| Objective: Based on the real world,to explore the clinical efficacy of Li’s Qingshu Yiqi decoction in the therapy of chronic atrophic gastritis of spleen deficiency and dampness heat,as well as its influence on the classification of atrophy under gastroscopy and the related indicators of gastric mucosal histopathological lesions,so as to explore the medical efficacy and security of Li’s Qingshu Yiqi decoction,analyze the independent risk factors related to chronic atrophic gastritis,and probe the research techniques suitable for the characteristics of traditional Chinese medicine.Methods: 1.Patients diagnosed with CAG of spleen deficiency and dampness heat in the Department of Spleen and Stomach Diseases of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from January 2022 to December 2022 were included in this research.After Pre-selection based on acceptance and rejection of requirements,they were given the choice of treatment group and matched group as required by their own will after detailed communication with sufferers.The matched group was given oral western medicine(folic acid,vitamin B12 tablets,rebamipide tablets),and patients were requested to go back to the hospital for regular follow up evaluation after the end of the 9-month treatment cycle.2.Fundamental patient data collected during the course of the therapy:impact factors including age,gender,history of Hp infection,history of smoking,history of drinking,history of hypertension,history of diabetes,history of NSAIDs use,history of PPI use,and history of Chinese patent medicine(Chinese patent medicine with therapeutic effect on CAG)were used as covariates for preliminary analysis.Confounding factors were adjusted by 1:1 propensity score matching to control data bias.3.The data of the successfully matched cases were statistically analyzed.The changes of TCM clinical symptoms,TCM syndromes and efficacy,atrophy grading and severity under gastroscopy,and pathological grading of gastric mucosa before and after therapy were evaluated.Therefore,the clinical benefit and security of Li’s Qingshu Yiqi decoction in the therapy of CAG of spleen deficiency and dampness heat were evaluated.4.Finally,multivariate ordinal logistic regression analysis was employed to investigate separate hazard elements for the severity of atrophy grading under gastroscopy in patients with chronic atrophic gastritis.Results: In this study,according to the actual clinical treatment and acceptance and rejection of requirements,163 patients concluded all therapy cycles and go back to the hospital on time for regular follow-up.According to the patient’s autonomous will and the actual clinical situation,89 patients chose Chinese medicine therapy,which was incorporated into the therapy group,and 74 patients chose western medicine therapy,which was incorporated into the matched group.There were 52 cases in each group,and104 cases in total were successfully matched with chronic atrophic gastritis of spleen deficiency and damp-heat type.Between the two groups,a statistical analysis and comparison were carried out:1.Comparison of basic information: in terms of gender,46 cases were male,and 58 cases were female.There were approximately 1:1.26 males to females.With regard to age,the youngest was 33 years old and the oldest was85 years old,respectively.There were 6 cases in the young adults group between the ages of 18 and 44,41 cases in the middle-aged group between 45 and 59 and above,and 57 cases in the elderly group of 59 years old and above,accounting for 5.8%,39.4%,and 54.8%,respectively.The overall distribution of patients was concentrated in the middle-aged to elderly group,that is,patients aged 45 to 59 years old and above.In terms of living materials,patients with a history of smoking and drinking accounted for 15.3% and16.3%,respectively.Patients with a past medical history,patients with a history of HP infection,diabetes,and hypertension accounted for 23.1%,12.5%,and 38.5%,respectively.In terms of special medication history,the proportion of patients taking PPI,NSAIDs and Chinese patent medicine was42.3%,13.5% and 24.0%,respectively.2.Comparison of TCM clinical symptom scores:(1)The TCM clinical symptom grades of the two groups were markedly improved,and the therapy group was markedly better than the matched group(P<0.05);(2)The aggregate marks of TCM clinical minor syndromes former and after therapy in the two groups were markedly improved(P<0.05),and the therapy group was more useful than the matched group(P<0.05).