【目的】探讨小柴胡汤合香砂六君子汤对肝郁脾虚型慢性萎缩性胃炎 （CAG） 患者胃黏膜病理积分改变与胃肠激素的影 响。 【方法】将156例肝郁脾虚型CAG患者随机分为对照组和观察组，每组各78例。对照组给予常规西医治疗，观察组在对 照组的基础上给予小柴胡汤合香砂六君子汤治疗，疗程为4周。观察2组患者治疗前后中医证候积分 （胃脘胀痛、纳差便溏、 四肢乏力、嗳气泛酸） 、胃黏膜病理积分、胃肠激素[胃动素 （MTL） 、胃泌素 （GAS） ]水平的变化情况，比较2组患者的幽门螺 旋杆菌 （Hp） 转阴率，评价2组患者的临床疗效和安全性。 【结果】（1） 治疗4周后，观察组的总有效率为93.59% （73/78） ，显著 高于对照组的82.05% （64/78） ，组间比较，差异有统计学意义 （P＜0.05） 。 （2） 治疗后，2组患者的胃脘胀痛、纳差便溏、四肢 乏力、嗳气泛酸等各项中医证候积分均较治疗前明显降低 （P＜0.05） ，且观察组的降低幅度均明显优于对照组 （P＜0.05） 。 （3） 治疗后，2组患者的胃黏膜病理积分均较治疗前明显降低 （P＜0.05） ，且观察组的降低幅度明显优于对照组 （P＜0.01） 。 （4） 治疗4周后，观察组的Hp转阴率为91.03% （71/78） ，明显高于对照组的75.64% （59/78） ，组间比较，差异有统计学意义 （P＜0.05） 。 （5） 治疗后，2组患者的血清GAS水平均较治疗前明显降低 （P＜0.05） ，血清MTL水平均较治疗前明显升高 （P＜ 0.05） ；且观察组对血清GAS水平的降低幅度及对血清MTL水平的升高幅度均明显优于对照组 （P＜0.05） 。 （6） 2组患者用药期 间的血、尿、大便常规以及肾、肝功能和心电图等安全性指标均无明显异常，也均未出现头晕、皮疹、胸闷等不良反应， 具有较高的安全性。 【结论】小柴胡汤合香砂六君子汤对肝郁脾虚型GAS的治疗效果显著，可有效减轻患者临床症状与胃黏 膜病理改变，促进Hp转阴，其作用机制可能与调节胃肠激素水平有关。

Objective To investigate the effect of Xiao Chaihu Decoction and Xiangsha Liujunzi Decoction on the changes of gastric mucosal pathological score and gastrointestinal hormones in patients with chronic atrophic gastritis （CAG） of liver stagnation and spleen deficiency type. Methods A total of 156 cases of CAG patients with liver stagnation and spleen deficiency syndrome were randomly divided into a control group and an observation group，78 cases in each group. The control group was treated with conventional western medicine，and the observation group was treated with Xiao Chaihu Decoction and Xiangsha Liujunzi Decoction on the basis of treatment for the control group. The course of treatment covered four weeks. The changes in the scores of traditional Chinese medicine （TCM） symptoms such as epigastric distention and pain，poor appetite，loose stools，limb weakness， belching and acid regurgitation， gastric mucosal pathological scores and serum levels of gastrointestinal hormones of motilin （MTL） and gastrin （GAS） in the two groups were observed before and after treatment. The negative conversion rate of Helicobacter pylori（Hp） in the two groups was compared，and the clinical efficacy and safety of the two groups were evaluated. Results （1） After four weeks of treatment，the total effective rate of the observation group was 93.59% （73/78） ，which was significantly higher than 82.05% （64/78） of the control group，and the difference between the two groups was statistically significant （P＜0.05） . （2） After treatment，the scores of TCM symptoms such as epigastric distention and pain，poor appetite，loose stool，limb weakness，belching and acid regurgitation in the two groups were significantly decreased compared with those before treatment （P＜0.05），and the decrease in the observation group was significantly superior to that in the control group （P＜0.05） . （3）After treatment，the pathological scores of gastric mucosa in the two groups were significantly decreased when compared with those before treatment （P＜0.05） ，and the decrease in the observation group was more significant than that in the control group （P＜0.01） . （4） After four weeks of treatment，the negative conversion rate of Hp in the observation group was 91.03% （71/78） ，which was significantly higher than that in the control group （75.64%，59/78） ，and the difference between the two groups was statistically significant （P＜0.05） . （5） After treatment，the level of serum GAS in the two groups was significantly decreased （P＜0.05） and the serum MTL level was significantly increased compared with that before treatment （P＜0.05） ；the decrease of serum GAS level and the increase of serum MTL level in the observation group were significantly superior to those in the control group （P＜0.05） . （6） There were no obvious abnormalities in the routine test of blood，urine，stool， kidney function，and liver function，electrocardiograph and other safety indicators during the treatment of the two groups of patients，no adverse reactions such as dizziness，rash and chest distress occurred either，with high safety. Conclusion Xiao Chaihu Decoction combined with Xiangsha Liujunzi Decoction exerts a significant therapeutic effect on GAS of liver stagnation and spleen deficiency type，which can effectively relieve the clinical symptoms， improve the pathological changes of gastric mucosa and promote Hp negative conversion. The therapeutic mechanism may be related to the regulation of gastrointestinal hormone levels.

R259.733

国家自然科学基金资助项目 （编号：81603417）