【摘要】 目的:观察活血通降方联合质子泵抑制剂(proton pump inhibitors, PPIs)对气滞血瘀型Barrett食管(Barrett’s esophagus, BE)的临床疗效，并初步探索其疗效机制。方法:采用回顾性研究方法，选择2022年1月—2024年12月符合纳入和排除标准的BE患者66例，按照治疗方法分为活血通降方联合PPIs治疗的中西医结合组(31例)和单纯PPIs治疗的西药组(35例)。收集2组患者一般情况、治疗前后内镜下表现、病理组织学结果、中医证候评分等，并采用免疫组织化学染色法检测治疗前后食管病变黏膜CDX2及SOX9表达水平。结果:2组患者治疗前一般资料、内镜下及病理学表现、中医证候总积分、主要症状评分均差异无统计学意义(P>0.05),具有可比性。治疗后，中西医结合组证候总有效率为90.3%(28/31),明显优于西药组的62.9%(22/35)(P=0.034)。治疗后，2组患者中医证候总积分[(4.71±3.99)分vs (9.60±5.82)分]、反酸评分[(1.87±1.45)分vs (3.14±1.96)分]、烧心评分[(1.03±1.45)分vs (2.91±1.84)分]与治疗前比较均明显下降(均P<0.01);治疗后，中西医结合组中医证候总积分、反酸评分、烧心评分均明显低于西药组(均P<0.01)。治疗后，中西医结合组食管病变黏膜病理组织学改善的总有效率为58.1%(18/31),显著优于西药组的22.9%(8/35)(P=0.008);中西医结合组内镜下食管病变范围改善的总有效率为25.8%(8/31),高于西药组的8.6%(3/35),但差异无统计学意义(P=0.061)。2组患者治疗后食管病变黏膜SOX9及CDX2表达水平较治疗前均明显降低(均P<0.05),且中西医结合组SOX9及CDX2表达水平较西药组降低更明显(均P<0.05)。结论:中药活血通降方联合PPIs治疗BE,在缓解临床症状、逆转其组织病理学、缩小其内镜下病变范围方面具有优势，疗效机制可能与阻断BE化生信号通路中关键因子CDX2及SOX9的表达水平有关。更多还原

【Abstract】 Objective: To observe the clinical efficacy of Huoxue Tongjiang Formula combined with proton pump inhibitors(PPIs) in treating Qi-stagnation and blood-stasis syndrome Barrett’s esophagus(BE) and to preliminarily explore its efficacy mechanism. Methods: A retrospective study was carried out. A total of 66 BE patients who met the inclusion and exclusion criteria of this study from January 2022 to December 2024 were included. According to the treatment methods, patients were divided into the integrated traditional Chinese and Western medicine group(31 cases) and the Western medicine group(35 cases). Patients in the integrated traditional Chinese and Western medicine group were treated with Huoxue Tongjiang Formula combined with PPIs, while patients in the Western medicine group were treated with PPIs alone. The general information, pre-and post-treatment endoscopic findings, pathological and histological results, and traditional Chinese medicine(TCM) syndrome scores of the two groups were collected. The pre-and post-treatment expression levels of CDX2 and SOX9 in the esophageal lesion mucosa were detected by immunohistochemical staining. Results: Before treatment, there were no significant differences in general data, endoscopic and pathological findings, total TCM syndrome scores, and main symptom scores between the two groups(P>0.05). After treatment, the total syndrome effective rate in the integrated traditional Chinese and Western medicine group was 90.3%(28/31), which was better than that of 62.9%(22/35) in the Western medicine group(P=0.034). After treatment, the total TCM syndrome scores([4.71±3.99]points vs [9.60±5.82]points), acid regurgitation scores([1.87±1.45]points vs [3.14±1.96]points), and heartburn scores([1.03±1.45]points vs [2.91±1.84]points) of the two groups were significantly lower than pre-treatment levels(all P<0.01). After treatment, the total TCM syndrome scores, acid regurgitation scores, and heartburn scores of the integrated traditional Chinese and Western medicine group were significantly lower than those of the Western medicine group(all P<0.01). After treatment, the total effective rate of pathological and histological improvement of the esophageal lesion mucosa in the integrated traditional Chinese and Western medicine group was 58.1%(18/31), which was significantly better than that of 22.9%(8/35) in the Western medicine group(P=0.008). The total effective rate of endoscopic improvement of the esophageal lesion range in the integrated traditional Chinese and Western medicine group was 25.8%(8/31), which was significantly higher than that of 8.5%(3/35) in the Western medicine group(P=0.061). After treatment, the expression levels of SOX9 and CDX2 in the esophageal lesion mucosa of the two groups were significantly lower than pre-treatment levels(all P<0.05), and the expression levels of SOX9 and CDX2 in the integrated traditional Chinese and Western medicine group were significantly lower than those in the Western medicine group(all P<0.05). Conclusion: The combination of traditional Chinese medicine Huoxue Tongjiang Formula and PPIs in the treatment of BE has advantages in relieving clinical symptoms, reversing histopathology, and reducing the endoscopic lesion range in patients. The therapeutic mechanism may be associated with inhibition of key metaplastic signaling factors CDX2 and SOX9.更多还原