【目的】 探讨中药白莲治萎方（由白花蛇舌草、半枝莲、五指毛桃、丹参、郁金、白术、鸡内金、延胡索、莪术、陈 皮、厚朴、甘草等组成）加减治疗脾虚湿热瘀阻型慢性萎缩性胃炎（chronic atrophic gastritis，CAG）的临床疗效及对血清胃蛋 白酶原表达水平的影响。【方法】 将64例脾虚湿热瘀阻型CAG患者随机分为对照组和治疗组，每组各32例。对照组给予摩罗 丹丸治疗，治疗组给予中药白莲治萎方加减治疗，疗程为2个月。观察2组患者治疗前后主要中医证候积分、胃镜下黏膜变 化的可操作的与胃癌风险联系的萎缩评估系统（OLGA）分期评分和血清胃蛋白酶原 Ⅰ（PGⅠ）、胃蛋白酶原 Ⅱ（PGⅡ）及其比 值（PGR）的变化情况，并评价2组患者的临床疗效。【结果】（1）疗效方面，治疗2个月后，治疗组的总有效率为96.88%（31/32）， 对照组为 81.25%（26/32），组间比较，治疗组的总有效率（χ2检验）和总体疗效（秩和检验）均明显优于对照组（P＜0.05）。 （2）中医证候积分方面，治疗后，2组患者的胃脘胀满、胃刺痛、口苦口臭、疲倦乏力等中医证候积分均较治疗前明显下降 （P＜0.01），且治疗组的下降幅度均明显优于对照组（P＜0.01）。（3）胃镜下的黏膜变化方面，治疗后，2组患者的 OLGA分期 评分均较治疗前降低（P＜0.01），且治疗组的降低幅度明显优于对照组（P＜0.01）。（4）检测指标方面，治疗后，2组患者的血 清PGⅠ、PGR水平均较治疗前升高（P＜0.01），血清PGⅡ水平均较治疗前降低（P＜0.01），且治疗组对血清PGⅠ、PGR水平 的升高幅度及对血清PGⅡ水平的降低幅度均明显优于对照组（P＜0.01）。【结论】 白莲治萎方加减治疗脾虚湿热瘀阻型CAG患 者的临床疗效确切，能有效缓解患者的临床症状，改善患者的胃黏膜状态，调节血清胃蛋白酶原的表达水平。

Objective To investigate the clinical efficacy of modified Bailian Zhiwei Prescription（mainly composed of Hedyotis Diffusae Herba， Scutellariae Barbatae Herba， Fici Simplicissimae Radix， Salviae Miltiorrhizae Radix et Rhizoma，Curcumae Radix，Atractylodis Macrocephalae Rhizoma，Galli Gigerii Endothelium Corneum， Corydalis Rhizoma， Curcumae Rhizoma， Citri Reticulatae Pericarpium， Cortex Magnoliae Officinalis， and Glycyrrhizae Radix et Rhizoma）in the treatment of chronic atrophic gastritis（CAG），and to observe its effect on serum pepsinogen expression level. Methods Sixty-four patients with CAG of spleen deficiency with damp-heat and stasis obstruction type were randomly divided into a control group and a treatment group，with 32 patients in each group. The control group was treated with Moluodan Pills， and the treatment group was treated with the modified Bailian Zhiwei Prescription. Both groups were treated for a period of 2 months. The changes of the primary traditional Chinese medicine （TCM） syndrome scores， staging scores of gastric mucosa under gastroscopy evaluated with the operative link for gastritis assessment （OLGA）， and serum pepsinogen Ⅰ（PG Ⅰ） and pepsinogenⅡ（PGⅡ）levels as well as PGⅠ/ PGⅡratio（PGR）in the patients of the two groups were observed before and after the treatment. We also evaluated the clinical efficacy of the two groups after treatment. Results （1） After 2 months of treatment，the total effective rate of the treatment group was 96.88%（31/32），and that of the control group was 81.25%（26/32），and the intergroup comparison showed that the total effective rate（tested by chi-square test）and overall therapeutic efficacy（tested by rank-sum test）of the treatment group were significantly superior to those of the control group（P＜0.05）.（2）After treatment， the TCM syndrome scores of epigastric flatulence， gastric stabbing pain， bitter mouth and halitosis， and fatigue in both groups were significantly decreased compared with those before treatment （P＜0.01）， and the decrease in the treatment group was significantly superior to that in the control group（P＜0.01）.（3）The analysis of the gastroscopic findings of gastric mucosa showed that after treatment， the OLGA staging scores of the two groups were lower than those before treatment（P＜0.01），and the decrease in the treatment group was significantly superior to that in the control group （P＜0.01）.（4）After treatment，the levels of serum PG Ⅰ and PGR in the two groups were increased compared with those before treatment（P＜0.01），and the level of serum PG Ⅱ was decreased that before treatment（P＜ 0.01）. The increase of serum PGⅠ and PGR levels and the decrease of serum PG Ⅱlevel in the treatment group were significantly superior to those in the control group （P＜0.01）. Conclusion Modified Bailian Zhiwei Prescription exerts certain effect in treating patients with CAG of spleen deficiency with damp-heat and stasis obstruction type，which can effectively alleviate the clinical symptoms of the patients，improve the gastroscopic fingdings of gastric mucosa of the patients，and regulate the expression level of serum pepsinogen.

R259.733

/