基于肠道菌群稳态探讨新蒲饮治疗脾胃湿热型幽门螺杆菌相关胃炎的临床疗效OA

Objective To explore the clinical efficacy of Xinpu Decoction combined with dual therapy in the treatment of Helicobacter pylori(Hp)-associated gastritis with spleen-stomach damp-heat pattern and its impact on intestinal microecology.Methods A total of 234 patients of Hp-associated chronic gastritis with spleen-stomach damp-heat pattern who met the inclusion criteria were enrolled.Subsequently,using a random number table,patients were randomly divided into three groups:Xinpu Decoction+dual therapy group(group A,Xinpu Decoction combined with dual therapy),the dual therapy group(group B,Xinpu Decoction combined with dual therapy),and the Bifico+dual therapy group(group C,Live Combined Bacillus subtilis and Enterococcus faecium Capsules),with 78 cases in each group.During the treatment,2,1,and 4 patients dropped out in the three groups,respectively.All patients received treatment for 14 days.After treatment,the Hp eradication rate,traditional Chinese medicine(TCM)syndrome efficacy,total score of TCM symptoms and the improvement of individual symptoms were observed among the three groups.Meanwhile,fresh fecal samples from 42 randomly selected patients were collected before and after this treatment(Due to the failure to provide stool samples,data from only 14,13,and 15 patients in each group were ultimately included in the final analysis),and 16S rRNA sequencing technology was used to analyze the changes in intestinal flora abundance and diversity among the three groups.Results After treatment,the Hp eradication rates of the three groups were 96.05%,94.81%,and 95.95%respectively,and the total effective rates of TCM syndrome after treatment were 98.68%,77.92%,and 89.12%respectively.Xinpu Decoction+dual therapy group showed a significantly higher rate compared to the other groups(P<0.001).Moreover,the symptom scores were significantly reduced(P<0.001).Specifically,improvements in epigastric pain,epigastric distension,loose stools,and somatic heaviness were significantly superior compared to the dual therapy group(P<0.05).In the analysis of species composition diversity,Xinpu Decoction+dual therapy group showed the following characteristics:at the phylum level,the abundances of Bacteroidetes and Actinobacteria were high,while the abundance of Proteobacteria was low;at the genus level,there was high abundance of Bacteroides,Prevotella and Faecalibacterium,while the relative abundances of Klebsiella and Escherichia-Shigella were low.Additionally,through Lefse analysis,the significantly enriched species were identified as Butyricimonas and Adlercreutzia.Further functional prediction analysis revealed that the functionally enriched pathways were taurine and hypotaurine metabolism,and steroid hormone biosynthesis pathways.In the dual therapy group,no significantly enriched species were found after treatment,so no differential pathways with enriched flora functions were observed between pre-and post-treatment.In the Bifico+dual therapy group,the significantly enriched species after treatment was Coprococcus,and the enriched pathways included lipopolysaccharide biosynthesis,interconversion of pentose and glucuronate,etc.Conclusion Xinpu Decoction combined with dual therapy in the treatment of Hp-associated gastritis with spleen-stomach damp-heat pattern shows a high Hp eradication rate and significant improvement in clinical symptoms.Its therapeutic mechanism may be as follows:promoting the production of butyric acid,increasing the number of beneficial bacteria,inhibiting the growth of conditional pathogens,restoring the anaerobic state of the intestine,and thereby regulating the homeostasis of intestinal flora.