脑肠肽、中医证型与胃食管反流病病程的相关性  

Correlation between brain gut peptides, traditional Chinese medicine syndrome and course of gastroesophageal reflux disease

作　　者：陈莉丽 卜平 方晓华 

机构地区：[1]扬州市中医院消化科,江苏省扬州市225000

出　　处：《世界华人消化杂志》2016年第16期2531-2536,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨血浆脑肠肽、中医证型与胃食管反流病(gastroesophageal reflux disease,GERD)病程之间的关系.方法:本文研究以178例GERD患者为研究对象,分为5个证型:肝胃郁热证、痰气交阻证、痰瘀互结证、中虚气逆证、气滞血瘀证,同时应用酶联免疫吸附法随机对部分入组患者进行血浆生长抑素、5-羟色胺、血管活性肠肽、内皮素、促胃动素水平检测.结果:178例GERD患者中,非糜烂性反流病(nonerosive reflux disease,NERD)组及反流性食管炎(reflux esophagitis,RE)组间比较,RE组肝胃郁热证较NERD明显升高,差异有统计学意义(P<0.05),NERD组中虚气逆证、痰瘀互结证较RE组明显升高,差异有统计学意义(P<0.05).不同中西医证型与病程有关:178例GERD患者中,病程不足1年患者73例(41%),病程1-5年患者72例(40.5%),病程超过5年患者33例(18.5%).其中NERD组病程超过5年的患者明显比RE组高;肝胃郁热证患者小于1年、1-5年明显比超过5年的患者多;中虚气逆证患者1-5年、大于5年明显比小于1年多;痰瘀互结证患者病程大于5年明显比小于1年患者多,差异均有统计学意义(P<0.05).血浆脑肠肽水平与病程有关:病程大于5年患者血浆促胃动素(motilin,MTL)水平显著低于病程小于1年患者,差异有统计学意义(P<0.05),3组间血浆MTL含量差异有统计学意义(P<0.05);病程大于5年患者血浆5-羟色胺(5-hydroxytryptamine,5-HT)、内皮素(endothelin,ET)高于病程1-5年及病程小于1年患者,但无统计学意义.结论:不同中西医分型GERD患者病程并不相同,NERD患者比RE患者病程容易迁延,病程长的GERD患者常表现为中虚气逆、痰瘀互结证,血浆5-HT、ET、MTL可能和GERD患者病情的反复、迁延有关.AIM： To investigate the relationship between plasma brain gut peptides, traditional Chinese medicine（TCM） syndrome and the course of gastroesophageal reflux disease（GERD）.METHODS： One hundred and sventy-eight GERD patients were included. They had five TCM syndromes： liver stomach heat, gas exchange resistance, phlegm stagnation and blood stasis, Qi deficiency, and Qi stagnation and blood stasis. Plasma levels of brain gut peptides including 5-hydroxytryptamine,somatostatin, vasoactive intestinal peptide,endothelin, and motilin were detected.RESULTS： In the 178 patients with GERD,the proportion of patients with liver stomach heat syndrome was significantly higher in the reflux esophagitis（RE） group than in the non-erosive gastroesophageal reflux disease（ NERD） group（ P〈0. 0 5）, while the proportions of patients with phlegm stagnation and blood stasis syndrome and Qi deficiency syndrome were significantly higher in the NERD group than in the RE group（P〈0.05）. Of the 178 GERD patients,73（41%） had a disease course 〈1 year, 72（40.5%） had a disease course between 1 and 5years, and 33（18.5%） had a course 〉5 years.The proportion of patients with a course 〉5years was significantly higher in the NERD group than in the RE group（P〈0.05）. The proportion of patients with a course 〈1 year or between 1 and 5 years in patients with liver stomach heat syndrome was significantly higher that of patients with a course 〉5 years（P〈0.05）, the proportion of patients with a course between 1-5 years or 〉5 years inpatients with Qi deficiency syndrome was significantly higher than that of patients with a course 1 year（P〈0.05）, and the proportion of patients with a course 〉5 years in patients with phlegm stagnation and blood stasis was significantly higher than that of patients with a course less than 〈1 year（P〈0.05）. Motilin levels were significantly lower in patients with a course 〉5 years than in patients with a course 〈1 year（P〈0.05）, and the

关 键 词：胃食管反流病 脑肠肽 中医证 反流性食管炎 非糜烂性食管炎 

分 类 号：R259[医药卫生—中西医结合]