从胃食管反流病中促胃动力药的应用现状谈中医健脾法的运用内涵  

Discussion on the Application Connotation of Invigorating Spleen Method in Chinese Medicine from the Application Status of Gastric Motility Drugs in Gastroesophageal Reflux Disease

作　　者：陈恂[1,2] 燕晓茹 张立平 CHEN Xun;YAN Xiaoru;ZHANG Liping(Beijing University of Chinese Medicine,Beijing China 100029;Oriental Hospital,the Second Clinical Medical College,Beijing University of Chinese Medicine,Beijing China 100078;Guang'anmen Hospital,China Academy ofChinese Medical Sciences,Beijing China 100053)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学第二临床医学院东方医院,北京100078 [3]中国中医科学院广安门医院,北京100053

出　　处：《中医学报》2019年第7期1401-1405,共5页Acta Chinese Medicine

基　　金：北京市科技计划项目(Z171100000417051);北京中医药大学自主课题项目(2019-JYB-JS-114)

摘　　要：胃食管反流病(gastroesophageal reflux disease,GERD)因发病机制复杂,症候群多样,单纯质子泵抑制剂(proton pump inhibitor,PPI)治疗难以达到满意疗效,联合用药成为趋势。近年来促胃动力药作为GERD的辅助用药,疗效不佳。寻找其他治疗方法势在必行。临床研究表明,GERD患者的消化道存在的诸如食管蠕动降低、食管下括约肌(low esophageal sphincter,LES)张力下降、胃排空延迟改变等动力学改变,作为主要发病机制,与中医脾虚的本质相切合。运用中医健脾法可通过调节相关胃肠激素和炎性因子水平,实现改善LES压力、增强食管蠕动,促进胃排空等消化道动力学层面的功能,进而缓解GERD反流症状。但由于各实验研究缺乏统一的干预手段、造模方法以及观测指标等,临床研究缺乏统一的纳排标准、干预措施,也缺乏大样本、多中心、长期的随机对照试验,该结论有待商榷。2017年,中医脾虚证的专家共识颁布,有益于明晰GERD发病的脾虚本质,也为中医健脾法临床治疗GERD提供了理论支持。The etiology and pathogenesis of gastroesophageal reflux disease( GERD) are complex,and the symptoms are diverse. It is difficult to achieve satisfactory results with simple proton pump inhibitor ( PPI), and the combination of drugs has become a trend. In recent years, as an adjuvant drug of GERD, gastric motility drugs have poor efficacy. It is imperative to find other treatments. Clinical studies have shown that the main pathogenesis of GERD is the decrease of esophageal peristalsis, the decrease of tension of low esophageal sphincter ( LES) and the delayed change of gastric emptying, which is consistent with the essence of spleen deficiency in TCM. Invigorating spleen method of TCM can improve LES pressure, esophageal peristalsis, gastric emptying and other gastrointestinal dynamic functions by regulating the levels of related gastrointestinal hormones and inflammatory factors, thus alleviating GERD reflux symptoms. However, due to the lack of uniform interventions, modeling methods and observation indi cators, clinical research lacks uniform standards, interventions, and large sample, multi-center, long-term randomized controlled trials ,the conclusion remains to be discussed. In 2017,the expert consensus of spleen deficiency syndrome of TCM was promulgated, which is helpful to clarify the essence of spleen deficiency in GERD, and also provides theoretical support for clinical treatment of GERD by invigorating spleen method of TCM.

关 键 词：胃食管反流病 促胃动力药 健脾法 

分 类 号：R259[医药卫生—中西医结合]