(3)The grades of TCM clinical syndromes were markedly better in the two groups former and after therapy(P<0.05),but when it came to the distinction among the two groups,the therapeutic effect of the therapy group was better than that of the matched group(P<0.05).There was no conspicuous difference among the two groups in the grades of body tiredness,arid oral,bitter oral and/or halitosis,nausea and vomiting,and feeling hot(P>0.05).(4)The aggregate score of TCM clinical syndromes(primary syndrome score + secondary syndrome score)former and after therapy in the two groups were markedly improved,and compared with the matched group,the curative effect in the therapy group was more conspicuous(P<0.05).3.Comparison of the overall benefits of TCM syndromes: after the full course of therapy,the overall successful rates of the therapy group and the matched group were 100.0% and 92.3%,respectively,and the efficacy of the therapy group was more significant than that of the matched group(P<0.05).4.Comparison of the improvement of atrophy under gastroscopy:(1)Before treatment,the severity of gastroscopic atrophy in the treatment group was mainly concentrated in the mild to moderate range(46.2% and 40.4%,respectively).After treatment,it was mainly concentrated in the mild range(61.6%),and the curative effect was significant before and after medication(P<0.05).(2)In the matched group,the serious degree of atrophy grading under gastroscopy was mainly concentrated in the mild to moderate range(50.0% and 40.4%,respectively),and was still mainly concentrated in the mild to moderate range after treatment(59.6% and 30.8%,respectively),and the curative outcome before and after therpay was invalid(P>0.05).(3)After therapy,the therapeutic outcome of the therapy group was observably than that of the matched group(P<0.05).5.Comparison of histopathological amelioration:(1)After therapy,the amelioration grade of chronic inflammation and intestinal metaplasia of gastric mucosa in the therapy group was observably better than that former therapy,and the curative effect was mainly concentrated in the range of mild to moderate gastric mucosal lesions,and the difference was significant(P<0.05),but there was no significant improvement in gastric mucosal dysplasia before and after treatment(P>0.05);(2)In the control group,the improvement of chronic inflammation of gastric mucosa after therapy was better than that before therapy,and the difference was import(P<0.05).For gastric intestinal metaplasia,there was a certain degree of amelioration,mainly concentrated in the range of mild gastric mucosal lesions,but the difference was insignificance(P>0.05).There was no significant effect(P>0.05).(3)Compared with the control group,the treatment group had more meaningful amelioration in chronic inflammation of gastric mucosa and mild to moderate intestinal metaplasia(P < 0.05).6.Analysis of risk factors for atrophy grading under gastroscopy:multiple ordinal Logistic regression analysis showed that age,Hp infection history and hypertension history were independent risk factors for the severity of atrophy grading under gastroscopy in patients with chronic atrophic gastritis(P<0.05).7.Safety: during the treatment,there were no obvious abnormalities in ECG,hepatorenal function in either group,and no obvious drug allergic reactions occurred during the treatment in the two groups.Conclusions: 1.Li’s Qingshu Yiqi decoction can effectively improve the TCM clinical syndromes of patients with CAG of spleen deficiency and dampness heat.Compared with conventional western medicine therapy there is a marked discrepancy in how effective TCM clinical symptoms,such as less food and anorexia,sticky stool and/or discomfort after defecation.2.Li’s Qingshu Yiqi decoction can significantly improve the degree of atrophy under gastroscopy in patients with CAG of spleen deficiency and dampness heat.3.The curative effect of Li’s Qingshu Yiqi decoction on managing chronic inflammation of gastric mucosa and IM of mild to moderate gastric mucosa is markedly better than that of western medicine,but the curative effect on improving gastric mucosal dysplasia is not significant.4.Multiple ordinal logistic regression analysis showed that Hp infection history,age and hypertension history were independent risk factors for the severity of gastroscopic atrophy in patients with CAG.Patients with age,Hp affection history and hypertension history may have more severe gastroscopic atrophy.5.Li’s Qingshu Yiqi decoction has good safety in the therapy of patients with CAG of spleen deficiency and damp heat. |
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