组患者的临床疗效和安全性。 【结果】（1）疗效方面，治疗 6个月后，治疗组的总有效率分别为 90.00%（36/40），对照组为 60.00%（24/40）。组间比较（χ2检 验），治疗组的疗效明显优于对照组（P＜0.05）。（2）中医证候积分方面，治疗后，2组患者的中医证候积分均较治疗前明显降 低（P＜0.05），且治疗组的降低幅度明显优于对照组（P＜0.05）。（3）胃镜评分方面，治疗后，2组患者的胃镜评分均较治疗前 明显降低（P＜0.05），但治疗后组间比较，差异无统计学意义（P＞0.05）。（4）病理积分方面，治疗后，2组患者的病理总积分 及治疗组的胃窦、胃角、胃体的胃黏膜萎缩和肠化生均较治疗前明显改善（P＜0.05），且治疗组的改善作用均明显优于对照 组（P＜0.05）；而2组患者的胃窦、胃角、胃体的胃黏膜异型增生和慢性炎症以及对照组的胃窦、胃角、胃体的胃黏膜萎缩 和肠化生均较治疗前无明显改善，差异均无统计学意义（P＞0.05）。（5）胃功能指标方面，治疗后，2组患者的血清胃蛋白酶 原Ⅰ（PGⅠ）、胃蛋白酶原II （PGⅡ）、胃泌素17（G-17）水平均治疗前明显降低（P＜0.05），且治疗组的降低作用均明显优于对 照组（P＜0.05）。（6）安全性方面，治疗过程中，2组患者均未出现明显不良反应，具有较高的安全性。【结论】 小建中汤合大 柴胡汤能明显提高平人型慢性萎缩性胃炎脾虚瘀热证患者的临床疗效，显著改善患者的胃肠功能和病理积分，且具有较 高的安全性。

Objective To evaluate the clinical efficacy of Xiaojianzhong Decoction plus Dachaihu Decoction in the treatment of chronic atrophic gastritis（CAG），and to provide scientific evidence for the clinical application of the formula. Methods The clinical observation was carried out in 80 CAG patients with spleen deficiency and stasisheat syndrome of normal-people pulse type（the ratio of patients’pulse to the number of respirations within one minute being 4-5 evaluated by Changsangjun pulse-taking method）who attended the clinic of the Department of Gastroenterology of Shunde Hospital， Guangzhou University of Chinese Medicine， from January 2020 to December 2023. According to the treatment method，the patients were divided into the treatment group and the control group，with 40 cases in each group. The control group was given conventional western medicine treatment， and the treatment group was given Xiaojianzhong Decoction plus Dachaihu Decoction. Seven days constituted one course of treatment， and the treatment covered 6 months. The changes of traditional Chinese medicine（TCM） syndrome score， gastroscopy score， pathological score and gastric function indicators in the two groups were observed before and after the treatment. After treatment，the clinical efficacy and safety of the two groups were evaluated. Results（1）After 6 months of treatment，the total effective rate of the treatment group was 90.00% （36/40），and that of the control group was 60.00%（24/40）. The intergroup comparison（tested by chi-square test）showed that the efficacy of the treatment group was significantly superior to that of the control group（P＜ 0.05）.（2）After treatment， the scores of TCM syndromes in the two groups were significantly lower than those before treatment（P＜0.05）， and the decrease of the scores in the treatment group was superior to that in the control group（P＜0.05）.（3）After treatment，the gastroscopy scores of the two groups were significantly lower than those before treatment（P＜0.05）， but there was no significant difference between the two groups after treatment（P＞0.05）.（4）After treatment，the total pathological scores of the two groups and the scores of the gastric mucosal atrophy and intestinal metaplasia of the gastric antrum， gastric angle and gastric body in the treatment group were significantly improved compared with those before treatment （P＜0.05）， and the improvement of the gastroscopy scores in the treatment group was significantly superior to that in the control group （P＜0.05）. No statistically significant differences were presented in the scores of the gastric mucosal dysplasia and chronic inflammation of gastric antrum，gastric angle and gastric body in the two groups and in the scores of the gastric mucosal atrophy and intestinal metaplasia of gastric antrum，gastric angle and gastric body in the control group when compared with those before treatment（P＞0.05）.（5）After treatment， the serum levels of gastric function indicators of pepsinogen Ⅰ（PGⅠ），pepsinogen Ⅱ（PGⅡ）and gastrin 17（G-17）in the two groups were significantly decreased compared with those before treatment（P＜0.05），and the decrease in the treatment group was significantly superior to that in the control group （P＜0.05）.（6） There were no obvious adverse reactions occurring in the two groups during the treatment，with high safety. Conclusion Xiaojianzhong Decoction plus Dachaihu Decoction can significantly enhance the clinical efficacy of CAG patients with spleen deficiency and stasis-heat syndrome of normal-people pulse type， significantly improve the gastrointestinal function and pathological scores of the patients，and has high safety.

R259.733

广东省科技计划项目（编号：2220001004385）