目的 探讨四环素和呋喃唑酮四联方案与常规方案治疗藏族地区幽门螺旋杆菌(Hp)阳性慢性萎缩性胃炎(CAG)的效果,并尝试探讨其作用机制.方法 前瞻性纳入2020年6月至2022年12月西藏自治区人民政府驻成都办事处医院收治的藏族地区Hp阳性CAG患者80例.根据随机抽签法分成实验组与对照组,每组各40例.实验组采用四环素和呋喃唑酮四联方案治疗,对照组采用常规方案治疗.比较两组临床疗效,分别在治疗前及疗程结束后,采集病变部位明显的胃黏膜进行病理评分,并比较两组血清胃蛋白酶原Ⅰ(PG Ⅰ)、胃蛋白酶原Ⅱ(PGⅡ)、胃泌素17(GA17)、白细胞介素-6(IL-6)、可溶性IL-2受体(sIL-2R)水平.记录两种方案的不良反应情况.结果 实验组的疗效等级优于对照组,差异有统计学意义(P<0.05).治疗后,两组胃黏膜炎症、肠上皮化生、腺体萎缩评分均低于治疗前,且实验组胃黏膜炎症、肠上皮化生评分分别为(1.05±0.16)、(1.10±0.47)分,均低于对照组[(1.31±0.27)、(1.36±0.28)分],差异均有统计学意义(P<0.05).治疗后,两组血清PGⅡ水平均低于治疗前,PG Ⅰ、GA17水平均高于治疗前,且实验组血清GA17水平为(1.19±0.28)nmol/L,高于对照组[(0.94±0.34)nmol/L],差异均有统计学意义(P<0.05).治疗后,两组血清IL-6、sIL-2R水平均低于治疗前,且实验组血清IL-6、sIL-2R水平分别为(25.62 ±5.12)ng/mL、(308.74±29.75)KU/L,均低于对照组[(30.48±6.90)ng/mL、(341.06±25.74)KU/L],差异均有统计学意义(P<0.05).实验组不良反应率为5.00%,与对照组的12.50%比较,差异无统计学意义(P>0.05).结论 四环素和呋喃唑酮四联方案能提高藏族地区Hp阳性CAG患者的临床治愈率,减轻病理症状,上调血清GA17水平,作用机制可能与其调控IL-6、sIL-2R有关.
Objective To investigate the effect of tetracycline and furazolidone quadruple regimen and conventional regimen in the treat-ment of Helicobacter pylori(Hp)positive chronic atrophic gastritis(CAG)in Tibetan area,and attempt to explore the mechanism of action.Methods Eighty Hp-positive CAG patients from Tibetan areas admitted to the Hospital of the Chengdu Office of the People's Government of Ti-bet Autonomous Region from June 2020 to December 2022 were prospectively included.According to the random drawing method,40 cases were divided into the experimental group and the control group.The experimental group was treated with tetracycline and furazolidone quadruple regi-men,while the control group was treated with conventional regimen.The clinical efficacy of the two groups was compared.Before treatment and af-ter treatment,the gastric mucosa with obvious lesions was collected for pathological score,and the serum levels of pepsinogen Ⅰ(PG-Ⅰ),pep-sinogen Ⅱ(PG-Ⅱ),gastrin 17(GA 17),interleukin-6(IL-6)and soluble interleukin-2 receptor(sIL-2R)were compared between the two groups.And the adverse reactions of the two regiments were recorded.Results The efficacy level of the experimental group was better than that of the control group,and the difference was statistically significant(P<0.05).After treatment,the scores of gastric mucosal inflammation,intestinal metaplasia and glandular atrophy in both groups were lower than those before treatment,and the scores of gastric mucosal inflammation and intestinal metaplasia in the experimental group were(1.05±0.16),(1.10±0.47)points,respectively,which were lower than those in the control group[(1.31±0.27),(1.36±0.28)points],the differences were statistically significant(P<0.05).After treatment,the serum levels of PG-Ⅱ were lower than those before treatment,the levels of PG-Ⅰ and GA17 were higher than those before treatment,and the serum level of GA17 in the experimental group was(1.19±0.28)nmol/L,which was higher than that in the control group[(0.94±0.34)nmol/L],the differences were statistically significant(P<0.05).After treatment,the levels of serum IL-6 and sIL-2R in two groups were lower than those before treatment,and the levels of serum IL-6 and sIL-2R in the experimental group were(25.62±5.12)ng/mL,(308.74±29.75)KU/L,respectively,which were lower than those in the control group[(30.48±6.90)ng/mL,(341.06±25.74)KU/L],the differences were statistically significant(P<0.05).The adverse reaction rate of the experimental group was 5.00%,which had no statistically significant differ-ence compared with 12.50%of the control group(P>0.05).Conclusion Tetracycline and furazolidone quadruple regimen can improve the clinical cure rate of Hp-positive CAG patients in Tibetan area,reduce pathological symptoms,and up-regulate serum GA17 level.The mecha-nism of action may be related to the regulation of IL-6 and sIL-2R.